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Inomata T, Nakaya K, Matsuhiro M, Takei J, Shiozaki H, Noda Y. Clinical Use of Hematoma Volume Based On Automated Segmentation of Chronic Subdural Hematoma Using 3D U-Net. Clin Neuroradiol 2024:10.1007/s00062-024-01428-w. [PMID: 38814451 DOI: 10.1007/s00062-024-01428-w] [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: 01/22/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To propose a method for calculating hematoma volume based on automatic segmentation of chronic subdural hematoma (CSDH) using 3D U‑net and investigate whether it can be used clinically to predict recurrence. METHODS Hematoma volumes manually measured from pre- and postoperative computed tomography (CT) images were used as ground truth data to train 3D U‑net in 200 patients (400 CT scans). A total of 215 patients (430 CT scans) were used as test data to output segmentation results from the trained 3D U‑net model. The similarity with the ground truth data was evaluated using Dice scores for pre and postoperative separately. The recurrence prediction accuracy was evaluated by obtaining receiver operating characteristic (ROC) curves for the segmentation results. Using a typical mobile PC, the computation time per case was measured and the average time was calculated. RESULTS The median Dice score of the test data were preoperative hematoma volume (Pre-HV): 0.764 and postoperative subdural cavity volume (Post-SCV): 0.741. In ROC analyses assessing recurrence prediction, the area under the curve (AUC) of the manual was 0.755 in Pre-HV, whereas the 3D U‑net was 0.735. In Post-SCV, the manual AUC was 0.779; the 3D U‑net was 0.736. No significant differences were found between manual and 3D U‑net for all results. Using a mobile PC, the average time taken to output the test data results was 30 s per case. CONCLUSION The proposed method is a simple, accurate, and clinically applicable; it can contribute to the widespread use of recurrence prediction scoring systems for CSDH.
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Affiliation(s)
- Takayuki Inomata
- Department of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science, 1001-1 Kishioka, 510-0293, Suzuka City, Mie, Japan.
- Department of Radiological Technology, Fuji City General Hospital, 50 Takashima-cho, 417-8567, Fuji City, Shizuoka, Japan.
| | - Koji Nakaya
- Department of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science, 1001-1 Kishioka, 510-0293, Suzuka City, Mie, Japan
| | - Mikio Matsuhiro
- Department of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science, 1001-1 Kishioka, 510-0293, Suzuka City, Mie, Japan
| | - Jun Takei
- Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, 105-8461, Tokyo, Japan
| | - Hiroto Shiozaki
- Department of Radiological Technology, Fuji City General Hospital, 50 Takashima-cho, 417-8567, Fuji City, Shizuoka, Japan
| | - Yasuto Noda
- Department of Neurosurgery, Fuji City General Hospital, 50 Takashima-cho, 417-8567, Fuji City, Shizuoka, Japan
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Yan C, Su C, Ye YF, Liu J. A Linear Regression Equation for Predicting the Residual Volume of Chronic Subdural Hematoma 1 Week After Surgery. Neuropsychiatr Dis Treat 2023; 19:2787-2796. [PMID: 38111595 PMCID: PMC10726707 DOI: 10.2147/ndt.s436127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
Objective The outcome of chronic subdural hematoma (CSDH) is influenced not only by the choice of treatment but also by various baseline characteristics. The main objective of this study is to identify the risk factors that can affect the prognosis of CSDH and develop a regression equation based on these risk factors. Methods A total of 212 patients with CSDH were included in the study. We collected clinical data including age, gender, and so on, and radiological data including preoperative hematoma volume (V1), effusion volume 1 day after surgery (V2), gas volume 1 day after surgery (V3), and so on. These were considered independent variables, while residual volume 1 week after surgery (V4) was the dependent variable. Univariate linear regression analysis was performed to identify factors that were significantly related. Subsequently, multivariate linear regression analysis was conducted to determine the relationship between each independent variable and the dependent variable. Multiple linear regression analysis was used to obtain a regression equation predicting V4. Results We have found that age (t = 3.109, P = 0.002), aspirin (t = 2.762, P = 0.006), hemostatic agents (haemocoagulase, t = 3.731, P < 0.001; vitamin K, t = 2.824, P = 0.005 < 0.05), V2 (t = 8.73, P < 0.001), and V3 (t = 5.968, P < 0.001) are significantly associated with V4. Furthermore, we have developed a regression equation that can predict this volume with CSDH. The fit of the model is robust with an R-squared value of 65.2% > 50%. Conclusion Age, aspirin, hemostatic agent, V2, and V3 are significantly associated with V4. We developed a regression equation to predict this volume with CSDH.
