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Wu Z, Wang H, Zhao J, Wang C, Liu H, Wang C, Li A, Hu J. Preoperative Fibrinogen Levels and Function as Predictive Factors for Acute Bleeding in the Hematoma Cavity After Burr Hole Drainage in Patients with CSDH. World Neurosurg 2023; 180:e364-e375. [PMID: 37769840 DOI: 10.1016/j.wneu.2023.09.072] [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: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Burr hole drainage (BHD) is the primary surgical intervention for managing chronic subdural hematoma (CSDH). However, it can lead to postoperative complications such as acute bleeding within the hematoma cavity and hematoma recurrence. The objective of this study is to identify the risk factors for these complications and develop a predictive model for acute hematoma cavity bleeding after BHD in patients with CSDH. METHODS This study presents a retrospective cohort investigation conducted at a single center. The clinical dataset of 308 CSDH patients who underwent BHD at a hospital from 2016 to 2022 was analyzed to develop and assess a prognostic model. RESULTS The nonbleeding group exhibited a significant correlation between fibrinogen (FIB) and thrombin time (TT), whereas no correlation was observed in the bleeding group. Notably, both FIB and TT were identified as risk factors for postoperative acute bleeding within the hematoma cavity. We developed a prognostic model to predict the occurrence of postoperative acute bleeding within the hematoma cavity after BHD in patients with CSDH. The model incorporated FIB, TT, coronary artery disease, and Glasgow Coma Scale scores. The model exhibited good discrimination (area under the curve: 0.725) and calibration (Hosmer-Leeshawn goodness of fit test: P > 0.1). Furthermore, decision curve analysis demonstrated the potential clinical benefit of implementing this prediction model. CONCLUSIONS The predictive model developed in this study can forecast the risk of postoperative acute bleeding within the hematoma cavity, thus aiding clinicians in selecting the optimal treatment approach for patients with CSDH.
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Affiliation(s)
- Zejun Wu
- Department of Neurosurgery, Taihe Hospital, Jinzhou Medical University Union Training Base, Shiyan, China; Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hui Wang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Junshuang Zhao
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Chaobin Wang
- Department of Neurosurgery, Taihe Hospital, Jinzhou Medical University Union Training Base, Shiyan, China
| | - Haodong Liu
- The First Clinical College, Hubei University of Medicine, Shiyan, China
| | - Chaojia Wang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Anrong Li
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Juntao Hu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China; Hubei KeyLaboratory of Embryonic Stem Cell Research, Tai-He Hospital, Hubei University of Medicine, Shiyan, China.
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Eun J, Ahn S, Lee MH, Choi JG, Kim YI, Cho CB, Park JS. Potential impact of high-density lipoprotein cholesterol in the postoperative outcomes of chronic subdural hematoma patients: multi-institutional study in Korea. Lipids Health Dis 2023; 22:197. [PMID: 37978499 PMCID: PMC10655259 DOI: 10.1186/s12944-023-01970-5] [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: 08/18/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common clinical situation in neurosurgical practice, but the optimal treatment option is controversial. This study aimed to evaluate the effect of cholesterol-lowering medications on and how they affected the prognoses of CSDH patients. METHODS In this multi-institutional observational study performed in Korea, data from recently treated CSDH patients were gathered from 5 hospitals. A total of 462 patients were collected from March 2010 to June 2021. Patient clinical characteristics, history of underlying diseases and their treatments, radiologic features, and surgical outcomes were analyzed. RESULTS Seventy-five patients experienced recurrences, and 62 had reoperations after the initial burr hole surgery. Among these, 15 patients with recurrences and 12 with reoperations were taking cholesterol-lowering medications. However, the use of medications did not significantly affect recurrence or reoperation rates (P = 0.350, P = 0.336, respectively). When analyzed by type of medication, no clinically relevant differences in total cholesterol (TC), triglyceride (TG), or low-density lipoprotein cholesterol (LDL-C) levels were identified. The combination of a statin drug and ezetimibe significantly elevated high-density lipoprotein cholesterol (HDL-C) levels (P = 0.004). TC, LDL-C, and TG levels did not significantly affect patient prognoses. However, HDL-C levels and recurrence (odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.94-0.99; p = 0.010) were negatively correlated. An HDL-C level of 42.50 mg/dL was identified as the threshold for recurrence and reoperation. CONCLUSIONS In this study, using cholesterol-lowering medications did not significantly impact the prognosis of patients who underwent surgical management for a chronic subdural hematoma. However, the findings showed that the higher the HDL-C level, the lower the probability of recurrence and reoperation.
