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Risk Factors of Reoperation and Outcome of Patients Operated for Chronic Subdural Hematoma in a Teaching Hospital in Rabat

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Open Journal of Modern Neurosurgery 2023年第2期13卷 60-68页

作者： Yolande Michèle Moune jose dimbi makosso Mustapha Hemama Alngar Djimrabeye Dognon Kossi François de Paul Adjiou Saad Elmi Moussa Nourou Dine Adeniran Bankole Nizar El Fatemi Rachid El Maaqili Neurosurgery Department Ibn Sina Hospital Rabat Morocco

Background: chronic subdural hematoma is a common pathology, especially in the elderly. Although it has a good prognosis, it poses the problem of recurrence after surgical evacuation. Objective: To analyze the risk factors of reoperation in patients surgically treated for chronic subdural hematoma (cSDH) and evaluate the outcome of patients who benefited from a reoperation. Materials and Methods: A retrospective review was conducted in a single University Hospital Center in Rabat (Morocco) on 49 patients operated on from January 2020 to June 2021 for cSDH. Possible risk factors described in the literature were analyzed and the outcome of post-operative course was evaluated. Statistical significance was defined by p-value Results: 49 patients underwent surgical evacuation of cSDH. The sex ratio of male/female was 3.08. The mean age was 70.6 years. Concerning the medical history, 8.2% were diabetics, 10.2% had heart disease, 18.4% had hypertension, 16.3% associated of comorbidities, 2% had pulmonary embolism, and 2% had neoplasm. 18.4% were on anticoagulation therapy, no patients were on new oral anticoagulants. The clinical findings upon admission were motor deficit at 57.1%, signs of intracranial hypertension at 20.4%, altered consciousness at 16.9% and impaired behavior at 6.1%. 28.6% of patients had a past history of head trauma. The pre-operative CT scan showed unilateral cSDH at 81.6%, midline shifts at 77.6%, and false membranes at 34.7%. Blood appeared chronic at 40.8%, subacute at 24.5%, and mixed densities at 34.7%. The post-operative course was uneventful in 73.5%. According to Ibanez grading 8 patients had mild complications (grade I) and 5 moderate complications (grade II) after the first surgery. We recorded 10.2% of patients who needed a second surgery because of the deterioration of neurologic status or motor deficit associated with an abnormal CT scan. According to the GOS, 85.7% of patients had a good recovery while 10.2% died. None of the factors as

关键词： Chronic Subdural Hematoma Risk Factors of Reoperation Outcome

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Risk Factors of Reoperation and Outcome of Patients Operated for Chronic Subdural Hematoma in a Teaching Hospital in Rabat

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Open Journal of Modern Neurosurgery（现代神经外科学进展） 2023年第2期

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Primary Pituitary Abscess Gland Mimicking Adenoma: A Rare Case Report

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Open Journal of Modern Neurosurgery 2022年第3期12卷 167-174页

作者： dimbi jose Alingar Djimrabeye Mehdi Hakkou Adyl Melhaoui Abdessamad el Ouahabi Service de neurochirurgie de l’H?pital Des Spécialités Rabat Morocco Faculté de médecine et pharmacie Université Mohamed V Rabat Morocco

Pituitary abscess gland is an uncommon lesion on sellar region. Clinical diagnosis is not easy to make and it is difficult to make difference from other pituitary lesions on clinical and sometimes on Neuroimaging. This pathology is characterized by vague symptoms, headaches, generalized tiredness and hypopituitarism manifestations. A 35-year-old woman was admitted to neurosurgery with complaints of headaches and blurred vision. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity. Treatment of the lesion of this lesion pituitary area through a transsphenoidal approach and spectrum antibiotic therapy with ceftriaxone metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and is treated with oral hydrocortisone. After the diagnosis, the surgery and antibiotics should be commenced rapidly. Our aim is to report this rare case and to show how sometimes it is difficult to make diagnosis and clinical features vary mimicking other pituitary lesions before pre-operative and how to manage pituitary abscess gland. The outcome is usually good with proper treatment.

关键词： Pituitary Abscess Endoscopy Transsphenoidal Antibiotics

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