{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,8,14]],"date-time":"2022-08-14T18:10:10Z","timestamp":1660500610480},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:p>Treprostinil is a synthetic analog of prostacyclin, which is used for treatment of pulmonary arterial hypertension (PAH). Continuous subcutaneous administration of treprostinil has been proven in randomized controlled trials to improve quality of life, hemodynamics, and 5-year survival in patients with PAH. The efficacy of treprostinil has been attributed to its vasodilatory and antiplatelet effects. Unfortunately, the efficacy of treprostinil in the treatment of PAH is rapidly reversed upon cessation of the continuous infusion. Furthermore, cases of patients rapidly declining or succumbing to disease progression upon cessation of treprostinil have raised significant concern regarding discontinuation of this medication. To date, there are no reports of emergency craniotomies performed in the setting of continuous subcutaneous infusion of treprostinil. The authors report a case of a patient with PAH, treated with continuous administration of subcutaneous treprostinil as well as warfarin, who developed an acute subdural hematoma (SDH). Despite adequate INR (international normalized ratio) correction, the patient eventually underwent an emergency craniotomy for evacuation of the SDH while on continuous treprostinil administration. This case highlights the neurosurgical dilemma regarding the appropriate management of acute SDHs in patients receiving continuous treprostinil infusion.<\/jats:p>","DOI":"10.3171\/2013.1.jns121512","type":"journal-article","created":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T18:36:17Z","timestamp":1359743777000},"page":"753-756","source":"Crossref","is-referenced-by-count":0,"title":["Successful management of an acute subdural hematoma in a patient dependent on continuous treprostinil infusion therapy"],"prefix":"10.3171","volume":"118","author":[{"given":"Mina","family":"Safain","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Shepard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Rahal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Kryzanski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Roguski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron I.","family":"Riesenburger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts Medical Center, and"},{"name":"Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns121512","series-title":"Blood Rev","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.blre.2008.05.001","article-title":"Warfarin and intracranial haemorrhage","volume":"23","author":"Appelboam","year":"2009"},{"key":"b2-jns121512","series-title":"Eur Respir J","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1183\/09031936.06.00044406","article-title":"Long-term outcome in pulmonary arterial hypertension patients treated with subcutaneous treprostinil","volume":"28","author":"Barst","year":"2006"},{"key":"b3-jns121512","series-title":"Chest","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1378\/chest.07-2111","article-title":"Treprostinil-based therapy in the treatment of moderateto- severe pulmonary arterial hypertension: long-term efficacy and combination with bosentan","volume":"134","author":"Benza","year":"2008"},{"key":"b4-jns121512","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1097\/00006123-199911000-00020","article-title":"Use of factor IX complex in warfarin-related intracranial hemorrhage","volume":"45","author":"Boulis","year":"1999"},{"issue":"3 Suppl","key":"b5-jns121512","series-title":"Neurosurgery","first-page":"S16","article-title":"Surgical management of acute subdural hematomas","volume":"58","author":"Bullock","year":"2006"},{"key":"b6-jns121512","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"343","DOI":"10.7326\/0003-4819-115-5-343","article-title":"Survival in patients with primary pulmonary hypertension. 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