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Lee SW, Sin EG. Risk Factors for the Recurrence of Chronic Subdural Hematoma. Korean J Neurotrauma 2024; 20:80-89. [PMID: 39021754 PMCID: PMC11249584 DOI: 10.13004/kjnt.2024.20.e18] [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: 04/24/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 07/20/2024] Open
Abstract
Objective Chronic subdural hematoma (CSDH) is commonly encountered in neurosurgery, and often occurs in elderly patients following a head injury. Despite favorable postoperative prognosis, recurrence remains common. Herein, we retrospectively analyzed the clinical and radiological data of patients at our institute to identify the risk factors for CSDH recurrence. Methods We investigated 370 patients who underwent surgery for CSDH at our institute. The following data were analyzed: sex, age, antiplatelet/anticoagulant use, preexisting diseases, radiological parameters, and surgical techniques. A univariate analysis was subsequently performed to examine the association between these variables and CSDH recurrence. Variables with a p-value of <0.05 in univariate analysis were further subjected to a multivariate logistic regression model to identify independent risk factors of CSDH. Results Of the 370 patients, 345 (93.2%) had no recurrence and 25 (6.8%) had recurrence. Univariate and multivariate analyses revealed that male sex, advanced age, bilateral hematoma, moderate or severe brain atrophy, separation type, gradation type, and burr hole trephination were independent risk factors for CSDH recurrence. Conclusion Sex, age, bilateral hematoma, brain atrophy, hematoma density and architecture, and surgical techniques are all associated with CSDH recurrence.
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Affiliation(s)
- Seung Woo Lee
- Department of Neurosurgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Eui Gyu Sin
- Department of Neurosurgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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2
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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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Schwarz J, Carnevale JA, Goldberg JL, Ramos AD, Link TW, Knopman J. Perioperative prophylactic middle meningeal artery embolization for chronic subdural hematoma: a series of 44 cases. J Neurosurg 2021; 135:1627-1635. [PMID: 34020417 DOI: 10.3171/2020.10.jns202856] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (cSDH) is a common and challenging pathology to treat due to both the historically high recurrence rate following surgical evacuation and the medical comorbidities inherent in the aging patient population that it primarily affects. Middle meningeal artery (MMA) embolization has shown promise in the treatment of cSDHs, most convincingly to avoid surgical evacuation in relatively asymptomatic patients. Symptomatic patients requiring surgical evacuation may also benefit from perioperative MMA embolization to prevent cSDH recurrence. The goal of this study was to determine the utility of perioperative MMA embolization for symptomatic cSDH requiring surgical evacuation and to assess if there is a decrease in the cSDH recurrence rate compared to historical recurrence rates following surgical evacuation alone. METHODS Symptomatic cSDHs were evacuated using a subdural evacuating port system (SEPS) with 5-mm twist-drill craniostomy in an intensive care unit or by performing a craniotomy in the operating room, using either a small (silver dollar, < 4 cm) or large (≥ 4 cm) craniotomy. MMA embolization was performed perioperatively using angiography, selective catheterization of the MMA, and infusion of polyvinyl particles. Outcomes were assessed clinically and radiographically with interval head CT imaging. RESULTS There were 44 symptomatic cSDHs in 41 patients, with 3 patients presenting with bilateral symptomatic cSDH. All cSDHs were evacuated using an SEPS (n = 18), a silver-dollar craniotomy (n = 16), or a large craniotomy (n = 10). Prophylactic MMA embolization was performed successfully in all cSDHs soon after surgical evacuation. There were no deaths and no procedural complications. There was an overall reduction of greater than 50% or resolution of cSDH in 40/44 (90.9%) cases, regardless of the evacuation procedure used. Of the 44 prophylactic cases, there were 2 (4.5%) cases of cSDH recurrence that required repeat surgical evacuation at the 1-year follow-up. These 2 cSDHs were initially evacuated using an SEPS and subsequently required a craniotomy, thereby representing an overall 4.5% recurrence rate of treated cSDH requiring repeat evacuation. Most notably, of the 26 patients who underwent surgical evacuation with a craniotomy followed by MMA embolization, none had cSDH recurrence requiring repeat intervention. CONCLUSIONS Perioperative prophylactic MMA embolization in the setting of surgical evacuation, via either craniotomy or SEPS, may help to lower the recurrence rate of cSDH.
