151
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Sarica C, Ozgunduz A, Ucler N, Dolas I, Kilinc S. Surgical Drains in Chronic Subdural Hematoma Surgery: From the Cheapest to the Most Expensive Drains. World Neurosurg 2018; 112:284-286. [PMID: 29374545 DOI: 10.1016/j.wneu.2018.01.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Among the various neurosurgical techniques currently being used in chronic subdural hematoma (CSDH) surgery, bur hole craniostomy is the most popular worldwide. Recent studies have strongly recommended that a drain be placed after surgical evacuation of a hematoma, and a broad spectrum of preformed surgical drains is widely available for this purpose. If preformed drains are unavailable, a surgeon-made drain can be used and various methods are available to develop a drain in the operating room. METHODS Using a case report, we demonstrate how to develop a surgeon-made drain. Next, we retrospectively screened for subdural drain usage in consecutive patients undergoing bur hole drainage for CSDH at Adiyaman University Hospital between January 2017 and April 2017, and data from only those patients in whom a surgeon-made drain was used were included for analyses. RESULTS A 74-year-old male was operated with the diagnosis of CSDH. Assembly of a surgeon-made drain was explained step by step. Our review identified 6 unilateral and 2 bilateral cases in which 10 surgeon-made drains were used. Mean age of the patients was 72, and mean follow-up period was 7 months, 23 days. No instances of infection or drain-related complications had been recorded. The recurrence rate was 0%, and the average drainage period was 3.4 days. CONCLUSIONS In case of unavailability of a preformed drain, a surgeon-made drain can be used during CSDH surgery. Different methods are available and can be further diversified using various combinations of simple medical materials.
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Affiliation(s)
- Can Sarica
- Department of Neurosurgery, Adiyaman University Research and Education Hospital, Adiyaman, Turkey.
| | - Arman Ozgunduz
- Department of Neurosurgery, Adiyaman University Research and Education Hospital, Adiyaman, Turkey
| | - Necati Ucler
- Department of Neurosurgery, Adiyaman University Research and Education Hospital, Adiyaman, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Adiyaman University Research and Education Hospital, Adiyaman, Turkey
| | - Suleyman Kilinc
- Department of Neurosurgery, Adiyaman University Research and Education Hospital, Adiyaman, Turkey
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152
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Heringer LC, Sousa UDO, Oliveira MFD, Nunes AS, Alves KDA, Zancanaro ML, Botelho RV. The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 75:809-812. [PMID: 29236825 DOI: 10.1590/0004-282x20170136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/07/2017] [Indexed: 11/22/2022]
Abstract
Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). OBJECTIVE To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. METHODS A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. RESULTS Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. CONCLUSIONS The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.
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Affiliation(s)
- Lindolfo Carlos Heringer
- Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil
| | - Ulysses de Oliveira Sousa
- Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil
| | | | - Aline Silva Nunes
- Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil
| | - Katiusa de Abreu Alves
- Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil
| | - Maria Luiza Zancanaro
- Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil
| | - Ricardo Vieira Botelho
- Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil
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153
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Altaf I, Shams S, Vohra AH. Radiolological predictors of recurrence of chronic subdural hematoma. Pak J Med Sci 2018; 34:194-197. [PMID: 29643906 PMCID: PMC5857011 DOI: 10.12669/pjms.341.13735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Chronic subdural hematoma is one of the most common clinical entities encountered in daily neurosurgical practice. Considerable recurrence rates have been reported for chronic subdural hematoma following surgical evacuation. Many studies have suggested various radiological factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. This study focuses on determining the radiological factors predictive of chronic subdural hematoma recurrence. Methods: A retrospective analysis of 113 patients diagnosed with chronic subdural hematoma who were surgically treated between August 2013 and December 2014 was performed. The radiological features were analyzed to clarify the correlation between these radiological factors and postoperative recurrence of chronic subdural hematoma. Results: Twenty patients (17.7%) experienced recurrence. Chronic subdural hematoma recurrence was found to be significantly associated (p<0.05) with preoperative hematoma thickness ≥ 20 mm. Midline shift, hematoma density and bilaterality were not significantly associated with recurrence. Post operative drainage also significantly (p<0.05) reduced chronic subdural hematoma recurrence. Conclusion: Preoperative hematoma thickness ≥ 20 mm is an independent predictor of recurrence of chronic subdural hematoma. Postoperative drainage also significantly reduces chronic subdural hematoma recurrence.
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Affiliation(s)
- Imran Altaf
- Dr. Imran Altaf, MS. Department of Neurosurgery, Khawja Muhammad Safdar Medical College, Sialkot, Pakistan
| | - Shahzad Shams
- Dr. Shahzad Shams, FRCS, FCPS. Department of Neurosurgery, Post Graduate Medical Institute, Lahore General Hospital, Lahore, Pakistan
| | - Anjum Habib Vohra
- Dr. Anjum Habib Vohra, FRCS. Department of Neurosurgery, Post Graduate Medical Institute, Lahore General Hospital, Lahore, Pakistan
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154
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Doan NB, Patel M, Nguyen HS, Doan H, Montoure A, Shabani S, Gelsomino M, Janich K. Safe Use of Tissue Plasminogen Activator in Conjunction with the Integra Camino Bolt for the Drainage of Chronic Subdural Hematoma. Asian J Neurosurg 2018; 13:485-486. [PMID: 29682068 PMCID: PMC5898139 DOI: 10.4103/ajns.ajns_230_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a relatively common condition encountered in a neurosurgical practice. There have been increased efforts in creating different treatment regimens for CSDH to improve patients' outcomes, including the addition of tissue plasminogen activator (tPA) in drains to reduce recurrences. Here, we present the first case report of the safe use of tPA in conjunction with an Integra Camino bolt for maximized drainage of CSDH with a successful neurological recovery and the complete resolution of the hematoma.
