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Wasfie T, Young C, Naisan M, Senger B, Brimmeier A, Sobell A, Stanbaugh S, Hille J, Hella J, Barber K. Acute Traumatic Subdural Hematoma in the Elderly and Associated Factors that May Influence Chronicity. Am Surg 2023; 89:6312-6314. [PMID: 36917853 DOI: 10.1177/00031348231157814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- T Wasfie
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - C Young
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - M Naisan
- Medical University of the Americas, Devens, MA, USA
| | - B Senger
- A.T. Still University, Kirksville, MI, USA
| | - A Brimmeier
- Central Michigan University Medical School, Ann Arbor, MI, USA
| | - A Sobell
- Central Michigan University Medical School, Ann Arbor, MI, USA
| | - S Stanbaugh
- Central Michigan University Medical School, Ann Arbor, MI, USA
| | - J Hille
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - J Hella
- Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - K Barber
- Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA
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Wasfie T, Young C, Naisan M, Senger B, Brimmeier A, Sobell FA, Stanbaugh C, Hille J, Hella J, Barber K. Acute Traumatic Subdural Hematoma in the Elderly and Associated Factors that May Influence Chronicity. Am Surg 2023; 89:6298-6300. [PMID: 36802907 DOI: 10.1177/00031348231157856] [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] [Indexed: 02/20/2023]
Abstract
Traumatic acute subdural hematomas (TASDH) is by far the most common traumatic brain injury in adult patients with blunt trauma, who presented to the Emergency Department (ED). One of the serious sequale of TASDH is the development of Chronic Subdural Hematomas (CSD) with associated deterioration in mental status and convulsion.1,2 Studies to identify the risk factors that favors development of chronicity of TASDH are few and inconclusive. As seen in our prior initial study, there were few factors which were common in those who developed chronicity of their TASDH, and we elected to expand our pool of patients to include those admitted between the years of 2015 and 2021 with ATSDH and identify the common factors associated with development of CSD.
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MESH Headings
- Adult
- Humans
- Aged
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Brain Injuries/complications
- Brain Injuries, Traumatic/complications
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
- Hematoma, Subdural, Chronic/surgery
- Risk Factors
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Affiliation(s)
- Tarik Wasfie
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Carly Young
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | | | | | - Alexis Brimmeier
- Central Michigan University Medical School, Mount Pleasant, MI, USA
| | | | | | - Jennifer Hille
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
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Clinical and Radiological Characteristics for Recurrence of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis. Neurol Int 2022; 14:683-695. [PMID: 36135992 PMCID: PMC9505137 DOI: 10.3390/neurolint14030057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic subdural hematoma (cSDH) is one of the most studied clinical entities in the neurosurgical literature. Management of cSDH is complicated by its propensity to recurrence. Various factors for the development of recurrence of cSDH have been described in various clinical, epidemiological, and observational studies, yet the evidence available is limited. A systematic review and meta-analysis as per PRISMA guidelines to identify clinical and radiological factors which can predict the development of recurrence in cSDH. A total of 14 studies were included for the systematic review and meta-analysis after a comprehensive search of the online databases. Eight studies were of high methodological quality. Age, use of anticoagulants, obesity, seizure, and liver disease were found to be statistically significant clinical risk factors for the development of recurrence in cSDH. Among the radiological parameters, the internal structure of the hematoma and the width of the hematoma was found to be significant risk factor predicting the development of recurrence. Age >75 years, use of anticoagulation therapy, liver disease, and obesity were significant risk factors for cSDH recurrence. Pneumocephalus, internal architecture of hematoma, bilateral cSDH, the width of hematoma, and the presence of bilateral cSDH are important radiological parameters of the development of recurrent cSDH
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Ou Y, Fan W, Yu X, Wu L, Liu W. A Single-Center Analysis of Sex Differences in Patients With Chronic Subdural Hematoma in China. Front Neurol 2022; 13:888526. [PMID: 35655622 PMCID: PMC9152211 DOI: 10.3389/fneur.2022.888526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Given the men's predominance in the prevalence of chronic subdural hematoma (CSDH), we investigated the relationship between sex differences and clinical features of CSDH. Methods We retrieved a large collection of clinical factors from CSDH patients between August 2011 and May 2019, and analyzed the differences and similarities in the clinical data and outcomes between men and women. Results In total 1,307 CSDH patients were enrolled in this study. When we did not account for age, a greater proportion of women relative to men manifested diabetes (p = 0.001) and cardiac disease (p = 0.035) prior to the onset of CSDH. Regarding recovery outcome and recurrence rate, we observed no significant differences between men and women. The sole difference between women and men after surgery was that women experienced more complications than men (p = 0.044), and both length of hospital stay (p < 0.001, B = 0.159, Exp [B] = 1.172, 95% CI = 1.078–1.274) and the presence of cardiac disease (p = 0.002, B = 2.063, Exp [B] = 7.867, 95% CI = 2.167–28.550) were identified as independent risk factors. After accounting for age, women with CSDH exhibited more frequent disorders of consciousness at admission than men in group of ≤ 40-year-old patients (p = 0.018), while proportion of women with diabetes was higher than that of men in 41–79 year-old group (p < 0.001). However, women after surgery experienced more complications (p = 0.047), longer length of hospital stays (p = 0.005), and higher mortality at discharge (p = 0.035) than men in middle-aged group. Finally, length of hospital stay (p < 0.001, B = 0.186, Exp [B] = 1.205, 95% CI = 1.091–1.331) and cardiac disease (p = 0.017, B = 2.040, Exp [B] = 7.693, 95% CI = 1.430–41.372) impacted occurrence of complications in women 41–79-year-old, while duration of drainage catheter use (p < 0.001, B = 1.132, beta = 0.280) and complications (p < 0.001, B = 5.615, beta = 0.366) were identified as independent risk factors for length of hospital stay in the same group of women. Conclusions Although sex differences did not constitute a crucial factor in all the CSDH patients, we still need to pay closer attention to disparities between men and women with respect to complications, length of hospital stay, and mortality at discharge in the various age groups (particularly with respect to 41–79 year-old women patients), to provide satisfactory management and treatment of CSDH patients.