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Erdogan B, Is M, Tural Emon S, Ceman D, Orakdogen M, Engin T. Retrospective analysis of 195 surgically treated cases of chronic subdural hematoma. Int J Clin Pract 2021; 75:e15014. [PMID: 34808025 DOI: 10.1111/ijcp.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/17/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The incidence of chronic subdural hematoma (CSDH) is increasing. This study evaluates the etiologic causes and findings of CSDH and compared unilateral CSDH with bilateral CSDH. This study aims to draw attention to this increasingly prevalent condition. METHODS We retrospectively analysed 195 surgically treated cases of CSDH in our clinic between 2008 and 2018. RESULTS The average age of the patients was 65.7 ± 19.6 years. The most common symptom was headache (53.3%). The case background was the use of anticoagulant (37.9%), head trauma (34.3%). The hematomas were 28.7% right side, 44.6% left side, and 26.7% bilateral. The mean Glasgow Coma Score (GCS) was 13.4 ± 2.9, early postop 13.8 ± 2.5, and late postop was 14.6 ± 1.1. Postoperative complications included acute subdural hematoma (5.1%), cerebral infarction (1.5%), wound infection (0.5%) and others (13.3%). Re-expansion of the brain were statistically significantly less frequent and impaired consciousness, anticoagulant use, early and late postop thickness were statistically significantly more frequent in patients with bilateral CSDH. CONCLUSIONS CSDH is seen more patients of advanced age, those who use anticoagulants, patients with hypertension and diabetes and in patients with a history of head trauma. Prognosis is worse in bilateral CSDH. We estimate that the incidence of CSDH will go up in the future.
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Affiliation(s)
- Baris Erdogan
- Department of Neurosurgery, Sanliurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Merih Is
- Department of Neurosurgery, University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Selin Tural Emon
- Department of Neurosurgery, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Duygu Ceman
- Department of Neurosurgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Metin Orakdogen
- Department of Neurosurgery, University of Trakya, Edirne, Turkey
| | - Taner Engin
- Department of Neurosurgery, University of Health Sciences Mehmet Akif İnan Training and Research Hospital, Istanbul, Turkey
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Tamura R, Sato M, Yoshida K, Toda M. History and current progress of chronic subdural hematoma. J Neurol Sci 2021; 429:118066. [PMID: 34488045 DOI: 10.1016/j.jns.2021.118066] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
Chronic subdural hematoma (CSDH) is characterized by an encapsulated collection of old blood. Although CSDH has become the most frequent pathologic entity in daily neurosurgical practice, there are some unresolved research questions. In particular, the causes and recurrent risk factors of CSDH remain as an object of debate. The split of the dural border layer forms a few tiers of dural border cells over the arachnoid layer. Tissue plasminogen activator plays an important role as a key factor of defective coagulation. Historically, CSDH has often been treated via burr hole craniostomy using a closed drainage system. Several different operative strategies and peri-operative strategies such as the addition of burr holes, addition of cavity irrigation, position of drain, or postural position, have been described previously. Although the direction of the drainage tube, residual air, low intensity of T1-weighted images on MRI, and niveau formation have been reported as risk factors for recurrence, antiplatelet or anticoagulant drug use has not yet been verified as a risk factor. Recently, pharmaceutical strategies, including atorvastatin, significantly improved the neurological function in CSDH patients. Many case series, without randomization, have been reported; and given its promising result, several randomized clinical trials using pharmaceutical as well as operative and perioperative strategies were initiated to obtain sufficient data. In contrast, relatively fewer basic studies have achieved clinical applications in CSDH, although it is one of the most common clinical entities. Further scientific basic research may be essential for achieving a novel treatment strategy for CSDH.
