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Wang C, Liu C. Clinical Characteristics and Surgical Outcomes of Super-Elderly Patients with Chronic Subdural Hematoma. World Neurosurg 2023; 173:e708-e716. [PMID: 36889636 DOI: 10.1016/j.wneu.2023.02.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Surgical intervention for chronic subdural hematoma (CSDH) in the extremely aged population remains a difficult challenge. This study aims to investigate the clinical characteristics and surgical outcomes after twist drill craniotomy (TDC) of CSDH in super-elderly (≥80 years) patients. METHODS A retrospective analysis of super-elderly patients with CSDH who underwent TDC treatment in our hospital between January 2013 and December 2021 was performed. Their clinical characteristics and surgical outcomes were compared with those of relatively younger patients (60-79 years). Factors that may affect functional outcomes were also investigated. RESULTS Fifty-nine super-elderly patients and 133 patients aged 60-79 years were included. The preoperative hematoma volume of the super-elderly patients was significantly larger than that of the 60-79 years group, whereas fewer super-elderly patients had headaches compared with the relatively younger counterparts. After surgical treatment using the TDC procedure, the incidence of complication and the hematoma recurrence rate were similar between the 2 groups. Moreover, according to the Markwalder score of the follow-up at 6 months after operation, the prognosis of the super-elderly group was not poorer than that of the patients of 60-79 years (P = 0.662). Preoperative dysfunction of coagulation (odds ratio, 28.421; 95% confidence interval, 1.185-681.677; P = 0.039) was an independent risk factor significantly related to unfavorable outcomes of super-elderly patients with CSDH. CONCLUSIONS Advanced age per se does not seem to be a contraindication for the operative intervention of CSDH. Surgical treatment using the TDC procedure can still provide considerable benefits for super-elderly patients with CSDH.
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Affiliation(s)
- Chengjun Wang
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Cang Liu
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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Wu L, Guo X, Ou Y, Yu X, Zhu B, Yang C, Liu W. Efficacy analysis of neuroendoscopy-assisted burr-hole evacuation for chronic subdural hematoma: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:98. [PMID: 37115314 DOI: 10.1007/s10143-023-02007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/13/2023] [Accepted: 04/23/2023] [Indexed: 04/29/2023]
Abstract
The purpose of this study was to compare neuroendoscopy-assisted burr-hole evacuation with conventional burr-hole evacuation in the treatment of chronic subdural hematoma (CSDH), and to evaluate the curative effect of neuroendoscopy. This study follows PRISMA guidelines and uses the keywords "chronic subdural hematoma," "neuroendoscopies," "neuroendoscopy," "endoscopy," "endoscopic neurosurgery," and "neuroendoscopic surgery" to conduct an electronic search of online databases, including PubMed, Embase, Web of Science, and Cochrane Library. There were no restrictions on language or publication year. This meta-analysis involved 948 patients in six studies. The results showed that the recurrence rate in the neuroendoscopy group was significantly lower than that in the conventional burr-hole group (3.1% vs. 13.8%, P<0.001). Compared with the control group, the neuroendoscopy group had a longer operation time (P<0.001) and a shorter postoperative drainage time (P<0.001). In addition, there was no significant difference in hospital stay (P=0.14), mortality (P=0.39), postoperative morbidity (P=0.12), or 6-month neurological outcomes (P=0.32) between the two groups. It should be noted that the comparison of neurological outcomes was based on 269 patients (6/106 vs. 14/163). Compared with conventional burr-hole evacuation, neuroendoscopy-assisted burr-hole evacuation reduces the recurrence rate of CSDH and shortens the postoperative drainage time. However, the neuroendoscopy group did not have lower mortality or morbidity or better functional outcomes. In the future, randomized controlled trials are needed to further evaluate the efficacy and safety of neuroendoscopic surgery.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xufei Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Xiaofan Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bingcheng Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cheng Yang
- The Third Clinical Medical College, Ningxia Medical University, Yinchuan, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Neurological Center, People's Hospital of Ningxia Hui Autonomous Region (The Third Clinical Medical College, Ningxia Medical University), Yinchuan, China.
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Puccio DJ, Deng H, Eagle SR, Okonkwo DO, Nwachuku EL. Pilot Biomarker Analysis and Decision Tree Algorithm Modeling of Patients with Chronic Subdural Hematomas. Neurotrauma Rep 2023; 4:184-196. [PMID: 36974123 PMCID: PMC10039273 DOI: 10.1089/neur.2022.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
The elderly population are at high risk for developing chronic subdural hematoma (cSDH). Surgical evacuation of cSDH is one of the most common procedures performed in neurosurgery. The present study aims to identify potential inflammatory biomarkers associated with its development and recurrence. Patients (>65 years of age) who presented with symptomatic cSDH (≥1 cm thickness or ≥5 mm midline shift [MLS]), requiring surgical intervention, were prospectively enrolled. The collected cSDH fluid was analyzed for inflammatory markers. Computed tomography (CT) scan data included pre-operative cSDH thickness and MLS. Outcome data included Glasgow Outcome Scale-Extended (GOS-E) score at 3, 6, and 12 months post-surgery, as well as cSDH recurrence. A decision tree model was used to determine the predictive power of extracted analytes for MLS, cSDH thickness, and recurrence. This pilot study includes 20 enrolled patients (mean age 77.9 ± 7.4 years and 85% falls). Rate of cSDH recurrence was 42%, with 21% requiring reoperation. Chemokine (C-X-C motif) ligand 9 (CXCL9) concentrations correlated with cSDH thickness (r = 0.975, p = 0.040). Interleukin (IL)-6 and vascular endothelial growth factor (VEGF)-A concentrations correlated with MLS (r = 0.974, p = 0.005; r = 0.472, p = 0.036, respectively). IL-5 concentrations correlated with more favorable GOS-E scores at 3, 6, and 12 months (r = 0.639, p = 0.006; r = 0.727, p = 0.003; r = 0.693, p = 0.026, respectively). Regulated on activation, normal T-cell expressed and secreted (RANTES) concentrations correlated with complete cSDH resolution (r = 0.514, p = 0.021). The decision tree model identified that higher concentrations of CXCL9 were predictive of MLS (risk ratio [RR] = 12.0), higher concentrations of IL-5 were predictive of cSDH thickness (RR = 4.5), and lower concentrations of RANTES were predictive of cSDH recurrence (RR = 2.2). CXCL9, IL-6, VEGF, IL-5, and RANTES are associated with recurrence after surgery and may be potential biomarkers for predicting cSDH recurrence and neurological outcomes.
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Affiliation(s)
- David J. Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Address correspondence to: David J. Puccio, BS, Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213, USA.
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shawn R. Eagle
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Enyinna L. Nwachuku
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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54
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Surgical treatment for chronic subdural hematoma in the elderly: A retrospective analysis. World Neurosurg X 2023; 18:100183. [PMID: 37013106 PMCID: PMC10066545 DOI: 10.1016/j.wnsx.2023.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/04/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
Background Chronic subdural hematoma (CSDH) is primarily a disease of the elderly. Less invasive interventions are often offered for elderly (> 80 years) patients due to concerns for elevated surgical risk, although data suggesting a clear outcome benefit is lacking. Methods All patients aged 65 years or older who underwent surgical treatment for CSDH at a single institution over a 4-year period were evaluated in this retrospective analysis. Surgical options included twist drill craniostomy (TDC), burr hole craniotomy (BHC), or standard craniotomy (SC). Outcomes, demographics, and clinical data were collected. Practice patterns and outcomes for patients older than 80 years old were compared to the age 65-80 cohort. Results 110 patients received TDC, 35 received BHC, and 54 received SC. There was no significant difference in post-operative complications, outcomes, or late recurrence (30-90 days). Recurrence at 30 days was significantly higher for TDC (37.3% vs. 2.9% vs 16.7%, p 80 group, SC had higher risk of stroke and increased length of stay. Conclusion Twist drill craniostomy, burr hole craniostomy, and standard craniotomy have similar neurologic outcomes in elderly patients. Presence of thick membranes is a relative contra-indication for TDC due to high 30-day recurrence. Patients > 80 have higher risk of stroke and increased length of stay with SC.
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Takroni R, Zagzoog N, Patel N, Martyniuk A, Singh S, Farrokhyar F, Trivedi A, Alotaibi M, Algird A. Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence. J Neurol Surg A Cent Eur Neurosurg 2023; 84:157-166. [PMID: 34784622 DOI: 10.1055/a-1698-6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH. METHODS We retrospectively analyzed the charts of 172 CSDH patients treated with bedside twist drill craniostomy (TDC) and subdural drain insertion. Patients were divided into two groups: group A (n = 123) received a pediatric size nasogastric tube [NGT]), whereas group B (n = 49) had a drain commonly used for external ventricular drainage (EVD). Various demographic and radiologic data were collected. Our main outcome was recurrence, defined as symptomatic re-accumulation of hematoma on the previously operated side within 3 months. RESULTS In all, 212 cases of CSDH were treated in 172 patients. The majority of patients were male (78%) and had a history of previous head trauma (73%). Seventeen cases had recurrence, 11 in group A and 6 in group B. The use of antiplatelet and anticoagulation agents was associated with recurrence (p = 0.038 and 0.05, respectively). There was no difference between both groups in terms of recurrence (odds ratio [OR] = 1.42; 95% confidence interval [CI]: 0.49-4.08; p = 0.573). CONCLUSION CSDH is a common disease with a high rate of recurrence. Although using a drain postoperatively has shown to reduce the incidence of recurrence, little is known about the best type of drain to use. Our analysis showed no difference in the recurrence rate between using the pediatric size NGT and the EVD catheter post-TDC.
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Affiliation(s)
- Radwan Takroni
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
- King Faisal Medical City for Southern Regions, Abha, Saudi Arabia
| | - Nirmeen Zagzoog
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Nimita Patel
- Department of Health, Evidence and Impact, McMaster University, Ontario, Canada
| | - Amanda Martyniuk
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Sheila Singh
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health, Evidence and Impact, McMaster University, Ontario, Canada
| | - Arunachala Trivedi
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Mazen Alotaibi
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Almunder Algird
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
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Familiari P, Lapolla P, Relucenti M, Battaglione E, Cristiano L, Sorrentino V, Aversa S, D'Amico A, Puntorieri P, Bruzzaniti L, Mingoli A, Brachini G, Barbaro G, Scafa AK, D'Andrea G, Frati A, Picotti V, Berra LV, Petrozza V, Nottola S, Santoro A, Bruzzaniti P. Cortical atrophy in chronic subdural hematoma from ultra-structures to physical properties. Sci Rep 2023; 13:3400. [PMID: 36854960 PMCID: PMC9975247 DOI: 10.1038/s41598-023-30135-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation.
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Affiliation(s)
- Pietro Familiari
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Oxford University Hospital, Headington, Oxford, OX3 9DU, UK.
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy.
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy.
| | - Michela Relucenti
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy
| | - Ezio Battaglione
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Loredana Cristiano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Veronica Sorrentino
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Sara Aversa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alessia D'Amico
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
- Unit of Rehabilitation, Istituto Neurotraumatologico Italiano, Rome, Italy
| | | | - Lucia Bruzzaniti
- DICEAM Department, University Mediterranea of Reggio Calabria, Reggio Calabria, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Giuseppe Barbaro
- DICEAM Department, University Mediterranea of Reggio Calabria, Reggio Calabria, Italy
| | | | | | - Alessandro Frati
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, Isernia, Italy
| | - Veronica Picotti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
- Division of Neurosurgery, Policlinico Tor Vergata, University Tor Vergata of Rome, Rome, Italy
| | | | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Stefania Nottola
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Placido Bruzzaniti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
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Zeng L, Yu J, Chen R, Yang H, Li H, Zeng L, Wang J, Xu W, Hu S, Chen K. Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study. Front Neurol 2023; 13:1069708. [PMID: 36793801 PMCID: PMC9924088 DOI: 10.3389/fneur.2022.1069708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/28/2022] [Indexed: 01/31/2023] Open
Abstract
Background Previous studies on the management of chronic subdural hematoma (cSDH) mainly focused on the risk of postoperative recurrence and measures to prevent it. In this study, we propose the use of a non-invasive postoperative treatment method, the modified Valsalva maneuver (MVM), as a means of reducing the recurrence of cSDH. This study aims to clarify the effects of MVM on functional outcomes and recurrence rates. Methods A prospective study was conducted at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2016 to December 2020. The study included 285 adult patients who underwent burr-hole drainage for the treatment of cSDH and received subdural drains. These patients were divided into two groups: the MVM group (n = 117) and the control group (n = 98). In the MVM group, patients received treatment with a customized MVM device for at least 10 times per hour, 12 h per day. The study's primary endpoint was the recurrence rate of SDH, while functional outcomes and morbidity 3 months after surgery were the secondary outcomes. Results In the current study, 9 out of 117 patients (7.7%) in the MVM group experienced a recurrence of SDH, while 19 out of 98 patients (19.4%, p < 0.05) in the HC group experienced a recurrence of SDH. Additionally, the infection rate of diseases such as pneumonia (1.7%) was significantly lower in the MVM group compared to the HC group (9.2%, p < 0.001, odds ratio (OR = 0.1). After 3 months of the surgery, 109 out of 117 patients (93.2%) in the MVM group achieved a favorable prognosis, compared to 80 out of 98 patients (81.6%) in the HC group (p = 0.008, with an OR of 2.9). Additionally, infection rate (with an OR of 0.2) and age (with an OR of 0.9) are independent predictors of a favorable prognosis at the follow-up stage. Conclusions The use of MVM in the postoperative management of cSDHs has been shown to be safe and effective, resulting in reduced rates of cSDH recurrence and infection following burr-hole drainage. These findings suggest that MVM treatment may lead to a more favorable prognosis at the follow-up stage.