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Affiliation(s)
- Chao Yan
- Department of Neurosurgery, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Chang Su
- Department of Neurosurgery, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Yu-fei Ye
- Department of Neurosurgery, Qingyuan People’s Hospital, Lishui, Zhejiang, 323800, People’s Republic of China
| | - Jin Liu
- Department of Neurosurgery, the Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, 323000, People’s Republic of China
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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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Development and validation of a recurrent prediction model for patients with unilateral chronic subdural hematoma without hematoma volumetric analysis. Clin Neurol Neurosurg 2023; 227:107678. [PMID: 36933403 DOI: 10.1016/j.clineuro.2023.107678] [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: 01/27/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Approximately 10 % of patients with chronic subdural hematoma (CSDH) undergo reoperation after initial surgery. This study aimed to develop a predictive model for the recurrence of unilateral CSDH at initial surgery without hematoma volumetric analysis. METHODS This single-center retrospective cohort study evaluated pre- and postoperative computed tomography (CT) images of patients with unilateral CSDH. The pre- and postoperative midline shift (MLS), residual hematoma thickness, and subdural cavity thickness (SCT) were measured. CT images were classified based on the internal architecture of the hematoma (homogenous, laminar, trabecular, separated, and gradation subtypes). RESULTS Total 231 patients with unilateral CSDH underwent burr hole craniostomy. After receiver operating characteristic analysis, preoperative MLS and postoperative SCT showed better areas under the curve (AUCs) (0.684 and 0.756, respectively). According to the CT classification of preoperative hematomas, the recurrence rate was significantly higher in the separated/gradation group (18/97, 18.6 %) than in the homogenous/laminar/trabecular group (10/134, 7.5 %). Four-point score was derived from the multivariate model using the preoperative MLS, postoperative SCT, and CT classification. The AUC of this model was 0.796, and the recurrence rates at 0-4 points were 1.7 %, 3.2 %, 13.3 %, 25.0 %, and 35.7 %, respectively. CONCLUSION Pre- and postoperative CT findings without hematoma volumetric analysis may predict CSDH recurrence.
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Wang XJ, Yin YH, Wang ZF, Zhang Y, Sun C, Cui ZM. Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma: An observational study. World J Clin Cases 2022; 10:12920-12927. [PMID: 36568991 PMCID: PMC9782954 DOI: 10.12998/wjcc.v10.i35.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/01/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. The traditional treatment methods include burr hole drainage, bone flap craniectomy and other surgical methods, and there are certain complications such as recurrence, pneumocephalus, infection and so on. With the promotion of neuroendoscopic technology, its treatment effect and advantages need to be further evaluated. AIM To study the clinical effect of endoscopic small-bone approach in CSDH. METHODS A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method: the neuroendoscopy group (n = 61 cases) and the burr hole drainage group (n = 61 cases). The clinical treatment effect of the two groups of patients with CSDH was compared. RESULTS At the early postoperative stage (1 d and 3 d), the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete re-expansion was higher in the neuroendoscopy group than in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). The recurrence rate of hematoma in the neuroendoscopy group was lower than that in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). No intracranial hematoma, low cranial pressure, tension pneumocephalus or other complications occurred in the neuroendoscopy group. CONCLUSION The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up. The surgical effect is apparent with few complications and definite curative effect, which is worthy of clinical promotion and application.