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Affiliation(s)
- Ninh B Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohit Patel
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hayley Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew Montoure
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Gelsomino
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karl Janich
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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155
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Goyal RK, Nayak B, Maharshi R, Bidhar DD, Panchal S, Pathak HC. Management of Chronic Subdural Hematoma: Burr Hole versus Twist Drill - A Prospective Study. Asian J Neurosurg 2018; 13:319-323. [PMID: 29682028 PMCID: PMC5898099 DOI: 10.4103/ajns.ajns_99_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Incidence of chronic subdural hematoma (CSDH) is about 5/100,000/year in the general population and still rising. Two surgical techniques, namely, burr-hole evacuation (BHE) versus twist-drill evacuation (TDE) are commonly used to manage such patients but the preferred surgical method continues to attract debate, and the time for an evidence-based approach is now overdue. In vogue with recent trends, a minimally invasive surgical approach is considered as best; therefore, we tried to establish the hypothesis that TDE is as safe and as effective as BHE for CSDH treatment. Materials and Methods: A prospective, randomized, controlled study including forty patients was conducted. The primary outcome variable studied was clinically significant recurrence rate. The secondary outcome variables in postoperative period and follow-up assessment of the patients include Glasgow coma scale (GCS), Markwalder grade, postoperative complication, and operative mortality rate. Results: In our study, results of BHE seem to be superior than TDE in terms of recurrence rate (5% vs. 15%), complication rate (15% vs. 20%), and mean Markwalder neurological grading score and mean GCS at time of discharge (0.16 vs. 0.45 and 14.95 vs. 14.65, respectively). TDE seems to be better than BHE in terms of duration of hospital stay (7.4 vs. 8.05). However, these differences were not statistically significant. TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and least invasive. Overall results were comparable across both techniques without any significant difference. Conclusion: Although both techniques appear to be similar in respect of their primary and secondary outcome variables, but TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and small incision.
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Affiliation(s)
- Ram Kumar Goyal
- Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Biswaranjan Nayak
- Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Rajiv Maharshi
- Department of Neurosurgery, Apollo Hospitals, Bhubaneswar, Odisha, India
| | | | - Sunil Panchal
- Department of Neurosurgery, Government T D Medical College, Vandanam, Aleppy, Kerala, India
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156
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Xu L, Lu T, Tao X, Wang D, Liu W, Li J, Liu B. Decompressive craniectomy for malignant middle cerebral artery infarctions: a meta-analysis. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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157
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Pedersen CB, Sundbye F, Poulsen FR. No Value of Routine Brain Computed Tomography 6 Weeks after Evacuation of Chronic Subdural Hematoma. Surg J (N Y) 2017; 3:e174-e176. [PMID: 29184916 PMCID: PMC5703687 DOI: 10.1055/s-0037-1607215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background
The aim of this study was to evaluate the value of planned control postoperative brain computed tomography (CT) scan performed 4 to 6 weeks after the evacuation of chronic subdural hematoma.
Materials and Methods
This retrospective study examined 202 patients who during a 2-year period from 2011 and 2012 underwent surgical treatment for chronic subdural hematoma (CSDH). Information on patient age, sex, alcohol consumption, anticoagulant/antiplatelet treatment, history of head trauma, Glasgow coma scale (GCS), neurological symptoms, laterality of CSDH, and surgical technique was retrieved from patient charts.
Results
Overall, 27 out of 202 patients had a recurrence of CSDH and re-evacuation of the hematoma was performed. In all patients recurrence of neurological symptoms preceded the planned postoperative control brain CT 4 to 6 weeks after primary surgery.
Conclusion
Routinely postoperative control brain CT scan 4 to 6 weeks after the evacuation of a CSDH has no clinical value.
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Affiliation(s)
| | - Filippa Sundbye
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
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158
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Alliez JR. Ematoma subdurale cronico dell’adulto. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)86805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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159
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The Swedish study of Irrigation-fluid temperature in the evacuation of Chronic subdural hematoma (SIC!): study protocol for a multicenter randomized controlled trial. Trials 2017; 18:471. [PMID: 29021000 PMCID: PMC5637093 DOI: 10.1186/s13063-017-2194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/13/2017] [Indexed: 11/16/2022] Open
Abstract
Background Chronic subdural hematoma (cSDH) is one of the most common conditions encountered in neurosurgical practice. Recurrence, observed in 5–30% of patients, is a major clinical problem. The temperature of the irrigation fluid used during evacuation of the hematoma might theoretically influence recurrence rates since irrigation fluid at body temperature (37 oC) may beneficially influence coagulation and cSDH solubility when compared to irrigation fluid at room temperature. Should no difference in recurrence rates be observed when comparing irrigation-fluid temperatures, there is no need for warmed fluids during surgery. Our main aim is to investigate the effect of irrigation-fluid temperature on recurrence rates and clinical outcomes after cSDH evacuation using a multicenter randomized controlled trial design. Methods The study will be conducted in three neurosurgical departments with population-based catchment areas using a similar surgical strategy. In total, 600 patients fulfilling the inclusion criteria will randomly be assigned to either intraoperative irrigation with fluid at body temperature or room temperature. The power calculation is based on a retrospective study performed at our department showing a recurrence rate of 5% versus 12% when comparing irrigation fluid at body temperature versus fluid at room temperature (unpublished data). The primary endpoint is recurrence rate of cSDH analyzed at 6 months post treatment. Secondary endpoints are mortality rate, complications and health-related quality of life. Discussion Irrigation-fluid temperature might influence recurrence rates in the evacuation of chronic subdural hematomas. We present a study protocol for a multicenter randomized controlled trial investigating our hypothesis that irrigation fluid at body temperature is superior to room temperature in reducing recurrence rates following evacuation of cSDH. Trials registration ClinicalTrials.gov, ID: NCT02757235. Registered on 2 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2194-y) contains supplementary material, which is available to authorized users.
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160
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Ban SP, Hwang G, Byoun HS, Kim T, Lee SU, Bang JS, Han JH, Kim CY, Kwon OK, Oh CW. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. Radiology 2017; 286:992-999. [PMID: 29019449 DOI: 10.1148/radiol.2017170053] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the effect of middle meningeal artery (MMA) embolization on chronic subdural hematoma (CSDH) and compare the treatment outcomes of MMA embolization and conventional treatment. Materials and Methods All consecutive patients 20 years or older with CSDH were assessed for eligibility. CSDHs with a focal location, a thickness of 10 mm or less, no mass effect, or underlying conditions were excluded. Seventy-two prospectively enrolled patients with CSDH underwent MMA embolization (embolization group; as the sole treatment in 27 [37.5%] asymptomatic patients and with additional hematoma removal for symptom relief in 45 [62.5%] symptomatic patients). For comparison, 469 patients who underwent conventional treatment were included as a historical control group (conventional treatment group; close, nonsurgical follow-up in 67 [14.3%] and hematoma removal in 402 [85.7%] patients). Primary outcome was treatment failure defined as a composite of incomplete hematoma resolution (remaining or reaccumulated hematoma with thickness > 10 mm) or surgical rescue (hematoma removal for relief of symptoms that developed with continuous growth of initial or reaccumulated hematoma). Secondary outcomes included surgical rescue as a component of the primary outcome and treatment-related complication for safety measure. Six-month outcomes were compared between the study groups with logistic regression analysis. Results Spontaneous hematoma resolution was achieved in all of 27 asymptomatic patients undergoing embolization without direct hematoma removal. Hematoma reaccumulation occurred in one (2.2%) of 45 symptomatic patients receiving embolization with additional hematoma removal. Treatment failure rate in the embolization group was lower than in the conventional treatment group (one of 72 patients [1.4%] vs 129 of 469 patients [27.5%], respectively; adjusted odds ratio [OR], 0.056; 95% confidence interval [CI]: 0.011, 0.286; P = .001). Surgical rescue was less frequent in the embolization group (one of 72 patients [1.4%] vs 88 of 469 patients [18.8%]; adjusted OR, 0.094; 95% CI: 0.018, 0.488; P = .005). Treatment-related complication rate was not different between the two groups (0 of 72 patients vs 20 of 469 patients [4.3%]; adjusted OR, 0.145; 95% CI: 0.009, 2.469; P = .182). Conclusion MMA embolization has a positive therapeutic effect on CSDH and is more effective than conventional treatment. © RSNA, 2017.