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Affiliation(s)
- Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Neurosurgery, Kawasaki Municipal Hospital, Shinkawadori, Kawasaki-ku, Kanagawa 210-0013, Japan
| | - Mizuto Sato
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Yu X, Wu L, Ou Y, Xu L, Guo X, Yang C, Liu W. Clinical characteristics and outcomes of chronic subdural hematoma in patients with a history of antiplatelet therapy. Clin Neurol Neurosurg 2021; 208:106817. [PMID: 34388598 DOI: 10.1016/j.clineuro.2021.106817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common neurosurgical disease. Many patients with CSDH take antiplatelet (AP) drugs. Several studies have focused merely on the relationship between AP drug use and recurrence without deeply analyzing the specific clinical features of these patients. The primary objective of this study was to investigate the detailed clinical characteristics and outcomes of CSDH patients with a history of AP therapy. METHODS A total of 1181 CSDH patients over 40 years of age who received burr-hole craniostomy were enrolled. Clinical information, computed tomographic findings, and data on long-term outcomes and recurrence among these patients were gathered. We divided these patients into two groups according to whether they had a history of AP therapy. Percentages and χ2 tests were applied for categorical variables. Standard deviations and 2-sided unpaired t-tests were applied for continuous variables. Univariate and multivariate logistic regression analyses were performed to identify independent factors of the outcomes (6 months after discharge). RESULTS AP therapy was not related to the outcomes of patients with CSDH (P = 0.48), and there were no differences in recurrence between the AP and non-AP group. Only Bender grade (P < 0.01, B = -3.14, Exp (B) = 0.04, 95% CI 0.01-0.29) was associated with the outcomes of patients in the AP group. The incidence of complications in the AP group was higher than that in the non-AP group (P < 0.01). Postoperative thrombotic events may be more likely to occur in the AP group than in the non-AP group (P = 0.02). Patients in the AP group were older (P < 0.01) and had more comorbidities (P < 0.01). CONCLUSIONS Patients treated with AP therapy had more complications. The outcomes of patients treated with AP therapy were associated with their status of admission. Patients treated with AP therapy were at greater risk for postoperative thrombotic events. The recurrence rate of CSDH did not appear to be affected by AP therapy.
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Affiliation(s)
- 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.
| | - Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, 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
| | - Long Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xufei Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cheng Yang
- The Third Clinical Medical College, Ningxia Medical University, Yinchuan, 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 (The Third Clinical Medical College, Ningxia Medical University), Yinchuan, China.
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7
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Grassner L, Petr O, Warner FM, Dedeciusova M, Mathis AM, Pinggera D, Gsellmann S, Meiners LC, Freigang S, Mokry M, Resch A, Kretschmer T, Rossmann T, Navarro FR, Gruber A, Spendel M, Winkler PA, Marhold F, Sherif C, Wais JP, Rössler K, Pfisterer W, Mühlbauer M, Trivik-Barrientos FA, Rath S, Voldrich R, Krska L, Lipina R, Kerekanic M, Fiedler J, Kasik P, Priban V, Tichy M, Krupa P, Cesak T, Kroupa R, Callo A, Haninec P, Pohlodek D, Krahulik D, Sejkorova A, Sames M, Dvorak J, Suchomel P, Tomas R, Klener J, Juran V, Smrcka M, Linzer P, Kaiser M, Hrabovsky D, Jancalek R, Kälin V, Bozinov O, Niggli C, Serra C, Guatta R, Kuhlen DE, Wanderer S, Marbacher S, Lavé A, Schaller K, Esculier C, Raabe A, Kramer JLK, Thomé C, Netuka D. Trends and outcomes for non-elective neurosurgical procedures in Central Europe during the COVID-19 pandemic. Sci Rep 2021; 11:6171. [PMID: 33731753 PMCID: PMC7969942 DOI: 10.1038/s41598-021-85526-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th-April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017-2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.
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Affiliation(s)
- Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, MZA 3rd floor, 6020, Innsbruck, Austria.
| | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, MZA 3rd floor, 6020, Innsbruck, Austria
| | - Freda M Warner
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Michaela Dedeciusova
- Department of Neurosurgery and Neuro-Oncology, 1St Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
| | - Andrea Maria Mathis
- Department of Neurosurgery, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, MZA 3rd floor, 6020, Innsbruck, Austria
| | - Sina Gsellmann
- Department of Neurosurgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Laura C Meiners
- Department of Neurosurgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Michael Mokry
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Alexandra Resch
- Department of Neurosurgery & Neurorestauration Klinikum Klagenfurt, Klagenfurt, Austria
| | - Thomas Kretschmer
- Department of Neurosurgery & Neurorestauration Klinikum Klagenfurt, Klagenfurt, Austria
| | - Tobias Rossmann
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Francisco Ruiz Navarro
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Mathias Spendel
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Peter A Winkler
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Franz Marhold
- Department of Neurosurgery, University Hospital of St, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Camillo Sherif
- Department of Neurosurgery, University Hospital of St, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Jonathan P Wais
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Sebastian Rath
- Department of Neurosurgery, General Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Richard Voldrich
- Department of Neurosurgery and Neuro-Oncology, 1St Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
| | - Lukas Krska
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Kerekanic
- Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Jiri Fiedler
- Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Petr Kasik
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Michal Tichy
- Department of Neurosurgery, Motol University Hospital, Motol, Czech Republic
| | - Petr Krupa
- Department of Neurosurgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tomas Cesak
- Department of Neurosurgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Robert Kroupa
- Unit of Neurosurgery, Municipal Hospital - Ostrava Fifejdy, Ostrava Fifejdy, Czech Republic
| | - Andrej Callo
- Department of Neurosurgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Haninec
- Department of Neurosurgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Daniel Pohlodek
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - David Krahulik
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Alena Sejkorova
- Department of Neurosurgery, Usti Nad Labem Hospital, Prague, Czech Republic
| | - Martin Sames
- Department of Neurosurgery, Usti Nad Labem Hospital, Prague, Czech Republic
| | - Josef Dvorak
- Department of Neurosurgery, Liberec Hospital, Prague, Czech Republic
| | - Petr Suchomel
- Department of Neurosurgery, Liberec Hospital, Prague, Czech Republic
| | - Robert Tomas
- Unit of Neurosurgery, Homolka Hospital, Prague, Czech Republic
| | - Jan Klener
- Unit of Neurosurgery, Homolka Hospital, Prague, Czech Republic
| | - Vilem Juran
- Department of Neurosurgery, University Hospital Brno and Masaryk University, Prague, Czech Republic
| | - Martin Smrcka
- Department of Neurosurgery, University Hospital Brno and Masaryk University, Prague, Czech Republic
| | - Petr Linzer
- Unit of Neurosurgery, Zlin Hospital, Prague, Czech Republic
| | - Miroslav Kaiser
- Unit of Neurosurgery, Pardubice Hospital, Prague, Czech Republic
| | - Dusan Hrabovsky
- Department of Neurosurgery, St. Anne's University Hospital Brno and Masaryk University, Prague, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne's University Hospital Brno and Masaryk University, Prague, Czech Republic
| | - Vincens Kälin
- Department of Neurosurgery, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Cedric Niggli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Ramona Guatta
- Clinic of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Dominique E Kuhlen
- Clinic of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonspital Aarau, Aarau, Switzerland
| | - Alexandre Lavé
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Clarinde Esculier
- Department of Neurosurgery, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - John L K Kramer
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, MZA 3rd floor, 6020, Innsbruck, Austria
| | - David Netuka
- Department of Neurosurgery and Neuro-Oncology, 1St Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
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Ou Y, Yu X, Liu X, Jing Q, Liu B, Liu W. A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma: A Retrospective Cross Sectional Study. Front Neurol 2020; 11:588242. [PMID: 33329333 PMCID: PMC7728855 DOI: 10.3389/fneur.2020.588242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical features of chronic subdural hematomas (CSDHs) in patients with and without a history of head trauma have remained unclear. Here, we investigated differences in clinical characteristics in CSDH patients with and without head trauma. Methods: We retrospectively collected clinical characteristics of CSDH patients who had undergone exhaustive drainage strategies via burr-hole craniostomies from August 2011 to May 2019. We divided patients into a trauma group (i.e., head trauma) and a no-trauma group. Chi-square tests or t-tests were used to analyze differences in clinical characteristics between the two groups. Multiple linear regression analysis was performed to analyze the relationships between the clinical characteristics and either reduction of the hematoma cavity or length of the hospital stay in CSDH patients with trauma. Results: We collected data from 1,307 CSDH patients, among whom 805 patients had a history of head trauma whereas 502 patients did not. The mean age of patients with head trauma was 64.0 ± 16.1 years, while that of patients without head trauma was significantly younger at 61.5 ± 17.9 years (p = 0.010). Furthermore, more patients in the no-trauma group had a history of hypertension compared to those in the trauma group (40.2 vs. 32.9%, p = 0.007). Dizziness occurred in 29.2% of patients with trauma and in 23.1% of patients without trauma (p = 0.016). A greater number of patients with trauma showed a reduction of hematoma cavity after surgery compared to that of patients without trauma (p = 0.002). The length of hospital stay in patients with trauma was 7.9 ± 4.5 days, which was longer than that of patients without trauma (7.3 ± 3.7 days, p = 0.016). In contrast, there were no significant different differences between the two groups in terms of the densities of hematomas on computed-tomography scans, complications, mortality rates, recurrence rates, or outcomes. Conclusion: Our findings indicate that there were some noteworthy differences in the clinical and pathogenic characteristics of CSDH patients with and without head trauma. However, our findings also indicate that if an optimal treatment method is employed, such as our exhaustive drainage strategy, similar treatment outcomes can be achieved between these groups.