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Affiliation(s)
- Xue-Jian Wang
- Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yu-Hua Yin
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Zhi-Feng Wang
- Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yi Zhang
- Department of Neurosurgery, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
| | - Cheng Sun
- Jiangsu Provincial Key Laboratory of Nerve Regeneration, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Zhi-Ming Cui
- Department of Orthopedic, Affiliated Hospital 2 to Nantong University, Nantong 226001, Jiangsu Province, China
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Han S, Feng Y, Xu C, Li X, Zhu F, Li Z, Zhang C, Bie L. Brain re-expansion predict the recurrence of unilateral CSDH: A clinical grading system. Front Neurol 2022; 13:908151. [PMID: 36247766 PMCID: PMC9554254 DOI: 10.3389/fneur.2022.908151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Assessing the risk of postoperative recurrence of chronic subdural hematoma (CSDH) is a clinical focus. To screen the main factors associated with the perioperative hematoma recurrence. The brain re-expansion is the core factor of recurrence. A clinical prognostic scoring system was also proposed. Methods We included 295 patients with unilateral CSDH as the training group for modeling. Factors predicting postoperative recurrence requiring reoperation (RrR) were determined using univariate and multivariate regression analyses, and bivariate Pearson correlation coefficient analysis was used to exclude related factors. Receiver operating characteristic curve analysis evaluates the ability of main factors to predict RrR and determines the cut-off value of brain re-expansion rate. We developed a prognostic scoring system and conducted preliminary verification. A verification group including 119 patients with unilateral CSDH was used to verify the grading systems. Results The key factors for predicting unilateral CSDH recurrence were cerebral re-expansion rate (≤ 40%) at postoperative days 7–9 (OR 25.91, p < 0.001) and the preoperative CT density classification (isodense or hyperdense, or separated or laminar types) (OR 8.19, p = 0.007). Cerebral atrophy played a key role in brain re-expansion (OR 2.36, p = 0.002). The CSDH prognostic grading system ranged from 0 to 3. An increased score was associated with a more accurate progressive increase in the RrR rate (AUC = 0.856). Conclusions Our prognostic grading system could screen clinically high-risk RrR patients with unilateral CSDH. However, increased attention should be paid to brain re-expansion rate after surgery in patients with CSDH.
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Affiliation(s)
- Shuai Han
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Yan Feng
- Department of Radiology of the First Clinical Hospital, Jilin University, Changchun, China
| | - Chuanna Xu
- Department of Radiology of the First Clinical Hospital, Jilin University, Changchun, China
| | - Xuezhen Li
- Department of Radiology of the First Clinical Hospital, Jilin University, Changchun, China
| | - Fulei Zhu
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Zean Li
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Chunyun Zhang
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Li Bie
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
- *Correspondence: Li Bie
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Yu T, Liu X, Sun L, Lv R, Wu J, Wang Q. Risk factors for Drug-resistant Epilepsy (DRE) and a nomogram model to predict DRE development in post-traumatic epilepsy patients. CNS Neurosci Ther 2022; 28:1557-1567. [PMID: 35822252 PMCID: PMC9437227 DOI: 10.1111/cns.13897] [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: 01/23/2022] [Revised: 05/22/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives To identify factors affecting the development of drug‐resistant epilepsy (DRE), and establish a reliable nomogram to predict DRE development in post‐traumatic epilepsy (PTE) patients. Methods This study conducted a retrospective clinical analysis in patients with PTE who visited the Epilepsy Center, Beijing Tiantan Hospital from January 2013 to December 2018. All participants were followed up for at least 3 years, and the development of DRE was assessed. Data from January 2013 to December 2017 were used as development dataset for model building. Those independent predictors of DRE were included in the final multivariable logistic regression, and a derived nomogram was built. Data from January 2018 to December 2018 were used as validation dataset for internal validation. Results Complete clinical information was available for 2830 PTE patients (development dataset: 2023; validation dataset: 807), of which 21.06% (n = 596) developed DRE. Among all parameters of interest including gender, age at PTE, family history, severity of traumatic brain injury (TBI), single or multiple injuries, lesion location, post‐TBI treatments, acute seizures, PTE latency, seizure type, status epilepticus (SE), and electroencephalogram (EEG) findings, four predictors showed independent effect on DRE, they were age at PTE, seizure type, SE, and EEG findings. A model incorporating these four variables was created, and a nomogram to calculate the probability of DRE using the coefficients of the model was developed. The C‐index of the predictive model and the validation was 0.662 and 0.690, respectively. The goodness‐of‐fit test indicated good calibration for model development and validation (p = 0.272, 0.572). Conclusions The proposed nomogram achieved significant potential for clinical utility in the prediction of DRE among PTE patients. The risk of DRE for individual PTE patients can be estimated by using this nomogram, and identified high‐risk patients might benefit from non‐pharmacological therapies at an early stage.