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Affiliation(s)
- Seung Pil Ban
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Gyojun Hwang
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Hyoung Soo Byoun
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Tackeun Kim
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Si Un Lee
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Jae Seung Bang
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Jung Ho Han
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Chae-Yong Kim
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - O-Ki Kwon
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
| | - Chang Wan Oh
- From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.)
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161
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Tsutsumi S, Ogino I, Miyajima M, Nonaka S, Ito M, Yasumoto Y, Arai H. Role of cathepsin K in the development of chronic subdural hematoma. J Clin Neurosci 2017; 45:343-347. [PMID: 28887075 DOI: 10.1016/j.jocn.2017.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Abstract
Despite extensive investigations, the process of development of chronic subdural hematoma (CSDH) is not known. The present study aims to investigate CSDH by measuring biomarkers in it, gas analysis, and immunohistochemical examination. A total of 42 patients with symptomatic CSDH who underwent burr-hole drainage were enrolled. Intraoperatively, hematoma fluid and peripheral venous blood (PVCSDH) were simultaneously collected. As controls, peripheral venous blood (PVControl) and intracranial cerebrospinal fluid (CSF) were collected from other subjects during other surgeries. CatK, lipocalin-type prostaglandin D synthase (PGDS), and cystatin C (CysC) present in these specimens were measured using enzyme-linked immunosorbent assay. Data obtained were statistically analyzed after age correction. In 15 patients, gas analysis was performed for CSDH and PVCSDH. Furthermore, immunohistochemical examination for the outer membrane was performed for four patients. CatK, PGDS, and CysC levels were markedly elevated in the CSF and CSDH. CatK levels in PVCSDH were significantly higher than in PVControl (P<0.0001). In contrast, CysC levels in PVCSDH were significantly lower than in PVControl (P=0.004). The gas analysis revealed that the internal environment of CSDH is characterized by marked hypoxia, hypoglycemia, and lactic acidosis. Furthermore, the outer membrane consistently showed a diffuse staining for CatK. Based on these, CatK was thought to play a role in the development of CSDH, with the levels in peripheral venous blood elevated in patients with CSDH.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Japan.
| | - Ikuko Ogino
- Department of Neurological Surgery, Juntendo University School of Medicine, Japan
| | - Masakazu Miyajima
- Department of Neurological Surgery, Juntendo University School of Medicine, Japan
| | - Senshu Nonaka
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Japan
| | - Masanori Ito
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Japan
| | - Hajime Arai
- Department of Neurological Surgery, Juntendo University School of Medicine, Japan
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Hussain R, Afzal M, Joshi S, Dardis R, Siddique S, Beltechi R, Amit A, El-Maghraby H, Saxena A, Shad A. Factors affecting the survival following surgical treatment of chronic subdural haematoma: Single institutional experience. J Clin Neurosci 2017; 44:75-79. [PMID: 28687445 DOI: 10.1016/j.jocn.2017.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is one of the most commonly treated condition in neurosurgery. It affects elderly populations who often have significant medical co-morbidities resulting in poor prognosis. The study aimed at identifying clinical factors influencing the survival following surgical management of CSDH. METHODS Retrospective study included 267 cases that underwent surgery for CSDH and followed over 5-year period (2010-2015); data retrieved with reference to operation details, radiology reports and discharge. Using logistic and Cox regression analysis, the patient survival data was analysed with respect to patient demographics, type of surgery, co-morbidities, anticoagulation treatment, and discharge destination. RESULTS The overall survival in the cohort was 37.0months (IQR: 20.0-60.0). The median age of the patients was 76years (IQR: 66-82) and the median length of hospital stay was 10days (range 1-126days; IQR: 6-17days). The recurrence rate was 6.37% (n=17). Fifty-three (19.85%) patients recorded deceased on the IPM database as of October 2016 and of those 11 died in hospital. Univariate Cox-regression analysis revealed increased age (HR: 1.80; 95%CI: 1.04-3.11), length of hospital stay (HR: 2.50; 95%CI: 1.41-4.41) and number of co-morbidities (HR: 2.19; 95%CI: 1.26-3.79) were associated with poor prognosis. Glasgow coma scale (GCS) at discharge was found to be significantly associated with survival whilst anticoagulation treatment did not. Multivariate analysis confirmed similar findings significant statistically. CONCLUSION Age at admission, median length of hospital stay, number of co-morbidities, GCS at discharge and discharge destination have been found to influence survival significant statistically.
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Affiliation(s)
- Rahim Hussain
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK.
| | - Mohammed Afzal
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Shabin Joshi
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Ronan Dardis
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Shahid Siddique
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Radu Beltechi
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Amit Amit
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Hussein El-Maghraby
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Amar Saxena
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Amjad Shad
- Department of Neurosurgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
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163
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Uno M, Toi H, Hirai S. Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign? Neurol Med Chir (Tokyo) 2017; 57:402-409. [PMID: 28652561 PMCID: PMC5566699 DOI: 10.2176/nmc.ra.2016-0337] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As the world population becomes progressively older, the overall incidence of chronic subdural hematoma (CSDH) is increasing. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. Many patients with CSDH have had prior treatment with anticoagulants and antiplatelet drugs, which have an accompanying risk of CSDH. In elderly patients with CSDH, symptoms of cognitive change (memory disturbance, urinary incontinence, and decreased activity) and disturbance of consciousness at admission were more frequent compared to younger patients with CSDH. The literature actually offers conflicting advice regarding CSDH treatment; however, burr hole surgery with drainage under local anesthesia is the most common surgical procedure, even in elderly patients. The recurrence rate of CSDH has not decreased over recent decades, and it has ranged from 0.36-33.3%. Outcomes in patients over 75 years old was significantly worse than for those younger than 75. Moreover, long-term outcomes for elderly patients with CSDH are poor. CSDH in the elderly is no longer a benign disease. In the future, it will be important for us to understand the mechanisms of onset and recurrence of CSDH and to develop more effective medical treatments and noninvasive surgical techniques for elderly patients.
