Chronic expanding intracerebral hematoma treated by mini-invasive ultrasonography-guided needle aspiration.
Chronic expanding intracerebral hematoma (CEIH) is a rare cerebrovascular disease that behaves as a slowly expanding lesion with a gradual onset of progressive neurological deficit or recurrent seizures. The etiology of the CEIH is still not clear. Even if about a half of these lesions are associated with vascular malformations, the remaining cases are post-traumatic, associated with coagulative disorders or are cryptogenic. Treatment of these lesions is controversary: while some neurosurgeons remove the hematoma with its capsule, others prefer to wait and observe it if the patient is neurologically stable. We discuss the opportunity of treating selected patients bearing a CEIH by means of ultrasonography(US)-guided aspiration in selected patients. A 42-year-old hepatopathic man with coagulation disorders was referred to us with a 2-month history of progressive right-sided weakness, speech disorders and difficulty in swallowing solid foods. Radiological findings supported a CEIH with a thin surrounding capsule. The patient underwent to US-guided aspiration of the lesion with a complete resolution of the hematoma, confirmed intraoperatively by real-time US-control and postoperatively by early and long term neuroradiological controls. US-guided aspiration is a low cost, not time consuming technique, that allows an intraoperative real-time control of the lesion and seems to be an effective alternative to open surgery in cases of CEIHs with a thin capsule.
Passacantilli
E
E
Department of Neuroscience-Neurosurgery, University of Rome La Sapienza, Rome, Italy.
Pichierri
A
A
Delfinis
C P
CP
Brogna
C
C
Santoro
A
A
Raco
A
A
D000328:Adult; D044963:Biopsy, Fine-Needle / Q000379:methods; D001778:Blood Coagulation Disorders / Q000150:complications; D001921:Brain / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery*; D002908:Chronic Disease; D003680:Deglutition Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D010291:Paresis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013064:Speech Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*