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Affiliation(s)
- Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lei Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ruijuan Lv
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianping Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
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Yan C, Yang MF. In Reply to the Letter to the Editor Regarding "A Reliable Nomogram Model to Predict the Recurrence of Chronic Subdural Hematoma After Burr Hole Surgery". World Neurosurg 2022; 163:145. [PMID: 35729810 DOI: 10.1016/j.wneu.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Chao Yan
- Department of Neurosurgery, Lishui People's Hospital, Lishui, Zhejiang, China
| | - Ming-Fei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai, China.
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Yang T, Yu J, Shen H, Yang C, Zhang P, Li Y, Wu H. Risk factors and risk nomogram model of reoperation for hemorrhages after severe traumatic brain injury craniotomy. IBRAIN 2022; 8:141-147. [PMID: 37786884 PMCID: PMC10529335 DOI: 10.1002/ibra.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/04/2023]
Abstract
Objective This study aimed to explore the risk factors associated with reoperation for postoperative hemorrhages after severe traumatic brain injury (sTBI) craniotomy and establish a risk nomogram model. Methods A retrospective case-control study was performed. Overall, 367 patients who were diagnosed with sTBI and fulfilled the inclusion criteria were enrolled from the Department of Neurosurgery of the Affiliated Hospital of Zunyi Medical University between January 2015 and December 2020. They were divided into a reoperation group and a non-reoperation group according to whether they underwent reoperation for hemorrhages. Using univariate binary logistic regression analysis, the possible risk factors were screened. Subsequently, the independent risk factors of reoperation for postoperative hemorrhages were screened using the forward step method of multivariate binary logistic regression analysis, and a corresponding nomogram model was constructed. The receiver operative characteristic (ROC) curve was used to evaluate the reliability of the model. Finally, 30% of the data were randomly selected for internal verification of the model. Results The reoperation rate for hemorrhage after sTBI emergency craniotomy was 14.71% (54/367); multivariate logistic regression analysis showed that multiple hemorrhages (odds ratio [OR] = 4.38, 95% confidence interval [CI]: 1.815-10.587, p = 0.001), day or night surgery (OR = 0.26, 95% CI: 0.119-0.547, p < 0.001), operation duration (OR = 0.74, 95% CI: 0.119-0.547, p < 0.025), and abnormal intraoperative blood pressure fluctuation (OR = 4.15, 95% CI: 2.090-8.245, p < 0.001) were statistically significant. The sensitivity and specificity of the nomogram model were 0.815 and 0.661, respectively, and the area under ROC curve was 0.76 (95% CI: 0.705-0.833). Internal verification showed that the area under the ROC curve was 0.783 (95% CI: 0.683-0.883). Conclusions Taken together, the results of our study reveal that multiple preoperative intracranial hemorrhages, day and night operation, operation duration, and abnormal fluctuation of intraoperative blood pressure were independent risk factors for postoperative bleeding and reoperation for sTBI. Through the analysis of the influencing factors, a prediction model for the risk of bleeding and reoperation after craniocerebral trauma was developed. Compared with other relevant studies, this prediction model has good prediction efficiency and can be used to predict the occurrence of bleeding and reoperation after sTBI in patients.