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Sağıroğlu S, Turgut M. Subdural Hematomas in Adults and Children. Adv Tech Stand Neurosurg 2023; 46:193-203. [PMID: 37318576 DOI: 10.1007/978-3-031-28202-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Subdural hematoma is a common entity encountered by the neurosurgeon. The disease has acute, subacute, and chronic forms. Management of the disease changes according to the etiology of the lesion, yet the main goals are, as with most neurosurgical interventions, decompression of neural tissue and restoration of perfusion. Due to various forms and causes of the disease such as trauma, anticoagulant/antiaggregant use, arterial rupture, oncologic hemorrhages, intracranial hypotension, and idiopathic hemorrhages, several approaches for management have been documented in the literature. Herewith, we present various up-to-date management options for the disease.
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Affiliation(s)
- Sinan Sağıroğlu
- Department of Neurosurgery, Aydın Adnan Menderes University School of Medicine, Efeler, Aydın, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Aydın Adnan Menderes University School of Medicine, Efeler, Aydın, Turkey
- Department of Histology and Embryology, Aydın Adnan Menderes University Health Sciences Institute, Efeler, Aydın, Turkey
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Laeke T, Kalleklev L, Tirsit A, Moen BE, Lund-Johansen M, Sundstrøm T. Surgical treatment and outcome of chronic subdural hematoma: a comparative study between Ethiopia and Norway. Acta Neurochir (Wien) 2023; 165:49-59. [PMID: 36495322 DOI: 10.1007/s00701-022-05435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Here, we studied differences in demographics, treatment, and outcome for CSDH patients in low-income (Ethiopia) and high-income (Norway) countries and assessed potential outcome determinants. METHODS We included patients from Addis Ababa University Hospitals (AAUH) and Haukeland University Hospital (HUH) who had surgery for CSDH (2013-2017). Patients were included prospectively in Ethiopia and retrospectively in Norway. RESULTS We enrolled 314 patients from AAUH and 284 patients from HUH, with a median age of 60 and 75 years, respectively. Trauma history was more common in AAUH (72%) than in HUH patients (64.1%). More patients at HUH (45.1%) used anticoagulants/antiplatelets than at AAUH (3.2%). Comorbidities were more frequent in HUH (77.5%) than in AAUH patients (30.3%). Burr hole craniostomy under local anesthesia and postoperative drainage was the standard treatment in both countries. Postoperative CT scanning was more common at HUH (99.3%) than at AAUH (5.2%). Reoperations were more frequent at HUH (10.9%) than at AAUH (6.1%), and in both countries, mostly due to hematoma recurrence. Medical complications were more common at HUH (6.7%) than at AAUH (1.3%). The 1-year mortality rate at HUH was 7% and at AAUH 3.5%. At the end of follow-up (> 3 years), the Glasgow Outcome Scale Extended (GOSE) score was 8 in 82.9% of AAUH and 46.8% of HUH patients. CONCLUSION The surgical treatment was similar at AAUH and HUH. The poorer outcome in Norway could largely be explained by age, comorbidity, medication, and complication rates.
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Affiliation(s)
- Tsegazeab Laeke
- Neurosurgery Division, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Line Kalleklev
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Abenezer Tirsit
- Neurosurgery Division, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bente E Moen
- Center for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Terje Sundstrøm
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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60
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Chen R, Wei Y, Xu X, Zhang R, Tan Y, Zhang G, Yin H, Dai D, Li Q, Zhao R, Huang Q, Xu Y, Yang P, Liu J, Zuo Q. A bibliometric analysis of chronic subdural hematoma since the twenty-first century. Eur J Med Res 2022; 27:309. [PMID: 36572939 PMCID: PMC9793598 DOI: 10.1186/s40001-022-00959-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common disease that forms between the dura and arachnoid membranes of the brain. With the development of medications and surgery, significant progress has been made in the diagnosis and treatment of CSDH. However, there is no comprehensive analysis available on CSDH-related studies published in the literature. This study aimed to collect and analyze CSDH-related studies published since the twenty-first century using bibliometric analysis and to summarize the current status of research in this field for the sake of providing systematic data for further study of CSDH. METHODS CSDH-related studies were searched in the Web of Science Core Collection (WoSCC) database using the Medical Subject Heading (MeSH) term 'chronic subdural hematoma'. Data analysis and visualization were performed by R and CiteSpace software. RESULTS This study retrieved 1424 CSDH-related articles published since the beginning of the twenty-first century. There was a general increase in both the number of published articles and the mean number of citations. The authors, institutions and journals that contributed the most to the field of CSDH were Jianning Zhang, Tianjin Medical University, and world neurosurgery, respectively. The reference co-citation network identified 13 clusters with significant modularity Q scores and silhouette scores (Q = 0.7124, S = 0.8536). The major research categories were (1) evolution of the therapeutic method and (2) the etiology and pathology of CSDH. Keyword analysis revealed that 'middle meningeal artery embolization' was the latest burst keyword. CONCLUSIONS This study identified the most influential countries, authors, institutions and journals contributing to CSDH research and discussed the hotspots and the latest subjects of CSDH research.
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Affiliation(s)
- Rundong Chen
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Yanpeng Wei
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Xiaolong Xu
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Renkun Zhang
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Yuhao Tan
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Guanghao Zhang
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Hongwei Yin
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Dongwei Dai
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Qiang Li
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Rui Zhao
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Qinghai Huang
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Yi Xu
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Pengfei Yang
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Jianmin Liu
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
| | - Qiao Zuo
- grid.73113.370000 0004 0369 1660Neurovascular Center, Changhai Hospital, Naval Medical University, #168 Changhai Road, Shanghai, 200433 China
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Sirinoglu D, Sarigul B, Aydin MV. Mini-Perforated Craniotomy with Subperiosteal Drain for Evacuation of Chronic Subdural Hematoma: A New Technique and Clinical Study. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1758658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Purpose Chronic subdural hematoma (cSDH) is a frequent disease of the elderly with favorable outcomes. The main choice of treatment is surgery. Along with many surgical techniques described for evacuation of cSDH, we are presenting the preliminary outcomes of a novel surgical method, mini-perforated craniotomy with a subperiosteal drain.
Materials and Methods Patients in whom cSDH with thickness of >10 mm was observed in computed tomography (CT) scans with parenchymal compression and/or midline shift were included in this study. Age, sex, complaint, neurological status, and medical history were recorded along with CT findings. Mini-perforated craniotomy was performed on all patients. A subperiosteal drain was used. The postoperative follow-up period was 3 months.
Results Ten cSDH patients who were admitted to Prof. Dr. Cemil Tascioglu City Hospital between December 2020 and May 2021 were included in this study. The mean age was 64.3 ± 6.272, and the most common admission complaint was a headache. Postoperatively, one patient showed acute rebleeding after the operation due to dual anticoagulant therapy. Besides, in 3 months follow-up, rebleeding, subdural or epidural effusion, wound infection, or cosmetic problems were not observed.
Conclusion Mini-perforated craniotomy with a subperiosteal drain may be an alternative method for evacuation of cSDH with low complication rates especially when the hematoma is suspected to be septated.
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Affiliation(s)
- Deniz Sirinoglu
- Department of Neurosurgery, Prof. Dr. Cemil Tascioglu City Hospital, İstanbul, Turkey
| | - Buse Sarigul
- Department of Neurosurgery, Tuzla Public Hospital, İstanbul, Turkey
| | - Mehmet Volkan Aydin
- Department of Neurosurgery, Prof. Dr. Cemil Tascioglu City Hospital, İstanbul, Turkey
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Salih M, Shutran M, Young M, Vega RA, Stippler M, Papavassiliou E, Alterman RL, Thomas A, Taussky P, Moore J, Ogilvy CS. Reduced recurrence of chronic subdural hematomas treated with open surgery followed by middle meningeal artery embolization compared to open surgery alone: a propensity score-matched analysis. J Neurosurg 2022:1-7. [PMID: 36681950 DOI: 10.3171/2022.11.jns222024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Middle meningeal artery embolization (MMAE) is an emerging endovascular treatment technique with proven promising results for chronic subdural hematomas (cSDHs). MMAE as an adjunct to open surgery is being utilized with the goal of preventing the recurrence of cSDH. However, the efficacy of MMAE following surgical evacuation of cSDH has not been clearly demonstrated. The authors sought to compare the outcomes of open surgery followed by MMAE versus open surgery alone. METHODS Patients who underwent surgical evacuation alone (open surgery-alone group) or MMAE along with open surgery for cSDH (adjunctive MMAE group) were identified at the authors' institution. Two balanced groups were obtained through propensity score matching. Primary outcomes included recurrence risk and reintervention rate. Secondary outcomes included decrease in hematoma size and modified Rankin Scale (mRS) score at last follow-up. Variables in the two groups were compared by use of the Mann-Whitney U-test, paired-sample t-test, and Fisher's exact test. RESULTS A total of 345 cases of open surgery alone and 52 cases of open surgery with adjunctive MMAE were identified. After control for subjective confounders, 146 patients treated with open surgery alone and 41 with adjunctive MMAE following open surgery with drain placement were included in the analysis. Before matching, the rebleeding risk and reintervention rate for open surgery trended higher in the open surgery alone than the open surgery plus MMAE group (14.4% vs 7.3%, p = 0.18; and 11.6% vs 4.9%, p = 0.17, respectively). No significant differences were seen in duration of radiographic or clinical follow-ups or decreases in hematoma size and mRS score at last follow-up. After one-to-one nearest neighbor propensity score matching, 26 pairs of cases were compared for outcomes. Rates of recurrence (7.7% vs 30.8%, p = 0.038) and overall reintervention (3.8% vs 23.1%, p = 0.049) after open surgery were found to be significantly lower in the adjunctive MMAE group than the open surgery-alone group. With one-to-many propensity score matching, 76 versus 37 cases were compared for open surgery alone versus adjunctive MMAE following open surgery. Similarly, the adjunctive MMAE group had significantly lower rates of recurrence (5.4% vs 19.7%, p = 0.037) and overall reintervention (2.7% vs 14.5%, p = 0.049). CONCLUSIONS Adjunctive MMAE following open surgery can lower the recurrence risks and reintervention rates for cSDH.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Max Shutran
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Michael Young
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Rafael A. Vega
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Martina Stippler
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Efstathios Papavassiliou
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Ron L. Alterman
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Ajith Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Philipp Taussky
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Justin Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Christopher S. Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
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Salih M, Young M, Shutran M, Stippler M, Papavassiliou E, Alterman RL, Thomas AJ, Taussky P, Moore J, Ogilvy CS. Effect of long-term anticoagulant therapy on the outcome of chronic subdural hematoma: a propensity score-matched analysis. J Neurosurg 2022:1-7. [PMID: 36681947 DOI: 10.3171/2022.11.jns222022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Chronic subdural hematomas (cSDHs) are particularly common in older adults who have increased risk of falls and the conditions that require anticoagulants (ACs). In such cases, clinicians are often left with the dilemma of co-managing the cSDH and the ongoing need for ACs. METHODS Patients who underwent surgical management for cSDH at the authors' institution between January 2006 and June 2022 were identified. Propensity score-matched analysis was used to obtain a balance in patients who were on ACs before the procedure versus those who were not, and in patients who were on ACs postprocedure versus those who were not. Length of hospitalization, periprocedural complications, reintervention rate during the same admission, rebleeding risk, and reintervention rates after discharge were compared. RESULTS In total, 104 patients were on long-term ACs before the procedure, whereas 372 were not. After matching, 55 pairs were included in the analysis. Postprocedure, 74 patients were started on long-term ACs; the rest were not. A total of 49 patients in each group were then included in the analysis after matching. Comparing the preprocedure AC group with the non-AC group, no significant differences were found in length of hospitalization (8.5 ± 6.7 days vs 8.1 ± 7.7 days, p = 0.75), periprocedural complications (7.3% vs 7.3%, p > 0.99), or reintervention during the same admission (1.8% vs 5.5%, p = 0.31). In the comparison of postprocedure AC and non-AC groups, no significant differences were seen in recurrence rate (8.2% vs 14.3%, p = 0.52), reintervention rate after discharge (4.1% vs 14.3%, p = 0.16), or disability (i.e., mRS ≤ 2; 83.7% vs 89.8%, p = 0.55). CONCLUSIONS Being treated with long-term ACs before cSDH procedures does not affect length of hospitalization, periprocedural complications, or reintervention during the same admission. Similarly, administration of long-term ACs after a procedure for cSDH does not increase rebleeding risk or reintervention rate. Patients who are on long-term ACs can have similar interventions to those who are not on ACs. In addition, it is safe to restart patients on AC agents in a 7- to 14-day window after admission for cSDH with or without acute/subacute components.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Michael Young
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Max Shutran
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Martina Stippler
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Efstathios Papavassiliou
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Ron L. Alterman
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Ajith J. Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Philipp Taussky
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Justin Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Christopher S. Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
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Ebel F, Greuter L, Lutz K, Häni L, Fandino J, Guzman R, Mariani L, Beck J, Raabe A, Z’Graggen WJ, Schucht P, Soleman J. The Role of Active or Passive Drainage after Evacuation of Chronic Subdural Hematoma: An Analysis of Two Randomized Controlled Trials (cSDH-Drain-Trial and TOSCAN Trial). Diagnostics (Basel) 2022; 12:3045. [PMID: 36553053 PMCID: PMC9777194 DOI: 10.3390/diagnostics12123045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/09/2022] Open
Abstract
The evacuation of a chronic subdural hematoma (cSDH) is one of the most common procedures in neurosurgery. The aim of this study was to assess the influence of drainage suction in the surgical treatment of cSDH on the recurrence rate. Post hoc analysis was conducted on two randomized controlled trials (cSDH-Drain-Trial and TOSCAN trial) stratifying a total of 581 patients into active or passive drain type. Of the 581 patients, 359 (61.8%) and 220 (37.9%) were stratified into the active and passive drainage groups, respectively. The reoperation rate following postoperative recurrence was 23.1% and 14.1% in the active and passive drainage groups, respectively (p < 0.011). After propensity score matching, the differences in recurrence rate remained significant (26.6% versus 15.6%, p = 0.012). However, the functional outcome (mRS) at 6−12 months did not differ significantly (median [IQR]) between the 2 groups (passive drainage group 0.00 [0.00, 2.00], active drainage group 1.00 [0.00, 2.00], p = 0.431). Mortality was comparable between the groups (passive drainage group 12 (5.5%), active drainage group 20 (5.6%), p = 0.968). In the univariate analysis, active drainage, short (<48 h) duration of drainage, and early (<48 h) postoperative mobilization were significantly associated with a higher recurrence rate. However, the multivariate logistic regression model could not confirm that any of these parameters were significantly associated with recurrence. Our post hoc analysis proposes that using a passive instead of an active drain might be associated with a reduced recurrence rate after evacuation of a cSDH. We suggest gathering further evidence by means of a randomized controlled trial.