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Affiliation(s)
- Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School
| | - Hiroyuki Toi
- Department of Neurosurgery, Kawasaki Medical School
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164
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Sjåvik K, Bartek J, Sagberg LM, Henriksen ML, Gulati S, Ståhl FL, Kristiansson H, Solheim O, Förander P, Jakola AS. Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study. J Neurosurg 2017; 133:1113-1119. [PMID: 28644099 DOI: 10.3171/2016.12.jns161713] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery for chronic subdural hematoma (CSDH) is one of the most common neurosurgical procedures. The benefit of postoperative passive subdural drainage compared with no drains has been established, but other drainage techniques are common, and their effectiveness compared with passive subdural drains remains unknown. METHODS In Scandinavian population-based cohorts the authors conducted a consecutive, parallel cohort study to compare different drainage techniques. The techniques used were continuous irrigation and drainage (CID cohort, n = 166), passive subdural drainage (PD cohort, n = 330), and active subgaleal drainage (AD cohort, n = 764). The primary end point was recurrence in need of reoperation within 6 months of index surgery. Secondary end points were complications, perioperative mortality, and overall survival. The analyses were based on direct regional comparison (i.e., surgical strategy). RESULTS Recurrence in need of surgery was observed in 18 patients (10.8%) in the CID cohort, in 66 patients (20.0%) in the PD cohort, and in 85 patients (11.1%) in the AD cohort (p < 0.001). Complications were more common in the CID cohort (14.5%) compared with the PD (7.3%) and AD (8.1%) cohorts (p = 0.019). Perioperative mortality rates were similar between cohorts (p = 0.621). There were some differences in baseline and treatment characteristics possibly interfering with the above-mentioned results. However, after adjusting for differences in baseline and treatment characteristics in a regression model, the drainage techniques were still significantly associated with clinical outcome (p < 0.001 for recurrence, p = 0.017 for complications). CONCLUSIONS Compared with the AD cohort, more recurrences were observed in the PD cohort and more complications in the CID cohort, also after adjustment for differences at baseline. Although the authors cannot exclude unmeasured confounding factors when comparing centers, AD appears superior to the more common PD.Clinical trial registration no.: NCT01930617 (clinicaltrials.gov).
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Affiliation(s)
- Kristin Sjåvik
- 2Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway
| | - Jiri Bartek
- 1Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- 7Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lisa Millgård Sagberg
- 3Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- 4Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
| | | | - Sasha Gulati
- 3Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- 4Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
| | - Fredrik L Ståhl
- 1Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kristiansson
- 1Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ole Solheim
- 3Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- 4Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
| | - Petter Förander
- 1Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Asgeir Store Jakola
- 4Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- 6Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; and
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165
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Zhang Y, Chen S, Xiao Y, Tang W. Effects of Dexamethasone in the Treatment of Recurrent Chronic Subdural Hematoma. World Neurosurg 2017; 105:115-121. [PMID: 28578110 DOI: 10.1016/j.wneu.2017.05.135] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Recurrent chronic subdural hematoma (CSDH) is not rare. Some studies have demonstrated the role of dexamethasone in the medical management of chronic subdural hematoma. However, no systematic study in the treatment of recurrent CSDH has been published. The aim of our study is to evaluate the efficacy and safety of dexamethasone in patients with recurrent CSDH. METHODS We retrospectively reviewed medical records of consecutive patients from July 2010 to September 2014. A total of 27 patients with symptomatic recurrent CSDH were included in the analysis. Follow-up for each patient consisted of computed tomography or magnetic resonance imaging every 28 days from admission to the resolution of hematoma. Data were collected on hematoma volume, complications, and outcome. RESULTS Among the 27 patients, 3 patients with recurrent CSDH were only treated by burr hole surgery. Of the other 24 patients who primarily underwent dexamethasone treatment, 17 (70.8%) patients were treated successfully with medical treatment, whereas 7 patients required reoperation. Complications were noted in 3 (12.5%) patients (1 hyperglycemia, 1 urinary tract infection, and 1 pneumonia). There was 1 mortality (4.2%) for massive brain infarction. Twenty-one of the 24 patients (87.5%) recovered to their previous functional levels. There was no statistical significance in Fisher text between surgery and dexamethasone regarding success, complication, and functional recovery rate. CONCLUSIONS Patients with recurrent CSDH can be treated successfully and safely with the nonsurgical medical treatment of dexamethasone. By use of this method, reoperation may be avoided.
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Affiliation(s)
- Yu Zhang
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Shiping Chen
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Wenhua Tang
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
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166
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Matsumoto H, Hanayama H, Okada T, Sakurai Y, Minami H, Masuda A, Tominaga S, Miyaji K, Yamaura I, Yoshida Y. Clinical investigation of chronic subdural hematoma with impending brain herniation on arrival. Neurosurg Rev 2017; 41:447-455. [DOI: 10.1007/s10143-017-0861-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 12/14/2022]
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167
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Postoperative Thromboembolic Prophylaxis with Low-Molecular-Weight Heparin and Risk of Rebleeding in Patients with Chronic Subdural Hematomas: A Comparative Retrospective Cohort Study. World Neurosurg 2017; 104:284-290. [PMID: 28478248 DOI: 10.1016/j.wneu.2017.04.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Early postoperative administration of low-molecular-weight heparin (LMWH) to prevent thromboembolic events in patients with chronic subdural hematoma (CSDH) is controversial. Our goal was to investigate impact of early postoperative LMWH administration on recurrence rate of CSDHs. METHODS Retrospective review was performed of 136 patients with CSDHs who were operated on during an 18-month period. Early postoperative administration of LMWH was at the discretion of the treating surgeon. This resulted in patients treated (heparin [H] group) or not treated with LMWH (no heparin [NH] group). All patients underwent imaging 4 weeks after surgery or earlier in cases of deterioration. The primary outcome variable was reoperation. Secondary outcomes were reoperation, important residual hematoma (defined as hematoma depth of more than one third of original size), and incidence of thromboembolic complications. Relative risk and absolute risk reduction were calculated. RESULTS We included 105 patients, 50 (47.6%) in the NH group and 55 (52.4%) in the H group. Nine patients (18%) in the NH group and 6 patients (10.9%) in the H group required secondary surgery (relative risk 0.61, 95% confidence interval 0.23-1.58, P = 0.404, absolute risk reduction 0.07). Eleven patients (22%) in the NH group and 15 patients (27.3%) in the H group presented with important residual hematoma or underwent surgery for hematoma recurrence (relative risk 1.24, 95% confidence interval 0.63-2.44, P = 0.532, absolute risk reduction -0.05). CONCLUSIONS Our data provide preliminary evidence that early postoperative administration of LWMH does not increase risk of clinically relevant recurrence of CSDHs.