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Affiliation(s)
- Tao Yang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jie Yu
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hao Shen
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Chao‐Zhi Yang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Ping Zhang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yi Li
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hai‐Tao Wu
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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Yang G, Mu Z, Pu K, Chen Y, Zhang L, Zhou H, Luo P, Zhang X. A reliable nomogram model for predicting esophageal stricture after endoscopic submucosal dissection. Medicine (Baltimore) 2022; 101:e28741. [PMID: 35119025 PMCID: PMC8812639 DOI: 10.1097/md.0000000000028741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Currently, endoscopic submucosal dissection (ESD) has gradually become the diagnosis and treatment of choice for initial esophageal cancer. However, the formation of esophageal stricture after ESD is one of its important complications. In this paper, we intend to identify the risk factors of esophageal stricture to develop a nomogram model to predict the risk of esophageal stricture and validate this model.A total, 159 patients were included in this study, including 21 patients with esophageal stenosis. Multivariate analysis showed that age greater than 60 years, high neutrophil-to-lymphocyte ratio, the extent of esophageal mucosal defect greater than 1/2, and postoperative pathological type of early esophageal squamous cell carcinoma were independent risk factors for predicting esophageal stricture. We constructed a nomogram model to predict esophageal stenosis by these 4 independent predictors.The prediction performance of the model was verified by the area under the receiver operating characteristic curve, the area under the receiver operating characteristic curve of the model was 0.889, and the sensitivity and specificity were 80.00% and 91.28%, respectively, indicating that the prediction performance of the model was good; The calibration curve constructed by internal cross-validation suggested that the predicted results of the nomogram agreed well with the actual observed values.The nomogram model has a high accuracy for predicting esophageal stricture after esophageal ESD and is extremely important to reduce or avoid the occurrence of esophageal stricture. But it needs more external and prospective validation.
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Affiliation(s)
- Guodong Yang
- Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Zhao Mu
- Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Ke Pu
- Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Yulin Chen
- Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Luoyao Zhang
- Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Haiyue Zhou
- Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Peng Luo
- Department of Gastroenterology, The Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Xiaoying Zhang
- Teaching, and Research Section of Parasitology, School of Basic Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
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Holl DC, Mikolic A, Blaauw J, Lodewijkx R, Foppen M, Jellema K, van der Gaag NA, den Hertog HM, Jacobs B, van der Naalt J, Verbaan D, Kho KH, Dirven CMF, Dammers R, Lingsma HF, van Klaveren D. External validation of prognostic models predicting outcome after chronic subdural hematoma. Acta Neurochir (Wien) 2022; 164:2719-2730. [PMID: 35501576 PMCID: PMC9519711 DOI: 10.1007/s00701-022-05216-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/07/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. We aimed to assess the performance of existing prediction models for outcomes in patients diagnosed with CSDH. METHODS We systematically searched relevant literature databases up to February 2021 to identify prognostic models for outcome prediction in patients diagnosed with CSDH. For the external validation of prognostic models, we used a retrospective database, containing data of 2384 patients from three Dutch regions. Prognostic models were included if they predicted either mortality, hematoma recurrence, functional outcome, or quality of life. Models were excluded when predictors were absent in our database or available for < 150 patients in our database. We assessed calibration, and discrimination (quantified by the concordance index C) of the included prognostic models in our retrospective database. RESULTS We identified 1680 original publications of which 1656 were excluded based on title or abstract, mostly because they did not concern CSDH or did not define a prognostic model. Out of 18 identified models, three could be externally validated in our retrospective database: a model for 30-day mortality in 1656 patients, a model for 2 months, and another for 3-month hematoma recurrence both in 1733 patients. The models overestimated the proportion of patients with these outcomes by 11% (15% predicted vs. 4% observed), 1% (10% vs. 9%), and 2% (11% vs. 9%), respectively. Their discriminative ability was poor to modest (C of 0.70 [0.63-0.77]; 0.46 [0.35-0.56]; 0.59 [0.51-0.66], respectively). CONCLUSIONS None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted.