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Affiliation(s)
- Florian Ebel
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
- Department of Neurosurgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Ladina Greuter
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
| | - Katharina Lutz
- Department of Neurosurgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Levin Häni
- Department of Neurosurgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Klinik Hirslanden, 8032 Zürich, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Werner J. Z’Graggen
- Department of Neurosurgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
- Department of Neurology, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
- Clinical Trial Unit, University Hospital of Basel, 4031 Basel, Switzerland
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Jarrar S, Al Barbarawi MM, Daoud SS, Samara QA, Qarqash AA, Alawneh RJ, Abu-amoud NA, Ababneh OE, Jbarah OF. Management of chronic subdural hematoma: A study from Jordan. J Taibah Univ Med Sci 2022; 17:1021-1030. [PMID: 36212589 PMCID: PMC9519793 DOI: 10.1016/j.jtumed.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Chronic subdural hematoma (CSDH) is a common condition encountered in neurosurgical practice. Few studies have reported the characteristics of CSDH patients in the Middle Eastern population. We describe the clinical presentation, surgical management, radiological findings, and post-operative outcomes in our hospital. Methods We performed a retrospective cohort study in King Abdullah University Hospital, Northern Jordan, between 2009 and 2019. Data were extracted from patients’ medical records and analyzed in patients treated with burr hole drainage (BHD). Univariate analysis was performed to identify correlations with age, laterality, and recurrence. Results A total of 172 CSDH patients were identified, of whom 128 (74.4%) were treated surgically. The mean age of patients treated with BHD (n = 108) was 60.9 years with a male-to-female ratio of 2.38:1. Headache was the most common presenting symptom (64.81%) and was significant in patients aged 41–64 years (p = 0.004), whereas muscle weakness and unsteady gait were significant in patients ≥ 65 years (p = 0.004 and p = 0.033, respectively). A higher pre-operative maximum thickness was associated with bilateral presentation (p = 0.001), whereas a higher pre-operative midline shift was associated with unilateral presentation (p = 0.027). Regarding CSDH recurrence, only a preoperative midline shift was significant (p = 0.021). Conclusion Clinical presentation was affected by age, as patients < 65 years commonly presented with headaches, whereas those ≥ 65 years presented with limb weakness, speech impairment, unsteady gait, and altered consciousness. BHD was the most utilized surgical option with low mortality and complication rates. Recurrence was only associated with a pre-operative midline shift.
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66
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Anagnostopoulos V, Brotis AG, Tzerefos C, Charalambidou A, Tasiou A, Karavelis A, Paterakis KN. Valve-controlled chronic subdural hematoma drainage: A feasibility study. BRAIN & SPINE 2022; 2:101693. [PMID: 36506285 PMCID: PMC9729815 DOI: 10.1016/j.bas.2022.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Pneumocephalus after chronic subdural hematoma (CSDH) evacuation is a potential predictor of hematoma recurrence. RESEARCH QUESTION To study the feasibility and safety of a novel CSDH evacuation technique using a valve-controlled method to avoid pneumocephalus. MATERIAL AND METHODS In a retrospective case series, we evacuated CSDH using very low-pressure valve-controlled drains and recorded the neurological, radiological, and functional outcomes. Patients with primary CSDH, without previous neurosurgical intervention, and who did not receive antiplatelet or anticoagulant therapy the week prior to the index surgery, were included in the study. Exclusion criteria were the evacuation with other treatment techniques and incomplete data files. Patients were assessed according to the Bender grading system to record the neurological status. The hematoma volume was estimated using the formula for ellipsoid volumes. RESULTS Thirty-six patients with a mean age of 73 years (±9 years) fulfilled our eligibility criteria. Our technique was effective since it decreased the CSDH volume from 141 ml (IQR 97 ml) to 20.6 ml (IQR 26.59 ml; p < 0.001) and improved the neurological status according to the Bender grading system from two (IQR 0.25) to 1 (IQR 0). However, pneumocephalus and hematoma recurrence occurred in one case each (2.8%). At six months, all patients returned to their previous status, except for two patients (5.6%) who died due to irrelevant pathologies. CONCLUSIONS Valve-controlled CSDH evacuation aiming to decrease the postoperative pneumocephalus and hematoma recurrence constitutes an effective and safe alternative. However, larger randomized controlled studies are required to establish its role in CSDH management.
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Affiliation(s)
| | - Alexandros G. Brotis
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Christos Tzerefos
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | | | - Anastasia Tasiou
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Antonios Karavelis
- Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larisa, Greece
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Angiogenetic Factors in Chronic Subdural Hematoma Development. Diagnostics (Basel) 2022; 12:diagnostics12112787. [PMID: 36428849 PMCID: PMC9689028 DOI: 10.3390/diagnostics12112787] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/15/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
The levels of angiogenic factors were analyzed in eight patients who underwent the embolization of chronic subdural hematoma (CSDH) with non-adhesive liquid embolic agents. Four of these patients had previously undergone surgical treatment for hematoma removal and had recurrences of a similar volume, and four had an increase in hematoma volume due to rebleeding. The levels of vascular endothelial growth factor (VEGF), matrix metallopeptidase 9 (MMP 9), angiopoietin-2 (Ang2), transforming growth factor beta 1 (TGF-β1) and platelet-derived growth factor BB (PDGF-BB) in the arterial and venous blood were analyzed. The most significant results were obtained from the peripheral venous blood samples. The levels of VEGF in the samples of all the patients were close to normal or slightly decreased. There was an increase in the MMP9 levels (the factor that contributes to the disintegration of the vessel wall components) in all the patients. The Ang2 and especially the PDGF TGF-β1 (the factor that plays an important role in the growth of the vessel wall from the already existing blood vessel tissue) levels were distinctly low in most of the cases and slightly elevated only in a number of patients who had previously been operated on. The results obtained show that there is an imbalance in the angiogenesis factors in patients with rebleeding CSDH. At the same time, the factors determining the formation of the vessel wall were reduced, and the levels of factors contributing to the degradation of extracellular matrix components were significantly increased. Such factors could help us to anticipate the increased risk of hemorrhages. Highlights: The levels of VEGF, MMP 9, Ang2, TGF-β1 and PDGF-BB in the arterial and venous blood were analyzed. The most significant results were obtained from the peripheral venous blood samples. The results obtained show that there is an imbalance in the angiogenesis factors in patients with rebleeding CSDH. Such a profile of factors could help us to anticipate the increased risk of hemorrhages.
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Saway BF, Roth W, Salvador CD, Essibayi MA, Porto GBF, Dowlati E, Felbaum DR, Rock M, Withington C, Desai SK, Hassan AE, Tekle WG, Spiotta A. Subdural evacuation port system and middle meningeal artery embolization for chronic subdural hematoma: a multicenter experience. J Neurosurg 2022:1-8. [PMID: 36681990 DOI: 10.3171/2022.10.jns221476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Middle meningeal artery (MMA) embolization and the Subdural Evacuation Port System (SEPS) are minimally invasive treatment paradigms for chronic subdural hematoma (cSDH). Although SEPS offers acute decompression of local mass effect from a cSDH, MMA embolization has been shown to reduce the rate of cSDH recurrence. In combination, these procedures present a potentially safer strategy to a challenging pathology. The authors present a multi-institutional retrospective case series that assessed the safety, efficacy, and complications of SEPS and MMA embolization for cSDH. METHODS A retrospective review was performed of patients who underwent SEPS placement and MMA embolization for cSDH between 2018 and 2021 at three institutions. RESULTS One hundred patients with 136 cSDHs and a median age of 73 years underwent both SEPS placement and MMA embolization. Initial Glasgow Coma Scale scores were between 14 and 15 in 81% of patients and between 9 and 13 in 14%. The median initial midline shift (MLS) was 7 mm, with subdural hematoma (SDH) in the left hemisphere (lh) in 30% of patients, right hemisphere (rh) in 34%, and bilateral hemispheres in 36%. Follow-up was available for 86 patients: 93.4% demonstrated decreased MLS, and all patients with lhSDH and rhSDH demonstrated progressive decrease in SDH size. The overall complication rate was 4%, including 1 case of facial palsy and 3 cases of iatrogenic acute SDH. Two subjects (2%) required craniotomy for hematoma evacuation. The rate of good functional outcomes, with modified Rankin Scale (mRS) score < 2, was 89% on final follow-up and the overall mortality rate was 2%. A good mRS score on admission was associated with increased odds of functional improvement at follow-up (p < 0.001). CONCLUSIONS SEPS placement with MMA embolization for cSDH can be done safely and effectively reduces cSDH size with minimal perioperative morbidity.