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Affiliation(s)
- Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Hefei Comprehensive National Science Center, The Institute of Artificial Intelligence, Hefei, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Wenhua Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaofan Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Neurological Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
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Lim MJR, Fong KY. Letter: Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-analyses: Lessons From a Collaborative Effort. Neurosurgery 2022; 90:e130-e131. [PMID: 35196292 DOI: 10.1227/neu.0000000000001896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Tang G, Chen J, Li B, Fang S. The Efficacy of Adjuvant Corticosteroids in Surgical Management of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis. Front Neurol 2022; 12:744266. [PMID: 35095713 PMCID: PMC8792049 DOI: 10.3389/fneur.2021.744266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: This systematic review aimed to assess the efficacy of adjuvant corticosteroids in managing patients with chronic subdural hematoma (CSDH) undergoing surgical intervention. Methods: We searched for eligible studies electronically on the databases of PubMed, Embase, and Google Scholar. The last date of the search was 15th Jun 2021. Outcomes were pooled to calculate risk ratios (RR) with 95% confidence intervals (CI). Results: Eleven studies were included. Four of them were randomized controlled trials (RCTs). Six studies reported data on good neurological outcomes but with variable definitions. Combining all studies, we noted no statistically significant difference in good neurological outcome with the use of adjuvant corticosteroids (RR: 0.91 95% CI: 0.74, 1.12 I2 = 92% p = 0.39). Similar results were obtained on subgroup analysis based on definition and study type. However, the use of adjuvant corticosteroids was associated with a significantly reduced risk of recurrence (RR: 0.51 95% CI: 0.40, 0.64 I2 = 0% p < 0.0001). The meta-analysis also demonstrated no statistically significant difference in mortality rates with the use of adjuvant corticosteroids (RR: 1.01 95% CI: 0.47, 2.21 I2 = 76% p = 0.97). The results did not differ between RCTs and non-RCTs. Limited studies reported data on complications, and pooled analysis indicated no significant increase in infectious, gastrointestinal, and neurological complications with the use of adjuvant corticosteroids. Conclusion: The use of corticosteroids with surgery for CSDH might be associated with a reduction in recurrence rate. However, corticosteroids do not improve functional outcomes or mortality rates. Future studies should assess the impact of different corticosteroid regimens on patient outcomes, and should use standardized reporting of neurological outcomes with uniform follow-up duration.
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Fujisawa N, Oya S, Yoshida S, Tsuchiya T, Nakamura T, Indo M, Matsui T. A Prospective Randomized Study on the Preventive Effect of Japanese Herbal Kampo Medicine Goreisan for Recurrence of Chronic Subdural Hematoma. Neurol Med Chir (Tokyo) 2020; 61:12-20. [PMID: 33208583 PMCID: PMC7812313 DOI: 10.2176/nmc.oa.2020-0287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although the recurrence of chronic subdural hematoma (CSDH) after surgical treatment significantly affects the patients' quality of life, the recurrence rate has not improved in decades. Goreisan, a Japanese herbal Kampo medicine, promotes the hydragogue effect and has been empirically used in the treatment of CSDH in Japan. We conducted a prospective randomized study to investigate whether Goreisan treatment decreases the recurrence rate of CSDH. Between March 2013 and December 2018, a total of 224 patients who underwent initial burr hole surgery for CSDH were randomly assigned to receive Goreisan for 3 months (Group G) or no medication (Group N). The primary endpoint was symptomatic recurrence within 3 months postoperatively, and the secondary endpoint was complications, including the adverse effects of Goreisan. Of 224 randomized patients, 208 were included in the final analysis (104 in Group G and 104 in Group N). The overall recurrence rate was 9.1% (19/208). The recurrence rate of Group G was lower than that of Group N (5.8% vs 12.5%, P = 0.09), but the difference was not statistically significant. However, a significant preventive effect of Goreisan was found in 145 patients with high-risk computed tomography (CT) features, namely, homogeneous and separated types (5.6% vs 17.6%, P = 0.04). Although the present study did not prove the beneficial effect of Goreisan treatment, it suggested the importance of selecting patients with an increased risk of recurrence. A subset of patients whose hematoma showed homogeneous and separated patterns on CT image might benefit from Goreisan treatment.
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Affiliation(s)
- Naoaki Fujisawa
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Tsukasa Tsuchiya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Takumi Nakamura
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Masahiro Indo
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
| | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University
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