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Affiliation(s)
- Dana C. Holl
- grid.5645.2000000040459992XDepartment of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands ,grid.414842.f0000 0004 0395 6796Department of Neurology, Haaglanden Medical Centre, Hague, The Netherlands
| | - Ana Mikolic
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jurre Blaauw
- grid.4494.d0000 0000 9558 4598Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roger Lodewijkx
- Department of Neurosurgery, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Merijn Foppen
- Department of Neurosurgery, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Korné Jellema
- grid.414842.f0000 0004 0395 6796Department of Neurology, Haaglanden Medical Centre, Hague, The Netherlands
| | - Niels A. van der Gaag
- grid.10419.3d0000000089452978University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre, Haga Teaching Hospital, Leiden, The Netherlands
| | - Heleen M. den Hertog
- grid.452600.50000 0001 0547 5927Department of Neurology, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - Bram Jacobs
- grid.4494.d0000 0000 9558 4598Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- grid.4494.d0000 0000 9558 4598Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - K. H. Kho
- Department of Neurosurgery, NeurocenterMedisch Spectrum Twente, Enschede, The Netherlands ,grid.6214.10000 0004 0399 8953Clinical Neurophysiology Group, University of Twente, Enschede, The Netherlands
| | - C. M. F. Dirven
- grid.5645.2000000040459992XDepartment of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ruben Dammers
- grid.5645.2000000040459992XDepartment of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Hester F. Lingsma
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - David van Klaveren
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
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Pei Y, Dong L. Letter to the Editor Regarding "A Reliable Nomogram Model to Predict the Recurrence of Chronic Subdural Hematoma After Burr Hole Surgery". World Neurosurg 2021; 152:239. [PMID: 34340286 DOI: 10.1016/j.wneu.2021.04.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Yunlong Pei
- Department of Clinical Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Lun Dong
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
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Zhou P, Wan J, Ran F, Gao F, Yang D, Dai X, Sun Y, Wang P. Development and validation of a prognostic prediction model for antithrombotic-related chronic subdural hematoma in patients with recent acute myocardial infarction. Cardiovasc Diagn Ther 2020; 10:1770-1784. [PMID: 33381422 PMCID: PMC7758749 DOI: 10.21037/cdt-20-763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/08/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Antithrombotic therapy is a cornerstone of acute myocardial infarction (AMI) treatment and is thought to be associated with an increased risk of chronic subdural hematoma (CSDH). However, no well-established model exists to predict subsequent antithrombotic treatment outcomes after CSDH in patients with recent AMI. We aimed to identify a prognostic model to predict the 6-month outcome of treatment with antithrombotic therapy. METHODS This multicenter retrospective analysis involved 553 patients with recent AMI with antithrombotic-related CSDH. Several candidate clinical variables and biomarkers were examined in the training cohort (Chengdu training cohort; n=368). Patients with unfavorable outcomes had experienced at least 1 of the following: major adverse cardiovascular events (MACE), recurrence, or a modified Rankin scale (mRS) score of 2 to 6. To develop a 6-month outcome prediction model, three approaches were used: (I) a demographic variable model, (II) a clinical marker model and (III) a decision-driven model. A clinical outcome prediction model based on the superior predictors was assessed by logistic regression analysis. The nomogram for the final model was internally validated using a bootstrap procedure and externally validated in an independent cohort (Anhui cohort; n=185). RESULTS Model A produced 7 predictors of unfavorable outcomes, while models B and C yielded 2 and 1 predictors, respectively. The areas under the curve (AUC) increased from 0.743 [model A; 95% confidence interval (CI): 0.680-0.782] to 0.889 (model A + B + C; 95% CI: 0.851-0.916). The final prediction model included age, systolic blood pressure (SBP), body mass index (BMI), the Glasgow Coma Scale (GCS), the estimated glomerular filtration rate (eGFR), the early resumption of antithrombotic therapy, hematoma thickness and the presence of abdominal obesity, frailty and previous bleeding. Internal and external validation of the selected final model revealed adequate C-statistics and calibration slope values (internal validation: 0.81 and 0.78; external validation: 0.80 and 0.76, respectively). CONCLUSIONS This model provided a risk stratification tool to predict unfavorable outcomes in patients with recent AMI with antithrombotic-related CSDH. Because the study was based on ten readily practical and available variables, it may be widely applicable to guide management and complement clinical assessment.