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Affiliation(s)
- Brian F Saway
- 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Warren Roth
- 2College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Craig D Salvador
- 2College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Muhammed Amir Essibayi
- 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Guilherme B F Porto
- 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Ehsan Dowlati
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Daniel R Felbaum
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Mitchell Rock
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Charles Withington
- 3Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Sohum K Desai
- 4Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas; and
| | - Ameer E Hassan
- 4Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas; and
| | - Wondwossen G Tekle
- 5Department of Neuroscience, Valley Baptist Medical Center, Harlingen, Texas
| | - Alejandro Spiotta
- 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
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69
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Mooney J, Erickson N, Saccomano B, Maleknia P, Fisher WS. Predictors and Outcomes of Subdural Hematomas Managed via Subdural Evacuation Port System. World Neurosurg X 2022; 17:100145. [PMID: 36341136 PMCID: PMC9626382 DOI: 10.1016/j.wnsx.2022.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Background Subacute subdural hematoma (SDH) is a common pathology most frequently affecting older patients and may be treated operatively through burr holes versus craniotomy or minimally invasively with bedside twist drill craniostomy. Less invasive intervention is favored when possible given a frequently comorbid population. The subdural evacuation port system (SEPS) is a popular treatment option that warrants investigation and reporting of its use and outcomes. Methods A retrospective review of consecutive patients undergoing SEPS drain placement for chronic or mixed density SDH between 2010 and 2021 was conducted. Outcomes of SDH recurrence, need for operating room procedure after SEPS placement, discharge disposition other than home, and modified Rankin Scale score <3 at discharge were modeled with logistic regression using multiple demographic, clinical, and radiographic features. Results Ultimately, 86 patients (mean age 68) were included in the analysis with 66 (78%) presenting with mixed-density SDHs. Radiographic factors such as hematoma thickness and midline shift were not associated with the need for an operating room procedure after SEPS placement or discharge disposition. However, the presence of septations and mixed-density SDH versus chronic SDH was significantly associated with increased odds of requiring an operative intervention after SEPS placement. Conclusions Subacute SDHs are a frequent neurosurgical issue in patient populations where less invasive measures are favored. SEPS drainage continues to be an effective treatment option. However, the presence of septations and mixed-density SDHs has a significantly increased odds of requiring surgical intervention that must be considered in the decision to pursue SEPS drainage.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA,To whom correspondence should be addressed: James Mooney, M.D.
| | - Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Ben Saccomano
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Pedram Maleknia
- School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Winfield S. Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
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Dubinski D, Won SY, Trnovec S, Gounko K, Baumgarten P, Warnke P, Cantré D, Behmanesh B, Bernstock JD, Freiman TM, Gessler F, Sola S. Recurrence of chronic subdural hematoma due to low-grade infection. Front Neurol 2022; 13:1012255. [PMID: 36212639 PMCID: PMC9539083 DOI: 10.3389/fneur.2022.1012255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the high incidence and multitudes of operative techniques, the risk factors for chronic subdural hematoma (CSDH) recurrence are still under debate and a universal consensus on the pathophysiology is lacking. We hypothesized that clinically inapparent, a low-grade infection could be responsible for CSDH recurrence. This investigation is a single-center prospective observational study including patients with recurrent CSDH. In total, 44 patients with CSDH recurrence received an intraoperative swab-based microbiological test. The intraoperative swab revealed an inapparent low-grade hematoma infection in 29% of the recurrent CSDH cases. The majority (69%) of the identified germs belonged to the staphylococcus genus. We therefore, propose a novel potential pathophysiology for CSDH recurrence.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
- *Correspondence: Daniel Dubinski
| | - Sae-Yeon Won
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Svorad Trnovec
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Kseniya Gounko
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Schiller University Jena, Jena, Germany
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas M. Freiman
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Florian Gessler
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Steffen Sola
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
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71
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Chen S, Shao L, Ma L. Peripheral blood eosinophil and classification of residual hematoma help predict the recurrence of chronic subdural hematoma after initial surgery. Front Surg 2022; 9:970468. [PMID: 36338617 PMCID: PMC9632999 DOI: 10.3389/fsurg.2022.970468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in neurosurgical practice, whose incidence has increased markedly in recent years. However, CSDH still troubles clinicians with a high postoperative recurrence rate. The presence of eosinophils has been confirmed in some CSDH surgical specimens. Furthermore, postoperative residual hematoma has not been classified, and its association with the recurrence of CSDH remains unknown. The present study aimed to test the hypothesis that the peripheral blood eosinophils and the classification of postoperative residual hematoma are significant for the prediction of CSDH recurrence after burr-hole surgery. A retrospective review of 258 CSDH patients who received burr-hole surgery was performed. A complete blood picture with differential count was taken before surgery. Clinical, laboratory, and radiographic factors predicting CSDH recurrence were identified in univariable and multivariable analyses. Univariable analysis showed that the percentage of eosinophils, peripheral blood eosinophil count <0.15 × 109/L, gradation and separated types, postoperative volume of the residual cavity ≥70 ml, residual air volume ≥28 ml, residual hematoma volume ≥55 ml, residual hematoma width ≥1.4 cm, postoperative midline shift ≥5.6 mm, postoperative brain re-expansion rate <41%, postoperative low-density type, and postoperative high-density type correlated with the recurrence of CSDH. Multivariable analysis, however, showed that peripheral blood eosinophil count <0.15 × 109/L, gradation and separated types, preoperative midline shift ≥9.5 mm, postoperative brain re-expansion rate <41%, postoperative low-density type, and postoperative high-density type are independent predictors for the recurrence of CSDH. We expect that peripheral blood eosinophils and the classification of postoperative residual hematoma may facilitate our understanding of the recurrence of CSDH after initial surgery.
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72
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Bader SE, Sönnerqvist C, Melander N, Olivecrona M. A Validation Study of Kwon's Prognostic Scoring System for Chronic Subdural Hematoma. World Neurosurg 2022; 165:e365-e372. [PMID: 35724882 DOI: 10.1016/j.wneu.2022.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Surgery for chronic subdural hematoma is one of the most frequent operations in neurosurgical practice. Chronic subdural hematoma mostly afflicts the elderly population. In 2018, Kwon and co-workers, published the Kwon scoring system (KSS), whereby 6 clinical and radiological factors are used to facilitate, and promote quality in, surgical decision-making and counseling of relatives. The aim of this study is to validate the KSS. METHODS Patients operated on for unilateral chronic subdural hematoma at Örebro University Hospital, Sweden, between 2013 and 2019 constituted the study population. General data and the 6 outcome predictors according to the KSS were extracted from the electronic patient records. The preoperative modified Rankin Scale score and the postoperative 6-month modified Rankin Scale score were assessed. RESULTS We identified 133 patients (69.2% male) with a median age of 80.2 years (interquartile range 72.6-85.9). The median Glasgow Coma Scale score at admission was 15; 57.1% had motor deficits and 36.81% were disoriented. For 39.1% of the patients, the prognosis was a favorable outcome (modified Rankin Scale 0-1) at 6 months. The median KSS score was 9; 63.9% of the patients scored ≥9, and 36 (42.4%) of these patients actually achieved a favorable outcome. This corresponds to a prediction model sensitivity of 0.667 and specificity of 0.424. A receiver operator characteristic curve analysis of the model yielded an area under the receiver operator characteristic curve of 0.62441. CONCLUSIONS In our material, the KSS did not predict outcome precisely enough to base treatment decisions or counseling of relatives on the scores obtained.
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Affiliation(s)
- Sam Er Bader
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline Sönnerqvist
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nils Melander
- Deptartment of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Olivecrona
- Department of Neurosurgery Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Khorasanizadeh M, Shutran M, Garcia A, Enriquez-Marulanda A, Moore JM, Ogilvy CS, Thomas AJ. Middle Meningeal Artery Embolization with Isolated Use of Coils for Treatment of Chronic Subdural Hematomas: A Case Series. World Neurosurg 2022; 165:e581-e587. [PMID: 35768059 DOI: 10.1016/j.wneu.2022.06.099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Middle meningeal artery embolization (MMAE) is a novel approach for treatment of chronic subdural hematoma (cSDH). Studies comparing different procedural techniques for MMAE are lacking. It is unclear whether isolated use of coils results in suboptimal outcomes compared to when particle embolization is also performed. The objectives of this study are to describe the outcomes of coil-only MMAE and compare them with those of combined use of coils and particles. METHODS A single-institution retrospective study of cSDH cases treated by MMAE was performed. Clinical outcomes, need for rescue surgery, and changes in hematoma's size were compared between the coil-only and coil + particle groups. RESULTS Ninety-four hematomas in 78 patients were included. Twelve cases were treated by a coil-only MMAE procedure, often due to presence of dangerous ophthalmic collaterals. No treatment-related complications were observed in the coil-only group. There was no significant difference between the coil-only and coil + particle groups in baseline hematoma axial thickness, volume, midline shift, and duration of follow-up. The rate of need for rescue surgery was similar between the 2 groups (8.3% vs. 8.5%; P = 0.98). Coiling alone resulted in a similar percentage of reduction in cSDH volume (68.3% vs. 71.8%; P = 0.8) and rate of achieving ≥50% reduction in volume (81.8% vs. 76.3%; P = 0.68) compared to coils + particles. CONCLUSIONS Isolated use of coils for endovascular treatment of cSDHs can be as effective as adjunct use of particle embolization. This method eliminates the risks of cranial nerve and visual complications associated with MMAE, can prevent procedural abortion due to presence of dangerous anastomoses, and reduces the technical complexity of the procedure.
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Affiliation(s)
- MirHojjat Khorasanizadeh
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Max Shutran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey, USA.
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74
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Peripheral Monocyte Percentage as a Potential Indicator of Prognosis in Patients with Chronic Subdural Hematoma Receiving Conservative Therapy. World Neurosurg 2022; 165:e92-e101. [PMID: 35654333 DOI: 10.1016/j.wneu.2022.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies have confirmed active and abnormal inflammation in the hematoma cavity of chronic subdural hematoma (CSDH). However, a relationship between the peripheral blood status and the prognosis of CSDH patients has not been demonstrated. METHODS We retrospectively analyzed 245 CSDH patients who received conservative therapy (67 under close follow-up observation, 103 treated with atorvastatin, and 75 treated with atorvastatin combined with dexamethasone) from 2014 to 2021 to evaluate the role of major inflammation-associated cells in the prognostic assessment of patients. Univariate and multivariate analyses were performed to assess the potential factors that could indicate the prognosis among the 103 patients who underwent observation only or atorvastatin therapy. Changes in peripheral blood inflammation-associated cells at different time points were compared between patients with good and poor outcomes. Furthermore, the changes in inflammatory cells in 75 patients who received atorvastatin combined with dexamethasone were analyzed. RESULTS The monocyte percentage was the only independent influencing factor in subsequent follow-up assessments. Patients with good outcomes had obviously lower circulating monocyte percentages in their peripheral blood counts throughout the treatment period. The monocyte percentage was also significantly decreased in the patients who responded well to atorvastatin combined with dexamethasone. The peripheral monocyte percentage was significantly higher in patients who transitioned to surgery because of a poor response to pharmacotherapy. CONCLUSIONS The peripheral monocyte percentage may be a convenient and effective indicator for predicting the outcome of CSDH for patients receiving conservative treatment. A higher percentage of monocytes could be a risk factor for a poor response.
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75
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Colasurdo M, Leibushor N, Robledo A, Vasandani V, Luna ZA, Rao AS, Garcia R, Srinivasan VM, Sheth SA, Avni N, Madziva M, Berejick M, Sirota G, Efrati A, Meisel A, Shaltoni H, Kan P. Automated detection and analysis of subdural hematomas using a machine learning algorithm. J Neurosurg 2022; 138:1077-1084. [PMID: 36461839 DOI: 10.3171/2022.8.jns22888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Machine learning algorithms have shown groundbreaking results in neuroimaging. Herein, the authors evaluate the performance of a newly developed convolutional neural network (CNN) to detect and quantify the thickness, volume, and midline shift (MLS) of subdural hematoma (SDH) from noncontrast head CT (NCHCT).
METHODS
NCHCT studies performed for the evaluation of head trauma in consecutive patients between July 2018 and April 2021 at a single institution were retrospectively identified. Ground truth determination of SDH, thickness, and MLS was established by the neuroradiology report. The primary outcome was performance of the CNN in detecting SDH in an external validation set, as measured using area under the receiver operating characteristic curve analysis. Secondary outcomes included accuracy for thickness, volume, and MLS.
RESULTS
Among 263 cases with valid NCHCT according to the study criteria, 135 patients (51%) were male, the mean (± standard deviation) age was 61 ± 23 years, and 70 patients were diagnosed with SDH on neuroradiologist evaluation. The median SDH thickness was 11 mm (IQR 6 mm), and 16 patients had a median MLS of 5 mm (IQR 2.25 mm). In the independent data set, the CNN performed well, with sensitivity of 91.4% (95% CI 82.3%–96.8%), specificity of 96.4% (95% CI 92.7%–98.5%), and accuracy of 95.1% (95% CI 91.7%–97.3%); sensitivity for the subgroup with an SDH thickness above 10 mm was 100%. The maximum thickness mean absolute error was 2.75 mm (95% CI 2.14–3.37 mm), whereas the MLS mean absolute error was 0.93 mm (95% CI 0.55–1.31 mm). The Pearson correlation coefficient computed to determine agreement between automated and manual segmentation measurements was 0.97 (95% CI 0.96–0.98).