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Affiliation(s)
- Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaofan Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qian Jing
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baiyun Liu
- 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, Ningxia People's Hospital, Ningxia, China
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9
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Tyngkan L, Malik N. Brainstem Bleed after Chronic Subdural Hematoma Drainage. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1714177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractChronic subdural hematoma (CSDH) is one of the most frequent benign neurosurgical pathologies. Burr hole drainage is known to be safe, with low-morbidity and low-mortality rates. However, postoperative complications have been reported. We report the case of a 40-year-old lady who suffered a fatal brain stem hemorrhage after burr hole drainage for unilateral chronic SDH. Rapid decompression or sudden increase in cerebral blood flow were the probable factors for her brainstem bleed. Therefore, a slow rate of evacuation of CSDHs and maintenance of a correct blood pressure perioperatively are recommended to prevent serious complications.
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Affiliation(s)
- Lamkordor Tyngkan
- Department of Neurosurgery, Sheri-Kashmir- Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil Malik
- Department of Neurosurgery, Sheri-Kashmir- Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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10
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Panciani PP, Saraceno G, Zanin L, Renisi G, Signorini L, Fontanella MM. Letter: COVID-19 Infection Affects Surgical Outcome of Chronic Subdural Hematoma. Neurosurgery 2020; 87:E167-E171. [PMID: 32304213 PMCID: PMC7188118 DOI: 10.1093/neuros/nyaa140] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Pier Paolo Panciani
- Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia Brescia, Italy
| | - Giorgio Saraceno
- Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia Brescia, Italy
| | - Luca Zanin
- Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia Brescia, Italy
| | - Giulia Renisi
- Department of Infection and Tropical Disease University of Brescia Brescia, Italy
| | - Liana Signorini
- Department of Infection and Tropical Disease University of Brescia Brescia, Italy
| | - Marco Maria Fontanella
- Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia Brescia, Italy
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11
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Karn M, Yonghang S. Acute on Chronic Bilateral Subdural Hematoma in a Woman with a Remote History of Previous Subdural Hematoma Managed by Trephination: A Case Report. ACTA ACUST UNITED AC 2020; 58:607-610. [PMID: 32968298 PMCID: PMC7580380 DOI: 10.31729/jnma.5122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Bilateral chronic subdural hematoma are not that common. It may be recurrent and rarely superimposed by acute bleed leading to rapid progression and poor clinical outcomes. We report the case of a seventy six years old lady with a history of traumatic subdural hematoma evacuated by trephination twenty years back, presenting at our hospital with a history of persistent headache and acute onset of several episodes of vomiting. A non-contrast head CT revealed bilateral chronic subdural hematoma with acute on chronic bleed on one side. Trephination was done initially unilaterally, but the symptoms persisted and bilateral trephination was performed. The patient developed bilateral pneumocephalus and chest infection post-surgery. Bilateral, recurrent subdural hematoma with acute superimposition of bleed is a rare entity that presents with signs of increased intracranial pressure as opposed to unilateral SDH. A single burr hole trephination can be an effective intervention in these cases.