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168
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Guilfoyle MR, Hutchinson PJA, Santarius T. Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma. Acta Neurochir (Wien) 2017; 159:903-905. [PMID: 28349381 PMCID: PMC5385189 DOI: 10.1007/s00701-017-3095-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
Abstract
Background Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial. Methods In the original trial patients at a single neurosurgical centre from 2004–2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016—a minimum of 8 years following enrollment—via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex. Results At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006). Conclusion Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated.
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Affiliation(s)
- Mathew R Guilfoyle
- Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Peter J A Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Thomas Santarius
- Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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169
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Tailor J, Fernando D, Sidhu Z, Foley R, Abeysinghe KD, Walsh DC. Clinical audit effectively bridges the evidence-practice gap in chronic subdural haematoma management. Acta Neurochir (Wien) 2017; 159:627-631. [PMID: 28078474 PMCID: PMC5350212 DOI: 10.1007/s00701-016-3063-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/21/2016] [Indexed: 10/29/2022]
Abstract
BACKGROUND Placement of a subdural drain after drainage of chronic subdural haematoma (CSDH) has been shown to reduce the rate of recurrence in several randomised controlled trials (RCT). The most recently published RCT was from Cambridge, UK, in 2009. Despite class I evidence for the use of subdural drains, it is unclear whether these results have been translated into clinical practice. In this clinical audit we review the use of subdural drains in our institution before and after the publication of the 2009 RCT results. METHODS A longitudinal retrospective study was performed on all adults having burr holes for CSDH between January 2009 and January 2014. Case notes were analysed to determine subdural drain use, re-operation for CSDH recurrence and post-operative complications. The audit loop was closed with data collected from August 2015 to January 2016. RESULTS Thirty-one per cent of patients had subdural drains placed at operation. Drain placement was associated with lower reoperation rates (8% vs. 17%, p = 0.021) without increasing complication rates. Drain usage doubled after publication of the Santarius et al. (2009) trial but we observed persisting and significant variability in drain utilisation by supervising consultants. The use of drains in the department increased from 35% to 75% of all cases after presentation of these results. CONCLUSIONS The use of subdural drains in our unit reduced recurrence rates following drainage of CSDH and reproduced the results of a 2009 clinical trial. Although the use of subdural drains doubled in the post-trial epoch, significant variability remains in practice. Clinical audit provided an effective tool necessary to drive the implementation of subdural drain placement in our unit.
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170
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171
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Kale A, Öz İİ, Gün EG, Kalaycı M, Gül Ş. Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage? Neurol Res 2017; 39:399-402. [DOI: 10.1080/01616412.2017.1296655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aydemir Kale
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
| | - İbrahim İlker Öz
- Faculty of Medicine, Department of Radiology, Bülent Ecevit University, Zonguldak, Turkey
| | - Eren Görkem Gün
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
| | - Murat Kalaycı
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
| | - Şanser Gül
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
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172
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Sivaraju L, Moorthy RK, Jeyaseelan V, Rajshekhar V. Routine placement of subdural drain after burr hole evacuation of chronic and subacute subdural hematoma: a contrarian evidence based approach. Neurosurg Rev 2017; 41:165-171. [DOI: 10.1007/s10143-017-0831-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
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173
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Chan DYC, Woo PYM, Mak CHK, Chu ACH, Li CCH, Ko NMW, Ng SCP, Sun TFD, Poon WS. Use of subdural drain for chronic subdural haematoma? A 4-year multi-centre observational study of 302 cases. J Clin Neurosci 2017; 36:27-30. [DOI: 10.1016/j.jocn.2016.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/17/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022]
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174
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Abstract
Chronic subdural hematoma (cSDH) is a common condition, the frequency of which further increases due to an aging population and more frequent use of antithrombotic drugs. It leads to unspecific symptoms and neurological deficits and is usually treated surgically. Burr hole trepanation and twist drill craniostomy have become the therapeutic standards with craniotomy being rarely used for recurrent cases. Although recurrences are relatively common, in most cases a good outcome can be achieved even in the elderly; however, as cSDH is associated with other comorbidities, it is indicative of an increased morbidity and mortality. Controlled trials need to be carried out to determine whether pharmacological therapies can also be beneficial in addition to surgical treatment.
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MESH Headings
- Aged, 80 and over
- Anticoagulants/adverse effects
- Anticoagulants/therapeutic use
- Craniotomy
- Female
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
- Hematoma, Subdural, Chronic/mortality
- Hematoma, Subdural, Chronic/surgery
- Humans
- Male
- Neurologic Examination/methods
- Platelet Aggregation Inhibitors/adverse effects
- Platelet Aggregation Inhibitors/therapeutic use
- Population Dynamics
- Prognosis
- Recurrence
- Risk Factors
- Tomography, X-Ray Computed/methods
- Trephining/methods
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Affiliation(s)
- T A Juratli
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - J Klein
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - G Schackert
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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175
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Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma. Acta Neurochir (Wien) 2017. [PMID: 28349381 PMCID: PMC5385189 DOI: 10.1007/s00701-017-3095-2;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial. METHODS In the original trial patients at a single neurosurgical centre from 2004-2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016-a minimum of 8 years following enrollment-via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex. RESULTS At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006). CONCLUSION Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated.
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176
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Stavrinou P, Katsigiannis S, Lee JH, Hamisch C, Krischek B, Mpotsaris A, Timmer M, Goldbrunner R. Risk Factors for Chronic Subdural Hematoma Recurrence Identified Using Quantitative Computed Tomography Analysis of Hematoma Volume and Density. World Neurosurg 2016; 99:465-470. [PMID: 28017760 DOI: 10.1016/j.wneu.2016.12.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH), a common condition in elderly patients, presents a therapeutic challenge with recurrence rates of 33%. We aimed to identify specific prognostic factors for recurrence using quantitative analysis of hematoma volume and density. METHODS We retrospectively reviewed radiographic and clinical data of 227 CSDHs in 195 consecutive patients who underwent evacuation of the hematoma through a single burr hole, 2 burr holes, or a mini-craniotomy. To examine the relationship between hematoma recurrence and various clinical, radiologic, and surgical factors, we used quantitative image-based analysis to measure the hematoma and trapped air volumes and the hematoma densities. RESULTS Recurrence of CSDH occurred in 35 patients (17.9%). Multivariate logistic regression analysis revealed that the percentage of hematoma drained and postoperative CSDH density were independent risk factors for recurrence. All 3 evacuation methods were equally effective in draining the hematoma (71.7% vs. 73.7% vs. 71.9%) without observable differences in postoperative air volume captured in the subdural space. CONCLUSIONS Quantitative image analysis provided evidence that percentage of hematoma drained and postoperative CSDH density are independent prognostic factors for subdural hematoma recurrence.