CONCLUSIONS
The described Viz.ai SDH CNN performed exceptionally well at identifying and quantifying key features of SDHs in an independent validation imaging data set.
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Affiliation(s)
- Marco Colasurdo
- Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas
| | | | | | | | | | | | | | - Visish M. Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; and
| | - Sunil A. Sheth
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | | | | | | | | | | | | | - Hashem Shaltoni
- Neurology, The University of Texas Medical Branch, Galveston, Texas
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Hoenning A, Lemcke J, Rot S, Stengel D, Hoppe B, Zappel K, Schuss P, Mutze S, Goelz L. Middle Meningeal Artery Embolization Minimizes Burdensome Recurrence Rates After Newly Diagnosed Chronic Subdural Hematoma Evacuation (MEMBRANE): study protocol for a randomized controlled trial. Trials 2022; 23:703. [PMID: 35996195 PMCID: PMC9396835 DOI: 10.1186/s13063-022-06506-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic subdural hematoma (cSDH) is the most common complication of mild traumatic brain injury demanding neurosurgery in high-income countries. If undetected and untreated, cSDH may increase intracranial pressure and cause neurological deficiencies. The first-line intervention of choice is burr hole trepanation and hematoma evacuation. However, any third patient may experience rebleeding, demanding craniotomy with excess morbidity. Adjunct endovascular embolization of the frontal and parietal branches of the middle meningeal artery (MMA) is a promising approach to avoid relapse and revision but was hitherto not studied in a randomized trial. Methods MEMBRANE is an investigator-initiated, single-center, randomized controlled trial. Male, female, and diverse patients older than 18 years scheduled for surgical evacuation of a first cSDH will be assigned in a 1:1 fashion by block randomization to the intervention (surgery plus endovascular MMA embolization) or the control group (surgery alone). The primary trial endpoint is cSDH recurrence within 3 months of follow-up after surgery. Secondary endpoints comprise neurological deficits assessed by the modified Rankin Scale (mRS) and recurrence- or intervention-associated complications during 3 months of follow-up. Assuming a risk difference of 20% of rebleeding and surgical revision, a power of 80%, and a drop-out rate of 10%, 154 patients will be enrolled onto this trial, employing an adaptive O’Brien-Fleming approach with a planned interim analysis halfway. Discussion The MEMBRANE trial will provide first clinical experimental evidence on the effectiveness of endovascular embolization of the MMA as an adjunct to surgery to reduce the risk of recurrence after the evacuation of cSDH. Trial registration German Clinical Trials Registry (Deutsches Register Klinischer Studien [DRKS]) DRKS00020465. Registered on 18 Nov 2021. ClinicalTrials.gov NCT05327933. Registered on 13 Apr 2022.
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Affiliation(s)
- Alexander Hoenning
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
| | - Johannes Lemcke
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Sergej Rot
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Dirk Stengel
- BG Kliniken - Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117, Berlin, Germany
| | - Berthold Hoppe
- Institute of Laboratory Medicine, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Kristina Zappel
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Patrick Schuss
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Sven Mutze
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.,Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Leonie Goelz
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.,Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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77
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Hasan D, Nikoubashman O, Pjontek R, Stockero A, Hamou HA, Wiesmann M. MRI appearance of chronic subdural hematoma. Front Neurol 2022; 13:872664. [PMID: 36003292 PMCID: PMC9393587 DOI: 10.3389/fneur.2022.872664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveWe aimed to describe the magnetic resonance imaging (MRI) characteristics of chronic subdural hematoma (cSDH) and to ascribe MRI patterns.MethodsA total of 20 patients having 27 subdural hematomas underwent contrast-enhanced (CE) MRI of the brain at our institution between April 2019 and May 2021. The images were independently evaluated by two experienced neuroradiologists with regard to imaging characteristics on T1w, T2w, T2*-GRE, FLAIR, diffusion-weighted magnetic resonance imaging (DWI), and CE images.ResultsThe signal characteristics of cSDH on T1- and T2-weighted images were rather heterogeneous. The majority of hematomas (74%) had internal septations. Surprisingly, contrast enhancement along the outer membrane adjacent to the cranium was noticed in all hematomas. There was also contrast enhancement along the inner membrane adjacent to the brain in more than one-third of the hematomas (37%). In approximately two-thirds of the cSDH (62%), there was a mass-like enhancement of the hematoma. Most hematomas (89%) were partially hypointense on T2*-GRE and/or susceptibility-weighted imaging (SWI). Restricted diffusion was detected in approximately one-third of the hematomas (33%).ConclusionConsistent contrast enhancement along the outer membrane, triangular-shaped contrast enhancement at the borders of the cSDH, and infrequent enhancement of the inner membrane may help to distinguish cSDH from other entities such as empyema and tumors. Mass-like enhancement may refer to non-solid hematomas and could be an indicator for hematoma growth and a possible surrogate for successful endovascular embolization. Restricted diffusion in a subdural mass is not specific for empyema but may also be found in cSDH.
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Affiliation(s)
- Dimah Hasan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
- *Correspondence: Dimah Hasan
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Rastislav Pjontek
- Department of Neurosurgery, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Andrea Stockero
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Hussam Aldin Hamou
- Department of Neurosurgery, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
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Martins LB, Bisinotto FMB, Dezena RA, Meirelles R. Intracranial rebleeding post spinal anesthesia in pregnant patient with undiagnosed chronic subdural hematoma: case report. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022; 72:522-524. [PMID: 34852267 PMCID: PMC9373423 DOI: 10.1016/j.bjane.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/01/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022]
Abstract
Intracranial hematoma after spinal anesthesia is a rare complication. It generally presents with posture-dependent headache that becomes persistent. We describe the case of patient submitted to spinal anesthesia for cesarean section who presented a non-posture-dependent headache, resistant to clinical treatment, that progressively worsened and with symptoms of intracranial hypertension. The patient had a history of head trauma without symptoms. The CT-scan revealed a chronic bilateral parietal hematoma with a recent bleeding component, treated surgically. We concluded that spinal puncture led to chronic hematoma to rebleed. We have reported the case to draw attention to the importance of investigating atypical headache after spinal anesthesia.
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MESH Headings
- Anesthesia, Spinal/adverse effects
- Cesarean Section/adverse effects
- Female
- Headache
- Hematoma, Subdural, Chronic/complications
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/surgery
- Hematoma, Subdural, Intracranial/diagnostic imaging
- Hematoma, Subdural, Intracranial/etiology
- Humans
- Pregnancy
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Affiliation(s)
| | - Flora Margarida Barra Bisinotto
- CET/SBA Integrado de Uberaba, Uberaba, MG, Brazil; Universidade Federal do Triângulo Mineiro (UFTM), Disciplina de Anestesiologia, Uberaba, MG, Brazil
| | - Roberto Alexandre Dezena
- Universidade Federal do Triângulo Mineiro (UFTM), Departamento de Neurocirurgia, Uberaba, MG, Brazil; Universidade Federal do Triângulo Mineiro (UFTM), Hospital de Clínicas, Programa de Residência Neurocirurgia, Uberaba, MG, Brazil
| | - Rafael Meirelles
- Universidade Federal do Triângulo Mineiro (UFTM), Hospital de Clínicas, Uberaba, MG, Brazil
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Neth BJ, Ighodaro ET, Brinjikji W, Cloft H, Scharf EL. Management of Chronic Subdural Hematoma in Patients Requiring Therapeutic Anticoagulation. Neurologist 2022; 27:211-213. [PMID: 34855670 DOI: 10.1097/nrl.0000000000000380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A common risk factor of chronic, nontraumatic subdural hematoma (SDH) is anticoagulation therapy. Anticoagulation is generally held in patients who develop SDH, but this can lead to thromboembolic events. While prior studies have reported the clinical outcomes of patients with anticoagulation-related SDH, there remains little evidence regarding ongoing anticoagulation treatment. CASE REPORT We report the management of 2 patients who developed anticoagulation-related SDH and underwent middle meningeal artery (MMA) embolization and successful reinitiation of anticoagulation therapy. In both patients, we conservatively managed anticoagulation with heparin and/or enoxaparin as a bridge to warfarin after MMA embolization. Follow-up computed tomography head revealed interval decrease of SDH and stable neurological status. CONCLUSIONS These cases provide anecdotal evidence of a challenging clinical scenario where there is a necessary indication for therapeutic anticoagulation (ie, venous sinus thrombosis or atrial appendage thrombus) and comorbid SDH. Endovascular MMA embolization may be an effective adjunct therapy for clinical scenarios in patients with SDH and an urgent indication for anticoagulation. Longer follow-up, prospective series, and future randomized clinical trials are needed to objectively assess outcomes in this clinically challenging patient population.
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Affiliation(s)
| | | | | | - Harry Cloft
- Radiology
- Neurosurgery, Mayo Clinic, Rochester, MN
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80
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Khorasanizadeh M, Chang YM, Enriquez-Marulanda A, Mizuhashi S, Salem MM, Gomez-Paz S, Siddiq F, Kan P, Moore J, Ogilvy CS, Thomas AJ. Morphological changes in chronic subdural hematomas following upfront middle meningeal artery embolization: sequence, timing, and association with outcomes. J Neurosurg 2022; 137:235-248. [PMID: 34826814 DOI: 10.3171/2021.8.jns211691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Middle meningeal artery embolization (MMAE) is an increasingly utilized approach for the treatment of chronic subdural hematomas (CSDHs). The course of morphological progression of CSDHs following MMAE is poorly understood. Herein, the authors aimed to describe these morphological changes and assess their prognostic significance for the outcomes on follow-up. METHODS A single-institution retrospective cohort study of CSDH cases treated by upfront MMAE, without prior or adjunctive surgical evacuation, was performed. Clinical outcomes, complications, and the need for rescue surgery on follow-up were recorded. Hematomas were categorized into 6 morphological subtypes. All baseline and follow-up head CT scans were assessed for CSDH structural appearance, density, and loculation. Changes in CSDH size were quantified via 3D reconstruction for volumetric measurement. RESULTS Overall, 52 CSDHs in 45 patients treated with upfront MMAE were identified. Hematomas were followed for a mean of 92.9 days. Volume decreased by ≥ 50% in 79.6% of the CSDHs. The overall rescue surgery rate was 9.6%. A sequence of morphological changes after MMAE was identified. Hematomas that diverged from this sequence (5.4%) all progressed toward treatment failure and required rescue surgery. The CSDHs were categorized into early, intermediate, and late stages based on the baseline morphological appearance. Progression from early to intermediate and then to late stage took 12.7 and 30.0 days, respectively, on average. The volume of early/intermediate- and late-stage hematomas decreased by ≥ 50%, a mean of 78.2 and 47.6 days after MMAE, respectively. Early- and intermediate-stage hematomas showed a trend toward more favorable outcomes compared with late-stage hematomas. The density of homogeneous hypodense hematomas (HSDHs) transiently increased immediately after MMAE (p < 0.001). A marked decrease in density and volume 1 to 3 weeks after MMAE in HSDHs was detected, the lack of which indicated an eventual need for rescue surgery. In HSDHs, a baseline mean density of < 20 HU, and a lower density than baseline by 1 month post-MMAE were predictors of favorable outcomes. The baseline hematoma volume, axial thickness, midline shift, and loculation were not correlated with MMAE outcomes. Loculated, trabecular, and laminar hematomas, which are known to have unfavorable surgical outcomes, had MMAE outcomes similar to those of other "surgical" hematomas. CONCLUSIONS The current study was the first to describe the nature, sequence, and timing of morphological changes of CSDHs after MMAE treatment and has identified structural features that can predict treatment outcomes.