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Affiliation(s)
- Jin Eun
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Stephen Ahn
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Ho Lee
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Gyu Choi
- Department of Neurosurgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Il Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Bum Cho
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Georgountzos G, Gkalonakis I, Anastasopoulos L, Stranjalis G, Κalamatianos T. Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review. Diagnostics (Basel) 2023; 13:2449. [PMID: 37510193 PMCID: PMC10378324 DOI: 10.3390/diagnostics13142449] [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: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The present systematic scoping review aimed at mapping and analyzing the available literature on biological fluid (biofluid) biomarkers showing promise in the prediction of chronic subdural hematoma (cSDH) recurrence and the prognosis of neurological/functional patient outcome. Twenty-three studies published between 2003 and 2023 investigating a diverse range of biomarkers in hematoma fluid and/or the circulation in 3749 patients were included. Immune cell populations and inflammatory/anti-inflammatory cytokines comprised the most studied category of biomarkers displaying significant findings. A notable time trend in biomarker studies was a recent shift in research focus towards the analysis of circulating biomarkers. Several biomarkers were indicated as independent predictors of cSDH recurrence and/or functional/neurological outcome, including circulating fibrinogen degradation products (FDP), brain natriuretic peptide (BNP-1) and high-density lipoprotein (HDL), as well as blood urea nitrogen (BUN) and the ratios of blood neutrophil to lymphocyte (NLR) or red blood cell distribution width to platelet count (RPR). While studies on cSDH prognostic biomarkers have gained, in recent years, momentum, additional multicenter prospective studies are warranted to confirm and extend their findings. The identification of prognostic biofluid biomarkers in cSDH is an active field of research that may provide future tools, guiding clinical decisions and allowing for the design of treatments based on risk stratification.
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Affiliation(s)
- Georgios Georgountzos
- Department of Neurosurgery, General Hospital of Nikaia-Piraeus “Agios Panteleimon”, 18454 Athens, Greece
- Clinical and Experimental Neuroscience Research Group, Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - Ioannis Gkalonakis
- Department of Neurosurgery, General Hospital of Nikaia-Piraeus “Agios Panteleimon”, 18454 Athens, Greece
| | - Lykourgos Anastasopoulos
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
| | - George Stranjalis
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
- Hellenic Centre for Neurosurgery Research, “Professor Petros S. Kokkalis”, 10675 Athens, Greece
| | - Theodosis Κalamatianos
- Clinical and Experimental Neuroscience Research Group, Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
- Hellenic Centre for Neurosurgery Research, “Professor Petros S. Kokkalis”, 10675 Athens, Greece
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Hashimoto H, Maruo T, Kimoto Y, Nakamura M, Fujinaga T, Ushio Y. Burr hole locations are associated with recurrence in single burr hole drainage surgery for chronic subdural hematoma. World Neurosurg X 2023; 19:100204. [PMID: 37206059 PMCID: PMC10189492 DOI: 10.1016/j.wnsx.2023.100204] [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: 12/08/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023] Open
Abstract
Background Various factors have been reported as risk factors for chronic subdural hematomas (CSDH) recurrence. However, few studies have quantitatively evaluated the impact of CSDH locations and burr hole positions on recurrence. This study aimed to reveal the relation between CSDH recurrence and the locations of CSDH and burr holes. Methods Initial single burr hole surgeries for CSDH with a drainage tube between April 2005 and October 2021 at Otemae Hospital were enrolled. Patients' medical records, CSDH volume, and CSDH computed tomography values (CTV) were evaluated. The locations of CSDH and burr holes were assessed using Montreal Neurological Institute coordinates. Results A total of 223 patients were enrolled, including 34 patients with bilateral CSDH, resulting in 257 surgeries investigated. The rate of CSDH recurrence requiring reoperation (RrR) was 13.5%. The RrR rate was significantly higher in patients aged ≥76 years, those with bilateral CSDH, and those with postoperative hemiplegia. In RrR, the preoperative CSDH volume was significantly larger, and CTV was significantly smaller. The locations of CSDH had no influence on recurrence. However, in RrR, the locations of burr holes were found to be more lateral and more ventral. Multivariate Cox proportional hazards regression analysis showed that bilateral CSDH, more ventral burr hole positions, and postoperative hemiplegia were risk factors for recurrence. Conclusions The locations of burr holes are associated with CSDH recurrence. In RrR, CSDH profiles tend to show a larger volume and reduced CTV. Hemiplegia after burr hole surgery serves as a warning sign for RrR.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540–0008, Japan
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Suita, Osaka, 565–0871, Japan
- Corresponding author. Department of Neurosurgery, Otemae Hospital, Osaka, 540-0008, Japan.