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Affiliation(s)
- Pantelis Stavrinou
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
| | | | - Jong Hun Lee
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Christina Hamisch
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Boris Krischek
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | | | - Marco Timmer
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
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177
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The efficacy and safety of burr-hole craniotomy without continuous drainage for chronic subdural hematoma and subdural hygroma in children under 2 years of age. Childs Nerv Syst 2016; 32:2369-2375. [PMID: 27613632 DOI: 10.1007/s00381-016-3233-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2 years old. We also aimed to determine the predictors of CSDH/SDHy recurrence. METHODS We conducted a retrospective chart review of 25 children under 2 years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period. We analyzed the relationship between CSDH/SDHy recurrence and factors such as abusive head trauma, laterality of CSDH/SDHy, and subdural fluid collection type (hematoma or hygroma). RESULTS CSDH/SDHy recurred in 5 of the 25 patients (20 %), requiring a second operation at an average of 0.92 ± 1.12 months after the initial procedure. The mean follow-up period was 25.1 ± 28.6 months. There were no complications related to either operation. None of the assessed factors were statistically associated with recurrence. CONCLUSIONS Burr-hole craniotomy without continuous drainage for CSDH/SDHy appears safe in children aged under 2 years and results in a relatively low recurrence rate. No predictors of CSDH/SDHy recurrence were identified. Advantages of this method include avoiding external subdural drainage-related complications. However, burr-hole drainage may be more effective for CSDH, which our data suggests is more likely to recur than SDHy, providing the procedure is performed with specific efforts to reduce complications.
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178
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Watanabe S, Amagasaki K, Shono N, Nakaguchi H. Fibrin glue injection into the hematoma cavity for refractory chronic subdural hematoma: A case report. Surg Neurol Int 2016; 7:S876-S879. [PMID: 27999712 PMCID: PMC5154205 DOI: 10.4103/2152-7806.194498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background: Repeat burr hole irrigation and drainage has been effective in most cases of recurrent chronic subdural hematoma (CSDH), however, refractory cases require further procedures or other interventions. Case Description: An 85-year-old male presented with left CSDH, which recurred five times. The hematoma was irrigated and drained through a left frontal burr hole during the first to third surgery and through a left parietal burr hole during the fourth and fifth surgery. The hematoma had no septation and was well-evacuated during each surgery. Antiplatelet therapy for preventing ischemic heart disease was stopped after the second surgery, the hematoma cavity was irrigated with artificial cerebrospinal fluid at the third surgery, and the direction of the drainage tube was changed to reduce the postoperative subdural air collection at the fourth surgery. However, none of these interventions was effective. He was successfully treated by fibrin glue injection into the hematoma cavity after the fifth surgery. Conclusion: This procedure may be effective for refractory CSDH in elderly patients.
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Affiliation(s)
- Saiko Watanabe
- Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Naoyuki Shono
- Department of Neurosurgery, Tokyo University, Tokyo, Japan
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179
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Lee SJ, Hwang SC, Im SB. Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage. Korean J Neurotrauma 2016; 12:107-111. [PMID: 27857917 PMCID: PMC5110898 DOI: 10.13004/kjnt.2016.12.2.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/07/2016] [Accepted: 08/23/2016] [Indexed: 11/29/2022] Open
Abstract
Objective Although twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option. Methods CSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed. Results Of the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC. Conclusion When the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.
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Affiliation(s)
- Seong-Jong Lee
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soo Bin Im
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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180
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Kim DH, Park ES, Kim MS, Park SH, Park JB, Kwon SC, Lyo IU, Sim HB. Correlation between Head Trauma and Outcome of Chronic Subdural Hematoma. Korean J Neurotrauma 2016; 12:94-100. [PMID: 27857915 PMCID: PMC5110926 DOI: 10.13004/kjnt.2016.12.2.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/08/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022] Open
Abstract
Objective Our study examined the prognostic factors involved in the outcome of patients with chronic subdural hematoma (CSDH) who had undergone burr hole drainage procedures, and investigated the association between outcome and traumatic head injury. In addition, we explored factors related to recurrence. Methods This study enrolled 238 patients with CSDH who had undergone burr hole drainage. Patients with history of head injury were categorized into the head trauma group and were compared with the no head trauma group. Outcome was considered good when modified Rankin Scale scores improved from admission to discharge and the final follow-up. Results Among 238 patients, 127 (53.4%) were included in the head trauma group. One hundred thirty-three (55.9%) patients demonstrated good outcome at discharge, and 171 (71.8%) patients demonstrated good outcome at the final follow-up. None of the factors examined was significantly correlated with good outcome at discharge. However, only history of head injury (p=0.033, odds ratio 0.511, 95% confidence interval 0.277-0.946) was significantly correlated with poor outcome at long-term follow-up. Recurrence occurred in 20 (8.4%) cases in the total cohort and 11 (55%) patients in the head trauma group. Conclusion History of head trauma is correlated with poor outcome at long-term follow-up in CSDH patients having undergone burr hole drainage. Therefore, CSDH patients with history of head injury are susceptible to poor outcome, warranting more careful evaluation and treatment after burr hole drainage.