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Affiliation(s)
| | - Yu-Ming Chang
- 2Neuroradiology Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Satomi Mizuhashi
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Mohamed M Salem
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Santiago Gomez-Paz
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Farhan Siddiq
- 3Division of Neurosurgery, University of Missouri, Columbia, Missouri; and
| | - Peter Kan
- 4Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Justin Moore
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Ajith J Thomas
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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Evaluation of Traumatic Subdural Hematoma Volume by Using Image Segmentation Assessment Based on Deep Learning. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3830245. [PMID: 35799650 PMCID: PMC9256325 DOI: 10.1155/2022/3830245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022]
Abstract
Rapid and accurate evaluations of hematoma volume can guide the treatment of traumatic subdural hematoma. We aim to explore the consistency between the measurement results of traumatic subdural hematoma (TSDH) using a deep learn-based image segmentation algorithm. A retrospective study was conducted on 90 CT images of patients diagnosed with TSDH in our hospital from January 2019 to January 2022. All image data were measured by manual segmentation, convolutional neural networks (CNN) algorithm segmentation, and ABC/2 volume formula. With manual segmentation as the “golden standard,” a consistency test was carried out with CNN algorithm segmentation and ABC/2 volume formula, respectively. The percentage error of CNN algorithm segmentation is less than ABC/2 volume formula. There is no significant difference between CNN algorithm segmentation and manual segmentation (P > 0.05). The area under curve of the ABC/2 volume formula, manual segmentation, and CNN algorithm segmentation is 0.811 (95% CI: 0.717~0.905), 0.840 (95% CI: 0.753~0.928), and 0.832 (95% CI: 0.742~0.922), respectively. From our results, the algorithm based on CNN has a good efficiency in segmentation and accurate calculation of TSDH hematoma volume.
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Hematoma cavity separation and neomembrane thickness are potential triggers of recurrence of chronic subdural hematoma. BMC Surg 2022; 22:236. [PMID: 35725399 PMCID: PMC9210812 DOI: 10.1186/s12893-022-01687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background Chronic subdural hematoma (CSDH) is the anomalous and encapsulated accumulation of fluid of complex origin consisting of old blood, mostly or totally liquified and cerebrospinal fluid (CSF) in the subdural space usually after a head injury in the elderly. Almost all the research on surgical techniques and endoscopic assisted evacuation of CSDH focused on the just the evacuation and not abnormal anatomical structures that causes recurrences. Objectives We investigated abnormal anatomical structures that triggers recurrence of CSDH during craniotomy as well as burr-hole craniostomy with endoscopic assistance. Materials and methods We retrospectively analyzed all patients with CSDH who underwent craniostomy and burr-hole craniotomy with endoscopic assisted evacuation of hematoma between April 2017 and November 2020 at our institution. Clinical data obtained was categorized into patient-related, radiology as well as surgery and endoscopic evaluations. Results A total of 143 patients (109 men and 34 women) aged 43–94 years (mean age, 68.35 years) with CSDH were included in this study. We observed a recurrence rate of 4.9% (7/143). Recurrences occurred between 2 and 6 months after the operation in patients with recurrences. Our data revealed that, age, hypertension, history of injury, diabetes, antiplatelet or anticoagulant use were not associated with hematoma recurrence. Nevertheless, all the patients with recurrence of hematoma were males. Interestingly, our univariate and multivariate analyses found neomembrane thickness and hematoma cavity separation as independent risk factors (OR,45.822; 95% CI,2.666-787.711; p = 0.008) for the recurrence of CSDH (p < 0.05). Also, we observed thickened membranes connecting/separating the dura and the thickened arachnoid/pia matters in all the 7 patients with hematoma recurrence. Conclusions The treatment of patients with CSDH ought to include the identification and resection of abnormal thickened membranes connecting/separating the dura and the thickened arachnoid/pia matters to avoid recurrence. Comparatively, endoscopy showed hematoma cavity separation or neomembrane thickness just as seen during craniotomy.
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83
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Ou Y, Fan W, Yu X, Wu L, Liu W. A Single-Center Analysis of Sex Differences in Patients With Chronic Subdural Hematoma in China. Front Neurol 2022; 13:888526. [PMID: 35655622 PMCID: PMC9152211 DOI: 10.3389/fneur.2022.888526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Given the men's predominance in the prevalence of chronic subdural hematoma (CSDH), we investigated the relationship between sex differences and clinical features of CSDH. Methods We retrieved a large collection of clinical factors from CSDH patients between August 2011 and May 2019, and analyzed the differences and similarities in the clinical data and outcomes between men and women. Results In total 1,307 CSDH patients were enrolled in this study. When we did not account for age, a greater proportion of women relative to men manifested diabetes (p = 0.001) and cardiac disease (p = 0.035) prior to the onset of CSDH. Regarding recovery outcome and recurrence rate, we observed no significant differences between men and women. The sole difference between women and men after surgery was that women experienced more complications than men (p = 0.044), and both length of hospital stay (p < 0.001, B = 0.159, Exp [B] = 1.172, 95% CI = 1.078–1.274) and the presence of cardiac disease (p = 0.002, B = 2.063, Exp [B] = 7.867, 95% CI = 2.167–28.550) were identified as independent risk factors. After accounting for age, women with CSDH exhibited more frequent disorders of consciousness at admission than men in group of ≤ 40-year-old patients (p = 0.018), while proportion of women with diabetes was higher than that of men in 41–79 year-old group (p < 0.001). However, women after surgery experienced more complications (p = 0.047), longer length of hospital stays (p = 0.005), and higher mortality at discharge (p = 0.035) than men in middle-aged group. Finally, length of hospital stay (p < 0.001, B = 0.186, Exp [B] = 1.205, 95% CI = 1.091–1.331) and cardiac disease (p = 0.017, B = 2.040, Exp [B] = 7.693, 95% CI = 1.430–41.372) impacted occurrence of complications in women 41–79-year-old, while duration of drainage catheter use (p < 0.001, B = 1.132, beta = 0.280) and complications (p < 0.001, B = 5.615, beta = 0.366) were identified as independent risk factors for length of hospital stay in the same group of women. Conclusions Although sex differences did not constitute a crucial factor in all the CSDH patients, we still need to pay closer attention to disparities between men and women with respect to complications, length of hospital stay, and mortality at discharge in the various age groups (particularly with respect to 41–79 year-old women patients), to provide satisfactory management and treatment of CSDH patients.
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Affiliation(s)
- Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Hefei Comprehensive National Science Center, The Institute of Artificial Intelligence, Hefei, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Wenhua Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaofan Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Neurological Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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84
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Posti JP, Luoto TM, Sipilä JOT, Rautava P, Kytö V. Prognosis of patients with operated chronic subdural hematoma. Sci Rep 2022; 12:7020. [PMID: 35488040 PMCID: PMC9054845 DOI: 10.1038/s41598-022-10992-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/14/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. We investigated case-fatality, excess fatality and need for reoperations following operated cSDH in a nationwide setting focusing on patient-related characteristics. Finnish nationwide databases were searched for all admissions with operated cSDH as well as later deaths in adults (≥ 16 years) during 2004–2017. There were 8539 patients with an evacuated cSDH (68% men) with a mean age of 73.0 (± 12.8) years. During the follow-up, 3805 (45%) patients died. In-hospital case-fatality was 0.7% (n = 60) and 30-day case-fatality 4.2% (n = 358). The 1-year case-fatality was 14.3% (95% CI = 13.4–15.2%) among men and 15.3% (95% CI = 14.0–16.7%) among women. Comorbidity burden, older age, and alcoholism were significantly associated with fatality. One-year excess fatality rate compared to general Finnish population was 9.1% (95% CI = 8.4–9.9) among men and 10.3% (95% CI = 9.1–11.4) among women. Highest excess fatality was observed in the oldest age group in both genders. Reoperation was needed in 19.4% (n = 1588) of patients. Older age but not comorbidity burden or other patient-related characteristics were associated with increased risk for reoperation. The overall case-fatality and need for reoperations declined during the study era. Comorbidities should be considered when care and follow-up are planned in patients with cSDH. Our findings underpin the perception that the disease is more dangerous than previously thought and causes mortality in all exposed age groups: even a minor burden of comorbidities can be fatal in the post-operative period.
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Affiliation(s)
- Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, P.O. Box 52, 20521, Turku, Finland.
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Jussi O T Sipilä
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurology, Siun Sote, North Karelia Central Hospital, Joensuu, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Centre and Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administative Center, Hospital District of Southwest Finland, Turku, Finland
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85
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A. Hamou H, Clusmann H, B. Schulz J, Wiesmann M, Altiok E, Höllig A. Chronic Subdural Hematoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:208-213. [PMID: 35236548 PMCID: PMC9277133 DOI: 10.3238/arztebl.m2022.0144] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 06/30/2021] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic subdural hematoma (cSDH) is typically a disease that affects the elderly. Neurosurgical evacuation is generally indicated for hematomas that are wider than the thickness of the skull. The available guidelines do not address the common clinical issue of the proper management of antithrombotic drugs that the patient has been taking up to the time of diagnosis of the cSDH. Whether antithrombotic treatment should be stopped or continued depends on whether the concern about spontaneous or postoperative intracranial bleeding, and a presumably higher rate of progression or recurrence, with continued medication outweighs the concern about a possibly higher rate of thrombotic complications if it is stopped. METHODS In this article, we review publications from January 2015 to October 2020 addressing the issue of the management of antithrombotics in patients with cSDH that were retrieved by a selective search in the Pubmed and EMBASE databases, and we present the findings of a cohort study of 395 patients who underwent surgery for cSDH consecutively between October 2014 and December 2019. RESULTS The findings published in the literature are difficult to summarize concisely because of the heterogeneity of study designs. Among the seven studies in which a group of patients on antithrombotics was compared with a control group, four revealed significant differences with respect to the risk of thromboembolic complications depending on previous antithrombotic use and the duration of discontinuation, while three others did not. In our own cohort, discontinuation of antithrombotics (including both plasmatic and antiplatelet drugs) was associated with thrombotic complications in 9.1% of patients. CONCLUSION These findings imply that the management of antithrombotics should be dealt with critically on an individual basis. In patients with cSDH who are at elevated risk, an early restart of antithrombotic treatment or even an operation under continued antithrombotic therapy should be considered.
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Affiliation(s)
| | - Hans Clusmann
- Department of Neurosurgery, University Hospital RWTH Aachen
| | - Jörg B. Schulz
- Department of Neurology, University Hospital RWTH Aachen
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care Medicine (Department of Internal Medicine I), University Hospital RWTH Aachen
| | - Anke Höllig
- Department of Neurosurgery, University Hospital RWTH Aachen
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86
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Di Cristofori A, Remida P, Patassini M, Piergallini L, Buonanno R, Bruno R, Carrabba G, Pavesi G, Iaccarino C, Giussani CG. Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives. Surg Neurol Int 2022; 13:94. [PMID: 35399896 PMCID: PMC8986643 DOI: 10.25259/sni_911_2021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/14/2022] [Indexed: 12/20/2022] Open
Abstract
Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases that affect elderly and fragile patients and as a consequence, management can be challenging. Surgery represents the standard treatment; however, alternative options are under investigation. Middle meningeal artery (MMA) embolization is considered a minimally invasive treatment although with poor evidence. In this review, we tried to summarize the findings about MMA embolization as a treatment for a CSDH to provide a useful guidance for clinical practice and for future speculative aspects. Methods: Literature review on PubMed until March 2021 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We conducted a research on PubMed with a various combinations of the keywords “CSDH” and “middle meningeal artery” and “embolization,” “refractory subdural hematoma,” and then we reviewed the references of the relevant studies as additional source of eligible articles. Results: Among the 35 studies eligible for this review, 22 were case series, 11 were case reports, one was a technical note, and 1 was a randomized trial. A total of 746 patients were found in the literature. Failure rate of MMA embolization was between 3.9 and 8.9% of the cases according the indication to treat CSDH (upfront vs. after surgery). Conclusion: The global impression deriving from the data available and the literature is that MMA embolization is a safe procedure with very low complications and with a low failure rate, both when associated with surgery or in case of a standalone treatment.