| | - Tomoyuki Maruo
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540–0008, Japan
| | - Yuki Kimoto
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540–0008, Japan
| | - Masami Nakamura
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540–0008, Japan
| | - Takahiro Fujinaga
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540–0008, Japan
| | - Yukitaka Ushio
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540–0008, Japan
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Zhu B, Yu X, Ou Y, Guo X, Liu W, Wu L. Nutritional and inflammatory peripheral blood markers for risk assessment of chronic subdural hematoma: a case-control study. Clin Neurol Neurosurg 2023; 227:107640. [PMID: 36870089 DOI: 10.1016/j.clineuro.2023.107640] [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: 11/24/2022] [Revised: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Some peripheral blood markers have been demonstrated to be correlated with the re-formation of chronic subdural hematoma (CSDH). The aim of this study was to identify the correlation between nutritional/inflammatory peripheral blood markers and CSDH. METHODS 188 CSDH patients and 188 age-matched healthy controls were included in this research. The clinical characteristics and peripheral blood markers associated with nutritional or inflammatory status were obtained and analyzed. Conditional logistic regression analysis was applied to identify the potential CSDH risk factors. All the participants were divided into 3 groups based on the tertiles of change in risk factors. The Cochran-Armitage test and one way ANOVA were applied to identify the association between baseline characteristics and independent risk factors. Moreover, the net reclassification index (NRI) and integrated discrimination index (IDI) were calculated to evaluate the improvement in model performance after adding the independent risk factors in the conventional model. RESULTS The logistic regression analysis demonstrated that the increased albumin (OR, 0.615; 95 %CI,0.489-0.773; P < 0.001) and lymphocyte count (OR, 0.141; 95 %CI,0.025-0.796; P = 0.027) were associated with lower risk of CSDH. Moreover, addition of albumin and lymphocyte to conventional risk factors significantly improved the risk prediction of CSDH(NRI: 46.47 %, P < 0.001; IDI: 30.92 %, P < 0.001; NRI: 22.45 %, P = 0.027; IDI: 1.23 %, P = 0.037, respectively) CONCLUSION: The decreased albumin and lymphocyte levels were correlated with a high risk of chronic subdural hematoma. The nutritional and inflammatory serum markers should be put great attention because these markers may play roles in finding the cause of CSDH and predicting its risk.
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Affiliation(s)
- Bingcheng Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaofan Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xufei Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 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, Yinchuan, China.
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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The Effect of Statins on the Recurrence of Chronic Subdural Hematomas: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 166:244-250.e1. [PMID: 35917921 DOI: 10.1016/j.wneu.2022.07.079] [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: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Statins have been proposed to improve the resolution of chronic subdural hematoma (cSDH), with conflicting results likely due to underpowered analysis or confounding factors, such as the use of antithrombotic medication. We performed a systematic literature review and meta-analysis to better elucidate the effect of statin therapy on cSDH recurrence. METHODS We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the number of recurrences requiring surgical evacuation or leading to neurological deterioration was reported and could be extracted separately for patients who did or did not receive statin therapy. RESULTS Seven studies were included, comprising 1359 cSDH patients (statin therapy, 449 vs. non-statin therapy, 910). Age was not different between groups (P = 0.548). The proportion of men was significantly different (statin, 80.1% vs. non-statin, 74.7%; P = 0.02). Use of antithrombotic medication was significantly higher (P = 0.005) in the statin group (11.7%) than in the non-statin group (7.3%). The statin group had a non-significant lower odds of recurrence (odds ratio 0.80, 95% confidence interval 0.35-1.81). In an exploratory data analysis of 4 studies without a difference between groups in antithrombotic medication use, the statin group had significantly lower odds of recurrence (odds ratio 0.29, 95% confidence interval 0.17-0.50). CONCLUSIONS Overall, we found that statin use did not result in lower odds of cSDH recurrence, likely due to a dilution caused by the higher rate of patients on antithrombotic medications in the statin group.