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Affiliation(s)
- Dong Han Kim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Soo Kim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Ho Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Uk Lyo
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hong Bo Sim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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181
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Seizeur R, Abed-Rabbo F, Obaid S, Saliou P, Simon A, Dam Hieu P, Magro E. Chronic subdural haematomas in elderly population. Neurosurgical aspects and focus on the single-burr hole technique performed under assisted local anaesthesia. Br J Neurosurg 2016; 31:258-261. [DOI: 10.1080/02688697.2016.1220503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Romuald Seizeur
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France
- Université de Brest, France
| | - Francis Abed-Rabbo
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France
- Université de Brest, France
| | - Sami Obaid
- Department of Surgery, Division of Neurosurgery, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal (Qc), Canada
| | - Philippe Saliou
- Service de Santé Publique, Hôpital Morvan, CHRU Brest, France
| | - Alexandre Simon
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France
| | - Phong Dam Hieu
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France
- Université de Brest, France
| | - Elsa Magro
- Service de Neurochirurgie, Hôpital Cavale Blanche, CHRU Brest, France
- Université de Brest, France
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182
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Peng D, Zhu Y. External drains versus no drains after burr-hole evacuation for the treatment of chronic subdural haematoma in adults. Cochrane Database Syst Rev 2016; 2016:CD011402. [PMID: 27578263 PMCID: PMC7083261 DOI: 10.1002/14651858.cd011402.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is one of the most common types of intracranial haematoma, and often occurs in older people. Burr-hole craniostomy, which is an evacuation through one or two burr holes drilled over the site of the haematoma, has been widely accepted as the most effective way to manage CSDH. Recurrences are a major problem and need reoperation, sometimes repeatedly. OBJECTIVES To assess the effects and safety of the use of external drains versus no drains after burr-hole evacuation for the treatment of CSDH in adults. SEARCH METHODS We ran our first search on 27 November 2014. We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE (OvidSP), Embase Classic+Embase (OvidSP), PubMed, ISI WOS (SCI-EXPANDED, SSCI, CPCI-S and CPSI-SSH), Chinese databases, and clinical trials registers, and screened reference lists. In compliance with the MECIR conduct standard 37, the Cochrane Injuries Group Information Specialist ran an update search within 12 months of publication (25 April 2016). We have screened these results but not incorporated the findings into the current review; as a result of the update search, one trial is awaiting classification. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared external subdural drains with no drains after burr-hole evacuation for the treatment of CSDH in adults. DATA COLLECTION AND ANALYSIS Two review authors identified potential articles from the literature search, extracted data independently using a data extraction form and assessed risk of bias using the Cochrane 'Risk of bias' tool. For dichotomous data, where statistical heterogeneity was low, we calculated summary risk ratios with 95% confidence intervals using a fixed-effect model. MAIN RESULTS Nine RCTs, including a total of 968 participants, reported outcomes specified by this review. Only one RCT reported the use of an adequate method of allocation concealment; this trial was a large, single-centre, high quality study and was adequately reported. All included trials reported a reduced recurrence of CSDH with external subdural drains. We found a significant reduction in the risk of recurrence with subdural drains (RR 0.45, 95% CI 0.32 to 0.61, I(2) = 38%; 9 studies, 968 participants; moderate-quality evidence). There was no strong evidence of any increase in complications (RR 1.15; 95% CI 0.77 to 1.72, I(2) = 0%; 7 studies, 710 participants; low-quality evidence), mortality (RR 0.78, 95% CI 0.45 to 1.33, I(2) = 22%; 5 studies, 539 participants; low-quality evidence), or poor functional outcome (which included deaths) (RR 0.68, 95% CI 0.44 to 1.05, I(2) = 31%; 5 studies, 490 participants; low-quality evidence). AUTHORS' CONCLUSIONS There is some evidence that postoperative drainage is effective in reducing the symptomatic recurrence of CSDH. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Due to the low quality of the evidence for the secondary outcomes, the effect of drainage on the occurrence of surgical complications, mortality and poor functional outcome is uncertain. This uncertainty can be clarified with data from high-quality studies which may be conducted in the future. There is no strong evidence of any increase in complications when drains are used.
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Affiliation(s)
- Deqing Peng
- The Second Affiliated Hospital of Zhejiang University School of MedicineDepartment of NeurosurgeryHangzhou CityZhejiang ProvinceChina31000
- Zhejiang Provincial People's HospitalDepartment of NeurosurgeryHangzhou CityZhejiang ProvinceChina
| | - Yongjian Zhu
- The Second Affiliated Hospital of Zhejiang University School of MedicineDepartment of NeurosurgeryHangzhou CityZhejiang ProvinceChina31000
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Shapey J, Glancz LJ, Brennan PM. Chronic Subdural Haematoma in the Elderly: Is It Time for a New Paradigm in Management? CURRENT GERIATRICS REPORTS 2016; 5:71-77. [PMID: 27213133 PMCID: PMC4851686 DOI: 10.1007/s13670-016-0166-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic subdural haematoma (CSDH) is a common neurological condition that usually affects the elderly. The optimal treatment strategy remains uncertain, principally because there is a lack of a good evidence base. In this paper, we review the literature concerning the peri-operative and operative care of patients. In particular, we highlight the non-surgical aspects of care that might impact on patient outcomes and CSDH recurrence. We propose that an integrated approach to care in patients with CSDH, similar to care of fragility fractures in the elderly, may be an important strategy to improve patient care and outcomes.
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Affiliation(s)
- J. Shapey
- />National Hospital for Neurology and Neurosurgeon, Queen Square, London, UK
| | - L. J. Glancz
- />Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - P. M. Brennan
- />Department of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, UK
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184
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Wang QF, Cheng C, You C. A New Modified Twist Drill Craniostomy Using a Novel Device to Evacuate Chronic Subdural Hematoma. Medicine (Baltimore) 2016; 95:e3036. [PMID: 26962823 PMCID: PMC4998904 DOI: 10.1097/md.0000000000003036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Compared with burr hole craniostomy (BHC), twist drill craniostomy (TDC) is increasingly popular because of its minimal invasiveness in evacuating chronic subdural hematoma (CSDH). However, the TDC technique varies and is continually developing; moreover, no consensus yet exists regarding the optimal protocol, and the efficacy and safety of TDC is still controversial, especially with respect to a specific method. This article introduces a new modified TDC technique using a novel device, the YL-1 puncture needle, and evaluates its efficacy and advantages compared with BHC.A retrospective study involving 121 patients with CSDH who underwent surgery at a single center was conducted, involving 68 patients undergoing modified TDC (TDC group) and 53 patients treated by BHC (BHC group). The neurological outcome was studied to evaluate the surgery efficacy, and the radiological outcome was assessed as a supplement to the surgery efficacy. In addition, complications, recurrence, and reoperation, as well as pneumocrania, operation duration, and length of stay, were studied to evaluate the advantages of the modified TDC compared with BHC. Independent sample t tests or rank-sum tests were used to compare the outcomes between the 2 groups.The neurological and radiological outcomes did not differ significantly between the TDC and BHC groups (P = 0.852 and P = 0.232, respectively), while the rates of complication and pneumocrania in patients who underwent the modified TDC were significantly lower than that in those who underwent BHC (P = 0.021 and P < 0.001, respectively). The recurrence and reoperation rates in patients from the 2 groups were similar (P = 0.566 and P = 0.715, respectively). The operation duration and length of hospital stay of the patients who underwent the modified TDC were significantly shorter than those of the patients who underwent BHC (both P < 0.001).Modified TDC with a YL-1 puncture needle is a minimally invasive surgical technique to treat CSDH; this procedure is as effective as BHC, but safer and simpler than BHC, and should be considered for patients with CSDH, especially the elderly.