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Affiliation(s)
- Andrea Di Cristofori
- Unit of Neurosurgery, Azienda Socio SanitariaTerritoriale - Monza, Ospedale San Gerardo,
| | - Paolo Remida
- Unit of Neuroradiology, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza,
| | - Mirko Patassini
- Unit of Neuroradiology, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza,
| | - Lorenzo Piergallini
- Unit of Neuroradiology, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza,
| | - Raffaella Buonanno
- Unit of Neurosurgery, Azienda Socio SanitariaTerritoriale - Monza, Ospedale San Gerardo,
- Unit of Neurosurgery, School of Medicine and Surgery, Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan,
| | - Raffaele Bruno
- Unit of Neurosurgery, Azienda Socio SanitariaTerritoriale - Monza, Ospedale San Gerardo,
- Unit of Neurosurgery, School of Medicine and Surgery, Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan,
| | - Giorgio Carrabba
- Unit of Neurosurgery, Azienda Socio SanitariaTerritoriale - Monza, Ospedale San Gerardo,
- Unit of Neurosurgery, School of Medicine and Surgery, Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan,
| | - Giacomo Pavesi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia,
- Neurosurgery Division, University Hospital of Modena, Modena, Italy
| | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia,
- Neurosurgery Division, University Hospital of Modena, Modena, Italy
| | - Carlo Giorgio Giussani
- Unit of Neurosurgery, Azienda Socio SanitariaTerritoriale - Monza, Ospedale San Gerardo,
- Unit of Neurosurgery, School of Medicine and Surgery, Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan,
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87
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Yu W, Chen W, Jiang Y, Ma M, Zhang W, Zhang X, Cheng Y. Effectiveness Comparisons of Drug Therapy on Chronic Subdural Hematoma Recurrence: A Bayesian Network Meta-Analysis and Systematic Review. Front Pharmacol 2022; 13:845386. [PMID: 35401183 PMCID: PMC8993499 DOI: 10.3389/fphar.2022.845386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/07/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives: We aim to compare the effectiveness of different drug treatments in improving recurrence in patients with chronic subdural hematoma (CSDH). Methods: Eligible randomized controlled trials (RCTs) and prospective trials were searched in PubMed, Cochrane Library, and Embase, from database inception to December 2021. After the available studies following inclusion and exclusion criteria were screened, the main outcome measures were strictly extracted. Taking the random-effects model, dichotomous data were determined and extracted by odds ratio (OR) with 95% credible interval (CrI), and a surface under the cumulative ranking curve (SUCRA) was generated to calculate the ranking probability of comparative effectiveness among each drug intervention. Moreover, we used the node-splitting model to evaluate inconsistency between direct and indirect comparisons of our network meta-analysis (NMA). Funnel plots were used to evaluate publication bias. Results: From the 318 articles found during initial citation screening, 11 RCTs and 3 prospective trials (n = 3,456 participants) were ultimately included in our study. Our NMA results illustrated that atorvastatin + dexamethasone (ATO+DXM) (OR = 0.06, 95% CrI 0.01, 0.89) was the most effective intervention to improve recurrence in patients with CSDH (SUCRA = 89.40%, 95% CrI 0.29, 1.00). Four drug interventions [ATO+DXM (OR = 0.06, 95% CrI 0.01, 0.89), DXM (OR = 0.18, 95% CrI 0.07, 0.41), tranexamic acid (TXA) (OR = 0.26, 95% CrI 0.07, 0.41), and ATO (OR = 0.41, 95% CrI 0.12, 0.90)] achieved statistical significance in improving recurrence in CSDH patients compared with the placebo (PLB) or standard neurosurgical treatment (SNT) group. Conclusion: Our NMA showed that ATO+DXM, DXM, ATO, and TXA had definite efficacy in improving recurrence in CSDH patients. Among them, ATO+DXM is the best intervention for improving recurrence in patients with CSDH in this particular population. Multicenter rigorous designed prospective randomized trials are still needed to evaluate the role of various drug interventions in improving neurological function or outcome. Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299491), identifier (CRD 42022299491).
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Affiliation(s)
- Wanli Yu
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weifu Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongxiang Jiang
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mincai Ma
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaolin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Cheng
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Majidi S, Matsoukas S, De Leacy RA, Morgenstern PF, Soni R, Shoirah H, Rapoport BI, Shigematsu T, Bederson JB, Berenstein A, Mocco J, Fifi JT, Kellner CP. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With D5W Push Technique. Neurosurgery 2022; 90:533-537. [DOI: 10.1227/neu.0000000000001882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022] Open
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89
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Fang H, Zhang Z, Liu Y, Wang L, Yang Y, Li S, Jing X, Bai G, Sheng H. Rigid Neuroendoscopy Assisted Hematoma Resection Reduces the Recurrence Rate of Chronic Subdural Hematoma With Mixed Density: A Retrospective Analytic Cohort Study. Front Surg 2022; 9:789118. [PMID: 35284472 PMCID: PMC8913710 DOI: 10.3389/fsurg.2022.789118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background The mixed density hematoma (MDH) has a high recurrence rate in chronic subdural hematoma (CSDH). This study adopted rigid neuroendoscopy assisted hematoma resection to evacuate CSDH and investigated its efficacy as compared with the traditional burr-hole craniostomy (BHC) in CSDH with mixed density. Methods A retrospective cohort study was conducted at two centers between January 2015 and December 2020. The data of 124 patients who underwent BHC for CSDH with mixed density were collected and analyzed. A total of 41 patients underwent rigid neuroendoscopy assisted hematoma resection (neuroendoscopy group) and 83 patients were treated by the traditional BHC (control group). Follow-ups were conducted 6 months after the surgery. Results There was no significant difference in the baseline characteristics and preoperative CT features between the two groups (p > 0.05). The neuroendoscopy group had a lower recurrence rate than the control group (p = 0.043). Besides the neuroendoscopy group had a higher rate of hematoma evacuation (p < 0.001), less pneumocephalus volume (p < 0.001), shorter hospital stay (p < 0.001) and better Markwalder score (p < 0.001) than the control group within 24–48 h after operation. However, there was no significant difference between the two groups in the incidence of pneumocephalus, Markwalder score (at discharge and 6 months after surgery) and mortality. Moreover, the operation time was longer in the neuroendoscopy group (p < 0.001). Conclusions When compared with the traditional BHC, rigid neuroendoscopy assisted hematoma resection can better reduce the recurrence rate of CSDH with mixed density. Also, it surpassed the results obtained from BHC in reducing the volume of pneumocephalus, improving hematoma evacuation rate, promoting short-term neurological recovery, and shortening hospital stays.
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Affiliation(s)
- Huangyi Fang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Department of Neurosurgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongding Zhang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yiru Liu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lingfei Wang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yue Yang
- Department of Neurosurgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shize Li
- Department of Neurosurgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiepan Jing
- Department of Neurosurgery, People's Hospital of Bayingolin Mongol Autonomous Prefecture, Korla, China
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hansong Sheng
- Department of Neurosurgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Hansong Sheng
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Su GJ, Gao J, Wu CW, Zou JF, Zhang D, Zhu DL, Liu J, Zhang JH, Huang XJ. Serum Levels of MMP-8 and MMP-9 as Markers in Chronic Subdural Hematoma. J Clin Med 2022; 11:jcm11040902. [PMID: 35207175 PMCID: PMC8878690 DOI: 10.3390/jcm11040902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/30/2022] [Accepted: 02/05/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic subdural hematoma (CSDH) is a common neurological disease that involves the collection of blood products in the subdural space. The progression of CSDH is an angiogenic and inflammatory process, but the multifactorial mechanisms underlying CSDH are still not fully understood. We aimed to identify one or more factors that may play an important role in the development of CSDH. We enrolled 83 patients with CSDH, including 17 postoperative patients, and analyzed 20 markers in the hematoma fluid and peripheral blood of each patient. Overall differential gene expression was examined to identify the representative markers. The concentration of MMP-8 was significantly lower in the postoperative group than in the preoperative group. The concentration of MMP-9 was significantly higher in the postoperative group than in the preoperative group. These findings indicate that MMP-8 and MMP-9 may play important roles in the pathophysiology of CSDH. Understanding the pathways associated with CSDH may provide insights for improving disease outcomes.
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91
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Wei Z, Jiang H, Wang Y, Wang C. Effect of Twist-Drill Craniostomy With Hollow Screws for Evacuation of Chronic Subdural Hematoma: A Meta-Analysis. Front Neurol 2022; 12:811873. [PMID: 35153988 PMCID: PMC8833031 DOI: 10.3389/fneur.2021.811873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective This study systematically reviews the clinical efficacy and safety of twist-drill craniostomy with hollow screws in chronic subdural hematoma treatment. Methods A computerized search of PubMed, Embase, Web of Science, Cochrane Library, World Health Organization International Trial Registry platform, CBM, CNKI, and Wanfang Database was performed to retrieve randomized controlled trials or case-control trials using twist-drill craniostomy (TDC) with hollow screws for the evacuation of chronic subdural hematoma from the date of databases' inception to July 2021. Two investigators independently screened the studies and extracted data in strict accordance with pre-established inclusion and exclusion criteria. RevMan 5.3 software or STATA was used for meta-analysis after evaluating the methodological quality of the included studies. Results A total of 4 randomized controlled trials and 16 case-control trials with a total of 2,536 cases were included. Results of the meta-analysis showed that the surgical success rate and postoperative recurrence rate of TDC with hollow screws were slightly higher compared to the burr hole craniostomy (BHC) group, but showed no statistical significance (RR = 1.03, P = 0.05; RR = 1.13, P = 0.50). However, subgroup analysis showed that the use of YL-1 needle had a higher success rate and lower recurrence rate (RR = 1.05, P = 0.02 < 0.05; RR = 0.584, P = 0.002), and TDC with hollow screws had a lower incidence rate of postoperative complications and postoperative acute intracranial hemorrhage compared with BHC, also revealing an overall shorter hospital stay (RR = 0.57, P = 0.0002 < 0.05; RR = 0.584, P = 0.027 < 0.05; WMD = −3.752, P < 0.001). However, the postoperative mortality rate was practically the same between the two groups (OR = 1.01, P = 0.95 > 0.05). Conclusion Twist-drill craniostomy with hollow screws is not inferior or superior to BHC in efficacy, and this strategy is safer and minimally invasive, which is reflected in a lower incidence of acute intracranial hemorrhage, overall complication rate, and length of hospital stay. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021270835.
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Affiliation(s)
- Zeng Wei
- Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Haixiao Jiang
- Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Ying Wang
- Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Cunzu Wang
- Northern Jiangsu People's Hospital (NJPH), Yangzhou, China
- *Correspondence: Cunzu Wang
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92
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Singh H, Patir R, Vaishya S, Miglani R, Gupta A, Kaur A. Endoscopic evacuation of septated chronic subdural hemorrhage – Technical considerations, results, and outcome. Surg Neurol Int 2022; 13:8. [PMID: 35127208 PMCID: PMC8813603 DOI: 10.25259/sni_963_2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic subdural hematoma (cSDH) is a common entity in the elderly. Homogeneous or well-liquefied CSDH has a standard line of treatment through burr hole and irrigation. However, the management of septated chronic subdural hematoma (sCSDH) with multiple membranes does not have a well-defined surgical approach. The neomembranes forming septations prevent evacuation of clots through burr holes, and the small remaining loculi with clots will enlarge overtime to cause recurrence. Methods: Patients with sCSDH were operated through a minicraniotomy (2.5 cm × 2.5 cm) using rigid endoscopes for visualization of the subdural space. Using endoscope, the entire subdural space can be visualized. The neomembranes are removed with standard neurosurgical microinstruments. The entire cavity is irrigated under vision to remove all clots and ensures hemostasis. Results: Eighty-three endoscope-assisted evacuations were done in 68 patients from January 2016 to April 2020. Fifty (73.5%) patients had unilateral and 18 (26.5%) had bilateral subdural. Only 1 patient (1.47%) had a clinically significant recollection of subdural bleeding 1 month after the procedure. Over a mean follow-up period of 25.3 months (range 1–53 months), rest of patients did not show any recollection. Conclusion: Endoscopic evacuation of sCSDH is a safe and effective method and can be used to improve clot evacuation, and remove neomembranes under direct vision to reduce the rates of recollection. This method also obviates the need for larger craniotomies to remove membranes.
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Affiliation(s)
- Harnarayan Singh
- Department of Neurosurgery, Narayana Super Speciality Hospital, Gurugram, Haryana, India
| | - Rana Patir
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Sandeep Vaishya
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Rahul Miglani
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Anurag Gupta
- Department of Neurosurgery, Narayana Super Speciality Hospital, Gurugram, Haryana, India
| | - Amandeep Kaur
- Department of Nursing, National Reference Simulation Center, SGT University, Gurugram, Haryana, India
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93
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Kwon SM, Lee MH, Seo Y, Kim YI, Oh HJ, Kim KH, Choi KS, Chong K. A Radiological Assessment of Chronic Subdural Hematomas. Korean J Neurotrauma 2022; 18:12-21. [PMID: 35557646 PMCID: PMC9064761 DOI: 10.13004/kjnt.2022.18.e24] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 11/15/2022] Open
Abstract
Chronic subdural hematoma (CSDH), which generally occurs in elderly patients, is a frequently diagnosed condition in neurosurgical departments. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most preferred diagnostic modalities for CSDH assessment. With early diagnosis and adequate management, CSDH may show favorable prognosis in majority of the patients; however, recurrence after surgery can occur in a significant number of patients. The recently increasing number of CSDH studies could reveal the prognostic factors affecting CSDH recurrence. Particularly, radiological characteristics regarding the internal architecture of CSDH are considered closely associated with recurrence in surgically treated CSDH patients. In this literature review, we evaluated the various diagnostic modalities of CSDH and its radiological characteristics on CT and MRI. Furthermore, we summarized the prognostic factors of recurrence for the hematoma type based on the radiological findings.