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Zhang P, Wang H, Bao H, Wang N, Chen Z, Tu Q, Lin X, Li Y, Zheng Z, Chen Y, Ruan L, Zhuge Q. Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma. Front Neurol 2022; 13:873124. [PMID: 35769370 PMCID: PMC9236226 DOI: 10.3389/fneur.2022.873124] [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: 02/10/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Although liver diseases have already been identified as a risk factor for increased recurrence and mortality in patients with chronic subdural hematoma (CSDH), the association between subclinical liver disease, specifically liver fibrosis (LF), and CSDH remains unknown. In the present study, we aimed to investigate the association between the LF scores and CSDH recurrence. Methods We retrospectively analyzed consecutive patients with CSDH who underwent burr-hole irrigation in the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2018. The clinical data were collected, and the LF scores were calculated including aspartate aminotransferase–platelet ratio index (APRI), fibrosis-4 (FIB-4), and Forns index. Multivariable logistic regression analysis was applied to identify the association between the LF scores and CSDH recurrence, and Cox regression model and Fine–Gray competing risks model were performed to calculate hazard ratios (HRs) for CSDH recurrence based on time-to-event outcomes. The C-statistic, the integrated discrimination improvement (IDI), and the net reclassification improvement (NRI) evaluated the additive value of the LF scores to predict the recurrence of CSDH. Results A total of 419 patients with CSDH were included, hematoma recurrence was observed in 62 patients (14.80%) within 1 year after surgery. The LF scores were significantly higher in those who recurred, whereas the standard hepatic assays were mostly normal. The patients were assigned to groups of high and low LF scores based on the validated cut-offs; compared with the subjects with low scores, those with high score levels had significantly higher recurrence rates. After adjusting for potential confounders, the LF scores were independently associated with CSDH recurrence, multivariable-adjusted HRs (95% CI) for those with higher levels of APRI, FIB-4, and Forns score were 4.32 (1.37–13.60), 2.56 (1.20–5.43), and 2.02 (1.07–3.79) for the recurrence of CSDH, respectively. Moreover, adding the APRI to the conventional model improved the C-statistic from 0.731 to 0.763, with an NRI and IDI of 7.50 and 1.35%, respectively. Two further commonly-used LF score indices (FIB-4 score and Forns index) yielded comparable results. Conclusions The data from this study first indicated that the high LF scores were significantly associated with the recurrence of CSDH and that careful follow-up in these patients may be needed.
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Affiliation(s)
- Peng Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hua Wang
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Han Bao
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ning Wang
- Neurointerventional Department, Zhejiang Hospital, Hangzhou, China
| | - Zhen Chen
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qi Tu
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao Lin
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Li
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zezheng Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linhui Ruan
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Linhui Ruan
| | - Qichuan Zhuge
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Qichuan Zhuge
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Younsi A, Riemann L, Habel C, Fischer J, Beynon C, Unterberg AW, Zweckberger K. Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma. Neurosurg Rev 2021; 45:729-739. [PMID: 34240268 PMCID: PMC8827308 DOI: 10.1007/s10143-021-01537-x] [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: 07/15/2020] [Revised: 02/14/2021] [Accepted: 03/24/2021] [Indexed: 10/26/2022]
Abstract
In an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.
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Affiliation(s)
- Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
| | - Lennart Riemann
- Department of Neurosurgery, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany
| | - Cleo Habel
- Department of Neurosurgery, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany
| | - Jessica Fischer
- Department of Neurosurgery, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany
| | - Christopher Beynon
- Department of Neurosurgery, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany
| | - Klaus Zweckberger
- Department of Neurosurgery, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany
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