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Affiliation(s)
- Peng Zhou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
| | - Jindong Wan
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
| | - Fei Ran
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
| | - Feng Gao
- Department of Cardiology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Dachun Yang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xiaozhen Dai
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, China
| | - Yun Sun
- Department of Party Secretary, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China
| | - Peijian Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
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Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis. Neuroradiology 2020; 63:27-40. [PMID: 33094383 PMCID: PMC7803717 DOI: 10.1007/s00234-020-02558-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/16/2020] [Indexed: 01/11/2023]
Abstract
Purpose Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. Methods Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. Results Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). Limitations Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. Conclusions Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.
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Zhang P, Li Y, Zhang J, Zhang H, Wang X, Dong L, Yan Z, She L, Wang X, Wei M, Tang C. Risk factors analysis and a nomogram model establishment for late postoperative seizures in patients with meningioma. J Clin Neurosci 2020; 80:310-317. [DOI: 10.1016/j.jocn.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/02/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
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Abstract
Soft tissue sarcoma (STS) of the extremities are a rare tumor. Metastases develop in about 40%-50% of patients, most of whom die from their disease. We sought to identify potential risk factors associated with metastatic diseases upon presentation for patients with STS and established a reliable nomogram model to predict distant metastasis of STS at presentation. The current study retrospectively analyzed 3884 STS of the extremities or trunk patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Based on patient registration, all patients were randomly allocated to training sets and validation sets (2:1). Then, univariate and binary logistic regression analysis was used to determine the significantly correlated predictors of metastasis. Finally, the nomogram model was established, using these predictors and validated it. 311 (8.21%) of the cases experienced distant metastatic disease was present at the time of presentation. The nomogram was developed from age, histology subtype, primary site, tumor size, grade and depth. Encouragingly, the nomogram showed favorable calibration with C-index 0.790 in the training set and 0.801 in validation set. The DCA showed that the novel model was clinically useful. This nomogram model had a high precision to predict the metastasis of soft tissue sarcoma of the extremities. We expect this model could be used in different clinical consultation and established risk assessment.