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Affiliation(s)
- Sae Min Kwon
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Min Ho Lee
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngbeom Seo
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam Universtiy College of Medicine, Daegu, Korea
| | - Young Il Kim
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Jin Oh
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kyung Hwan Kim
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyu-Sun Choi
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Kyuha Chong
- Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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94
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Ozevren H, Cetin A, Hattapoglu S, Baloglu M. Burr hole and craniotomy in the treatment of subdural hematoma: A comparative study. Niger J Clin Pract 2022; 25:1056-1060. [DOI: 10.4103/njcp.njcp_1511_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zhuang Z, Chen Z, Chen H, Chen B, Zhou J, Liu A, Luo J. Using Local Anesthesia for Burr Hole Surgery of Chronic Subdural Hematoma Reduces Postoperative Complications, Length of Stay, and Hospitalization Cost: A Retrospective Cohort Study From a Single Center. Front Surg 2022; 9:783885. [PMID: 35433811 PMCID: PMC9010536 DOI: 10.3389/fsurg.2022.783885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/11/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The purpose of the current study was to compare the effects of local anesthesia (LA) and general anesthesia (GA) on the surgical process and postoperative recovery of patients with unilateral chronic subdural hematoma (CSDH). PATIENTS AND METHODS A retrospective cohort study was conducted on patients with unilateral CSDH who underwent burr hole surgery between the years 2013 and 2018. Patients who received local anesthesia were allocated to the LA group, and the patients who received general anesthesia were allocated to the GA group. The clinical data, postoperative complication, length of stay, and hospitalization cost of these two groups were compared and analyzed. RESULTS Data from 105 patients was collected for this study. Fifty one patients were assigned to the LA group and 54 to GA group. The duration of anesthesia and operation of the LA group was 37.71 (10.55) min; while for the GA group the duration was 56.04 (8.37) min (p < 0.001). The time from operation to discharge in GA group was greatly longer than that in LA group [(8.51 (1.49) days vs. 10.46 (2.34) days, respectively; p < 0.001]. Hospitalization cost for LA group was 2,721.54 (504.66) USD, which was significantly lesser than that for GA patients [3,314.82 (493.52) USD; p < 0.001]. The total number of complications in LA patients was less than that in GA patients [6 vs. 29 cases, respectively; p < 0.001]. The number of patients with residual hematoma in the LA group was <that in the GA group (p = 0.014). CONCLUSION As compared to GA, LA might be a simpler, safer, and more effective method for burr hole surgery of CSDH to promote patients' recovery. However, further research is still required to confirm this conclusion.
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Affiliation(s)
- Zerui Zhuang
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Neurosurgery, Shantou Central Hospital, Shantou, China
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Zelin Chen
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Hui Chen
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Bin Chen
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Jianzhi Zhou
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Anmin Liu
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianming Luo
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
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Kerttula S, Huttunen J, Leinonen V, Kämäräinen OP, Danner N. The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort. Acta Neurochir (Wien) 2022; 164:2699-2708. [PMID: 35972559 PMCID: PMC9519695 DOI: 10.1007/s00701-022-05337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/02/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE To study the effect of antithrombotic therapy (ATT) on the outcome of operatively treated chronic subdural hematomas (CSDH). METHODS A retrospective population-based cohort study from Eastern Finland including all adult patients who underwent a burr-hole craniostomy (BHC) for CSDH during 2016 and 2017. The follow-up time for recurrence was 6 months and for mortality 3 years. RESULTS A total of 301 CSDH patients were included in the study. ATT (antithrombotic therapy; antiplatelet or anticoagulant medication) was used by 164 patients (54.5%) at the time of diagnosis. The hematoma was bilateral in 102 patients (33.9%). Forty-seven patients (15.8%) encountered hematoma recurrence. Bilateral CSDHs required reoperations more often than unilateral hematomas (12.6% vs. 22.0%; p = 0.036) regardless of the primary operation (uni- or bilateral). A bivariate logistic regression analysis showed that bilateral hematoma (OR 1.918; 95% CI 1.013-3.630; p = 0.045) and male gender (OR 2.363; 95% CI 1.089-5.128; p = 0.030) independently predicted hematoma recurrence. The overall three-year mortality was 27.9%. The use of ATT was not associated with CSDH recurrence, and the length of the temporary postoperative ATT discontinuation did not correlate with the rate of thromboembolic events. CONCLUSIONS ATT did not affect CSDH recurrence in our study population, and the duration of the temporary postoperative ATT discontinuation was not associated with the rate of thromboembolic complications. Male gender and bilateral hematomas were more frequently associated with recurrences.
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Affiliation(s)
- Santtu Kerttula
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.
| | - Jukka Huttunen
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Nils Danner
- Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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Shi M, Xiao LF, Zhang TB, Tang QW, Zhao WY. Adjuvant Corticosteroids With Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis. Front Neurosci 2021; 15:786513. [PMID: 34955733 PMCID: PMC8692773 DOI: 10.3389/fnins.2021.786513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
The use of adjuvant corticosteroids with surgery for chronic subdural hematoma (CSDH) has received considerable attention in recent years. However, there is no conclusive evidence regarding its effectiveness and safety for CSDH. Therefore, we performed a meta-analysis and systematic review to evaluate the effectiveness and safety of corticosteroids as an adjuvant treatment for the treatment of CSDH. We comprehensively searched electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) to identify relevant trials that investigated the efficacy and safety of adjuvant corticosteroids with surgery for CSDH, published from inception until May 2021. Outcome measures included recurrence rate, all-cause mortality, good functional outcome, length of hospitalization, and adverse events. We used the Cochrane risk of bias method to evaluate the quality of randomized controlled trials (RCTs), and the Newcastle Ottawa Scale to evaluate the quality of observational studies. We included nine studies, consisting of three RCTs and six observational studies, that compared corticosteroids as an adjuvant treatment to surgery with surgery alone. Pooled results revealed that the risk of recurrence was significantly reduced in patients who received adjuvant corticosteroids with surgery compared to those who underwent surgery alone (relative risk [RR] = 0.52, 95% confidence interval [CI] = 0.39–0.69, p < 0.00001). However, no statistically significant difference was observed between these groups in all-cause mortality (RR = 0.91, 95% CI = 0.37–2.23, p = 0.83), good functional outcome (RR = 1.03, 95% CI = 0.96–1.10, p = 0.47), length of hospitalization (MD = 0.35, 95% CI = –2.23 to 1.67, p = 0.83), and infection rates (RR = 0.99, 95% CI = 0.64–1.53, p = 0.95). Adjuvant corticosteroids with surgery reduce the risk of recurrence of CDSH, but do not improve the all-cause mortality or functional outcome, as compared to surgery alone. These findings support the use of adjuvant corticosteroids with surgery for CSDH patients. Further high-quality RCTs are required to confirm the efficacy and safety of adjuvant corticosteroids in the treatment of CSDH patients.
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Affiliation(s)
- Min Shi
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ling-Fei Xiao
- Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ting-Bao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qing-Wen Tang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen-Yuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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98
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Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2021; 163:3229-3241. [PMID: 34647183 DOI: 10.1007/s00701-021-05019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is a clinical equipoise between burr hole drainage (BHD) or twist drill craniotomy (TDC) as initial surgical intervention in patients with chronic subdural hematoma (cSDH). Moreover, the impact of type of postoperative drainage is not well elucidated. We performed a systematic review and meta-analysis comparing outcomes following BHD and TDC for initial surgical management in cSDH and to understand the impact of negative suction drainage with TDC. METHODS A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that directly compared TDC and BHD. The following outcomes were compared between TDC and BHD: mortality, recurrence, reoperations, complications, and cure rates. Subgroup analysis was performed to determine impact of negative suction drainage with TDC. RESULTS Sixteen articles (n = 1,235; TDC: 663; BHD: 591) met inclusion criteria. Although complications (OR: 0.68, 95% CI: 0.38-1.23, p = 0.21; I2 = 31%), recurrence (OR: 1.16, 95% CI: 0.84-1.62, p = 0.37; I2 = 28%), cure (OR: 1.11, 95% CI: 0.72-1.72, p = 0.64, I2 = 34%), and mortality rates (OR: 1.20, 95% CI: 0.60-2.41; p = 0.61; I2 = 0%) were not significantly different between the two groups, TDC was associated with a higher reoperations than BHD (OR: 1.48, 95% CI:1.01-2.16, p = 0.04; I2 = 41%). Subgroup analysis demonstrated that TDC with negative suction drainage conferred equivalent reoperation rates as BHD (OR: 0.75, 95% CI: 0.24-2.35; p = 0.62; I2 = 65%); however, TDC without negative suction was associated with higher reoperations (OR: 1.62, 95% CI: 1.08-2.42; p = 0.02; I2 = 40%). CONCLUSION A systematic review and meta-analysis of available literature directly comparing TDC and BHD for primary evacuation of cSDH did not demonstrate clear superiority of either technique, although reoperations may be higher following TDC. Use of negative suction drainage with TDC may lead to similar rates of reoperation as BHD.
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99
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Erdogan B, Is M, Tural Emon S, Ceman D, Orakdogen M, Engin T. Retrospective analysis of 195 surgically treated cases of chronic subdural hematoma. Int J Clin Pract 2021; 75:e15014. [PMID: 34808025 DOI: 10.1111/ijcp.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/17/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The incidence of chronic subdural hematoma (CSDH) is increasing. This study evaluates the etiologic causes and findings of CSDH and compared unilateral CSDH with bilateral CSDH. This study aims to draw attention to this increasingly prevalent condition. METHODS We retrospectively analysed 195 surgically treated cases of CSDH in our clinic between 2008 and 2018. RESULTS The average age of the patients was 65.7 ± 19.6 years. The most common symptom was headache (53.3%). The case background was the use of anticoagulant (37.9%), head trauma (34.3%). The hematomas were 28.7% right side, 44.6% left side, and 26.7% bilateral. The mean Glasgow Coma Score (GCS) was 13.4 ± 2.9, early postop 13.8 ± 2.5, and late postop was 14.6 ± 1.1. Postoperative complications included acute subdural hematoma (5.1%), cerebral infarction (1.5%), wound infection (0.5%) and others (13.3%). Re-expansion of the brain were statistically significantly less frequent and impaired consciousness, anticoagulant use, early and late postop thickness were statistically significantly more frequent in patients with bilateral CSDH. CONCLUSIONS CSDH is seen more patients of advanced age, those who use anticoagulants, patients with hypertension and diabetes and in patients with a history of head trauma. Prognosis is worse in bilateral CSDH. We estimate that the incidence of CSDH will go up in the future.
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Affiliation(s)
- Baris Erdogan
- Department of Neurosurgery, Sanliurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Merih Is
- Department of Neurosurgery, University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Selin Tural Emon
- Department of Neurosurgery, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Duygu Ceman
- Department of Neurosurgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Metin Orakdogen
- Department of Neurosurgery, University of Trakya, Edirne, Turkey
| | - Taner Engin
- Department of Neurosurgery, University of Health Sciences Mehmet Akif İnan Training and Research Hospital, Istanbul, Turkey
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100
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Zhang J. Expert consensus on drug treatment of chronic subdural hematoma. Chin Neurosurg J 2021; 7:47. [PMID: 34809712 PMCID: PMC8607705 DOI: 10.1186/s41016-021-00263-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between arachnoid and dura mater, which is usually formed in the third week after traumatic brain injury. Surgical treatment is usually the first choice for patients with CSDH having a significant space-occupying effect. Most of the patients showed good results of surgical treatment, but still some patients had a postoperative recurrence (the recurrence rate was up to 33%). Because CSDH is often seen in the elderly, patients are weak and have many basic diseases. The risk of surgical treatment is high; serious complications and even death (the death rate is up to 32%) can often occur. The overall good prognosis rate of patients aged more than 90 years is 24%. The drug treatment can provide a safe and effective treatment for elderly patients who are weak, intolerable to surgery, or failed in surgery. Low-dose and long-term use of atorvastatin (20mg/d) is suggested for continuous treatment for at least 8 weeks, while low-dose and short-term use of dexamethasone can improve the therapeutic effect of atorvastatin on CSDH. Patients should undergo CT or MRI scanning at least one time within 2 weeks after the start of drug treatment.
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Affiliation(s)
- Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China. .,Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, China. .,Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, 300052, China. .,Tianjin Neurological Institute, Tianjin, 300052, China.
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