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Affiliation(s)
- Qing-Feng Wang
- From the Department of Neurosurgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu (Q-FW); Department of Neurosurgery, The Second Clinical School, Yangzhou University, Yangzhou (CC); and Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu (CY), China
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185
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Agawa Y, Mineharu Y, Tani S, Adachi H, Imamura H, Sakai N. Bilateral Chronic Subdural Hematoma is Associated with Rapid Progression and Poor Clinical Outcome. Neurol Med Chir (Tokyo) 2016; 56:198-203. [PMID: 26923835 PMCID: PMC4831946 DOI: 10.2176/nmc.oa.2015-0256] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Chronic subdural hematoma (CSDH) has been recognized as a benign disease, but its clinical outcome is not well documented. This study aims to expand the knowledge base regarding the outcome of CSDH. We retrospectively reviewed clinical characteristics of CSDH operated in the Kobe City Medical Center General Hospital between June 2005 and June 2012. Variants included age at onset, sex, laterality, presence of headache, consciousness level, and risk factors for hemorrhage such as malignancy or intake of anticoagulants. A total of 368 cases were analyzed. Six patients (1.4%) had a poor outcome, defined as any morbidity or mortality at 7 days postoperatively. Bilateral hematoma was significantly associated with a poor outcome (p = 0.041). Warfarin use and malignancy, albeit statistically not significant, were more frequently observed in patients with a poor outcome. Bilateral CSDH was observed in 53 patients (14.4%). Age at onset, sex, history of malignancy, anticoagulant use, and antiplatelet use did not differ between bilateral and unilateral CSDH. Recurrence rate was not different between bilateral and unilateral CSDH (14.2% vs. 11.3%), but poor outcome as a result of brain herniation was significantly higher in bilateral than in unilateral hematomas (5.7% vs. 0.3%, p = 0.01). Bilateral CSDH was associated with rapid progression and showed worse outcome as a result of brain herniation in comparison with unilateral CSDH. Urgent trephination surgery for decompression of hematoma pressure may be recommended for bilateral CSDH.
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Affiliation(s)
- Yuji Agawa
- Department of Neurosurgery, Kobe City Medical Center General Hospital
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186
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Phang I, Sivakumaran R, Papadopoulos MC. No association between seniority of surgeon and postoperative recurrence of chronic subdural haematoma. Ann R Coll Surg Engl 2016; 97:584-8. [PMID: 26492904 DOI: 10.1308/rcsann.2015.0042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Neurosurgical trainees should achieve competency in chronic subdural haematoma (CSDH) drainage at an early stage in training. The effect of surgeon seniority on recurrence following surgical drainage of CSDH was examined. METHODS All CSDH cases performed at St George's Hospital in London between March 2009 and March 2012 were analysed. Recurrence was defined as clinical deterioration with computed tomography evidence of CSDH requiring reoperation within six months. The following risk factors were considered: seniority of primary and supervising surgeons, timing of surgery (working hours, outside working hours), patient related factors (age, antiplatelets, warfarin) and operative factors (general vs local anaesthesia, burr holes vs craniotomy, drain use). For recurrent cases, we examined the distance of the cranial opening from the thickest part of the CSDH. RESULTS A total of 239 patients (median age: 79 years, range: 33-98 years) had 275 CSDH drainage operations. The overall recurrence rate was 13.1%. The median time between the initial procedure and reoperation was 16 days (range: 1-161 days). The only statistically significant risk factor for recurrence was antiplatelets (odds ratio: 2.62, 95% confidence interval: 1.13-6.10, p<0.05). Warfarin, grade of surgeon, timing of surgery, type of anaesthesia, type of operation and use of drains were not significant risk factors. In 26% of recurrent CSDH cases, the burr holes or craniotomy flaps were placed with borderline accuracy. CONCLUSIONS CSDH drainage is a suitable case for neurosurgical trainees to perform without increasing the chance of recurrence.
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Affiliation(s)
- I Phang
- Academic Neurosurgery Unit, St. George's, University of London , UK
| | - R Sivakumaran
- Academic Neurosurgery Unit, St. George's, University of London , UK
| | - M C Papadopoulos
- Academic Neurosurgery Unit, St. George's, University of London , UK
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187
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What Ingredients Have You Used to Prepare This Delicious Lunch? A Critical Look Behind a Meta-analysis. Ann Surg 2015; 262:e113-4. [DOI: 10.1097/sla.0000000000000754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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188
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Ivamoto HS, Lemos HP, Atallah AN. Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review. World Neurosurg 2015; 86:399-418. [PMID: 26485412 DOI: 10.1016/j.wneu.2015.10.025] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. OBJECTIVE To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. METHODS We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. RESULTS A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burr-hole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34-0.66, P < 0.00001) with no other clear benefits or complications. CONCLUSIONS This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.
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Affiliation(s)
- Henrique Seiji Ivamoto
- Federal University of Sao Paulo Postgraduate Program on Evidence-Based Health Care, Brazilian Cochrane Centre.
| | - Hernani Pinto Lemos
- Federal University of Sao Paulo Postgraduate Program on Evidence-Based Health Care, Brazilian Cochrane Centre
| | - Alvaro Nagib Atallah
- Federal University of Sao Paulo Postgraduate Program on Evidence-Based Health Care, Brazilian Cochrane Centre
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189
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Emich S. A burr hole is not a burr hole--answer to the editor. Acta Neurochir (Wien) 2015; 157:663-4. [PMID: 25697837 DOI: 10.1007/s00701-015-2372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Stephan Emich
- Christian Doppler Klinik, PMU Salzburg, Salzburg, Salzburg, Austria,
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190
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Weigel R, Schlickum L, Weisser G, Krauss JK. Treatment concept of chronic subdural haematoma according to an algorithm using evidence-based medicine-derived key factors: A prospective controlled study. Br J Neurosurg 2015; 29:538-43. [DOI: 10.3109/02688697.2015.1015101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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191
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Gelabert-González M, Rico-Cotelo M, Arán-Echabe E. [Chronic subdural hematoma]. Med Clin (Barc) 2015; 144:514-9. [PMID: 25746613 DOI: 10.1016/j.medcli.2015.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/19/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Miguel Gelabert-González
- Servicio de Neurocirugía, Departamento de Cirugía, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - María Rico-Cotelo
- Servicio de Neurocirugía, Departamento de Cirugía, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Eduardo Arán-Echabe
- Servicio de Neurocirugía, Departamento de Cirugía, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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