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Affiliation(s)
| | - Qiang Zhou
- Department of Orthopedic Surgery, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, 75 Jinxiu Road, Wenzhou
| | - A-Bing Li
- Department of Orthopedics, Ningbo Yinzhou Second Hospital, Ningbo Zhejiang, China
| | - Hong-Zhen Zhang
- Department of Orthopedic Surgery, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, 75 Jinxiu Road, Wenzhou
| | - Zhong-Qin Lin
- Department of Orthopedic Surgery, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, 75 Jinxiu Road, Wenzhou
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Alford EN, Rotman LE, Erwood MS, Oster RA, Davis MC, Pittman HBC, Zeiger HE, Fisher WS. Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality. J Neurosurg 2020; 132:1616-1622. [PMID: 30978691 DOI: 10.3171/2019.1.jns182895] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/14/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the development of a novel prognostic score, the Subdural Hematoma in the Elderly (SHE) score. The SHE score is intended to predict 30-day mortality in elderly patients (those > 65 years of age) with an acute, chronic, or mixed-density subdural hematoma (SDH) after minor, or no, prior trauma. METHODS The authors used the Prognosis Research Strategy group methods to develop the clinical prediction model. The training data set included patients with acute, chronic, and mixed-density SDH. Based on multivariate analyses from a large data set, in addition to review of the extant literature, 3 components to the score were selected: age, admission Glasgow Coma Scale (GCS) score, and SDH volume. Patients are given 1 point if they are over 80 years old, 1 point for an admission GCS score of 5-12, 2 points for an admission GCS score of 3-4, and 1 point for SDH volume > 50 ml. The sum of points across all categories determines the SHE score. RESULTS The 30-day mortality rate steadily increased as the SHE score increased for all SDH acuities. For patients with an acute SDH, the 30-day mortality rate was 3.2% for SHE score of 0, and the rate increased to 13.1%, 32.7%, 95.7%, and 100% for SHE scores of 1, 2, 3, and 4, respectively. The model was most accurate for acute SDH (area under the curve [AUC] = 0.94), although it still performed well for chronic (AUC = 0.80) and mixed-density (AUC = 0.87) SDH. CONCLUSIONS The SHE score is a simple clinical grading scale that accurately stratifies patients' risk of mortality based on age, admission GCS score, and SDH volume. Use of the SHE score could improve counseling of patients and their families, allow for standardization of clinical treatment protocols, and facilitate clinical research studies in SDH.
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Affiliation(s)
| | | | | | - Robert A Oster
- 2Department of Medicine, Division of Preventive Medicine; and
| | | | | | - H Evan Zeiger
- 3Department of Neurology, University of Alabama at Birmingham, Alabama
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René O, Martin H, Pavol S, Kristián V, Tomáš F, Branislav K. Factors influencing the results of surgical therapy of non-acute subdural haematomas. Eur J Trauma Emerg Surg 2019; 47:1649-1655. [PMID: 31705170 DOI: 10.1007/s00068-019-01258-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/25/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify predictive factors with an impact on the outcome of surgical treatment of non-acute subdural haematomas (NASH). METHODS One hundred eleven patients who underwent an evacuation of 132 NASH by means of burr hole or craniotomy from January 2014 to December 2018 were retrospectively analyzed. We evaluated the impact of factors that could possibly predict the result of surgical treatment. The assessment was focused on the impact of factors, such as age, gender, pre-operative clinical symptoms, timing and extent of surgical procedure, intake of anticoagulants and antiplatelet drugs, morphological type, recurrence, side localization or bilateral occurrence of NASH. Patients' functional outcome was quantified using the Glasgow Outcome Score (GOS) with a follow-up period of 3 months. RESULTS Morphological type of NASH did not have any significant impact on the final GOS. The risk factors associated with less favorable GOS included preoperative intake of anticoagulants and preoperative finding of phatic disorder, quantitative disorder of consciousness and disorientation. Preoperative intake of antiplatelet drugs or anticoagulants and craniotomy were risk factors for postoperative development of a surgically significant acute extracerebral haematoma. The complications occurred significantly more often after a craniotomy when compared to the burr hole evacuation (p = 0.0163), but the incidence of recurrence of NASH was significantly lower (p = 0.0439). CONCLUSION The risk factors for the surgical treatment of NASH included preoperative intake of antithrombotic drugs and evacuation of NASH through craniotomy. Craniotomy resulted in a significantly lower incidence of recurrence.
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Affiliation(s)
- Opšenák René
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59, Martin, Slovakia
| | - Hanko Martin
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59, Martin, Slovakia
| | - Snopko Pavol
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59, Martin, Slovakia
| | - Varga Kristián
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59, Martin, Slovakia
| | - Fejerčák Tomáš
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59, Martin, Slovakia
| | - Kolarovszki Branislav
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59, Martin, Slovakia.
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