Risk factors for need of reoperation in bilateral chronic subdural haematomas

BACKGROUND

Chronic subdural haematoma (CSDH) is one of the most common neurosurgical diseases. A subtype of CSDH is bilateral chronic subdural haematoma (bCSDH) which represents 20-25% of patients with CSDH and has a higher recurrence rate. There is no clear consensus on how bCSDH should be treated regarding upfront unilateral- or bilateral evacuation of both haematomas. The purpose of this study was to identify risk factors associated with reoperation of bCSDH.

METHODS

A total of 326 patients with radiological evidence of bCSDH were included in this retrospective cohort study where 133 (40.8%) patients underwent primary bilateral evacuation and 193 (59.2%) primary unilateral evacuation. The two centres operated using different surgical approaches. Analyses were performed to identify risk factors associated with reoperation of bCSDH. Reoperation rate was defined as reoperation of CSDH on either side of the hemisphere within 3 months after primary evacuation.

RESULTS

The cohort had a total reoperation rate of 26.4%. Patients which underwent unilateral evacuation had a reoperation rate of 32.1%, and the bilateral group had a reoperation rate of 18.0% (p=0.005). Multivariable logistic regression identified unilateral evacuation (OR 1.91, p=0.022) and complications according to Ibanez (OR 2.20, p=0.032) to be associated with the need of reoperation of bCSDH. One-burr hole craniostomy with active subgaleal drain was primarily performed in bilateral approach (69.4%) whereas patients operated with minicraniotomy with passive subdural drain were primarily operated by unilateral evacuation of the larger symptomatic side (92.8%).

CONCLUSIONS

Unilateral evacuation of bCSDH was associated with a higher risk for reoperation than upfront bilateral evacuations in this study. There is a need to further discuss the criteria for uni- or bilateral evacuation since patients are treated differently at different centres.

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Background

To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage.

Methods

A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019.

Results

A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH.

Conclusions

This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Risk factors for the development of chronic subdural hematoma in patients with subdural hygroma

OBJECTIVE

Patients with subdural hygroma (SDG) are at increased risk of developing chronic subdural hematoma (CSDH). However, the factors that increase the risk of conversion are not fully understood. This study was to assess the risk factors of SDG conversion to CSDH.

METHODS

We reviewed the literature and retrospectively studied a series of cases in which CSDH was preceded by SDG to understand the natural history. We reviewed 45 cases of SDG from our hospital between 2015 and 2018. The cases were divided into two groups according to whether SDG converted into CSDH. Data were collected clinical presentation, imaging findings et al. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SDG conversion.

RESULTS

Univariate analysis showed that the SDG thickness (p = .009), SDG location (p = .026), and bilateral SDG (p = .042) were significantly associated with CSDH development. Multivariate analysis revealed that SDG thickness (odds ratio, 1.6; 95% confidence interval, 1.111-2.324; p = .012) and bilateral SDG (odds ratio, 27.6; 95% confidence interval 2.889-263.548; p = .004) were independent risk factors for SDG development. Receiver operating characteristic curve analysis revealed that SDG thickness was a significant variable for predicting SDG development. A thickness >11.37 mm was an appropriate cutoff value, and the possibility of SDG conversion had a sensitivity 50.0% and specificity of 87.0%.

CONCLUSIONS

Bilateral SDG and SDG thickness were independent risk factors for SDG progression into CSDH. An SDG thickness >11.37 mm had a high risk of SDG conversion.