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Affiliation(s)
- Mitesh Karn
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Sapana Yonghang
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
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12
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Shim YW, Lee WH, Lee KS, Kim ST, Paeng SH, Pyo SY. Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas. Korean J Neurotrauma 2019; 15:110-116. [PMID: 31720264 PMCID: PMC6826100 DOI: 10.13004/kjnt.2019.15.e25] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Chronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas. Methods From January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images. Results 60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group. Conclusion Burr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.
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Affiliation(s)
- Yong Woo Shim
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Won Hee Lee
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Keun Soo Lee
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Se Young Pyo
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
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13
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Holl DC, Volovici V, Dirven CMF, van Kooten F, Miah IP, Jellema K, Peul WC, van der Gaag NA, Kho KH, den Hertog HM, Dammers R, Lingsma HF. Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2019; 161:1231-1242. [PMID: 30972566 DOI: 10.1007/s00701-019-03881-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is an ongoing debate on the role of corticosteroids in the treatment of chronic subdural hematoma (CSDH). This study aims to evaluate the effectiveness of corticosteroids for the treatment of CSDH compared to surgery. METHOD A systematic search was performed in relevant databases up to January 2019 to identify RCTs or observational studies that compared at least two of three treatment modalities: the use of corticosteroids as a monotherapy (C), corticosteroids as an adjunct to surgery (CS), and surgery alone (S). Outcome measures were good neurological outcome, need for reintervention, mortality, and complications. Effect estimates were pooled and presented as relative risk (RR) with 95% confidence interval (95%CI). RESULTS Of 796 initially identified studies, 7 were included in the meta-analysis. Risk of bias was generally high. There were no differences in good neurological outcome between treatment modalities. The need for reintervention varied between 4 and 58% in C, 4-12% in CS, and 7-26% in S. The need for reintervention was lower in CS compared with C (RR 3.34 [95% CI 1.53-7.29]; p < 0.01) and lower in CS compared with S (RR 0.44 [95% CI 0.27-0.72]; p < 0.01). Mortality varied between 0 and 4% in C, 0-13% in CS, and 0-44% in S. Mortality was lower in CS compared with S (RR 0.39 [95% CI 0.25-0.63]; p < 0.01). There were no differences in complications between treatment modalities. CONCLUSIONS This meta-analysis suggests that the addition of corticosteroids to surgery might be effective in the treatment of CSDH. However, the results must be interpreted with caution in light of the serious risk of bias of the included studies. This study stresses the need for large randomized trials to investigate the use of corticosteroids in the management of CSDH.
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Affiliation(s)
- Dana C Holl
- Department of Neurosurgery, Erasmus MC Stroke Centre, Erasmus Medical Centre, 2040, 3000 CA Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Centre, Erasmus Medical Centre, 2040, 3000 CA Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Public Health and Medical Decision Making, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC Stroke Centre, Erasmus Medical Centre, 2040, 3000 CA Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus MC Stroke Centre, Erasmus Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Ishita P Miah
- Department of Neurology, Haaglanden Medical Centre, Postbus 432, 2501 CK, The Hague, The Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Centre, Postbus 432, 2501 CK, The Hague, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Haaglanden MC and Haga Teaching Hospital, Postbus 432, 2501 CK, The Hague, The Netherlands
| | - Kuan H Kho
- Department of Neurosurgery, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
| | - Heleen M den Hertog
- Department of Neurology, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Centre, Erasmus Medical Centre, 2040, 3000 CA Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health and Medical Decision Making, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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14
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Salama H. Outcome of single burr hole under local anesthesia in the management of chronic subdural hematoma. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0033-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Lee KS. How to Treat Chronic Subdural Hematoma? Past and Now. J Korean Neurosurg Soc 2018; 62:144-152. [PMID: 30486622 PMCID: PMC6411568 DOI: 10.3340/jkns.2018.0156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022] Open
Abstract
Treatment of chronic subdural hematoma (CSDH) is relatively straightforward, however, there is still some debate regarding the best strategy for treatment. The most practical recommendations of up to date were identified by a review of literature. The author reviewed the literature on CSDH management from the past to now to identify the best methods. Till 1970s, craniotomy was the most commonly used method. Burr hole (BH) became the most preferred method from 1980s. In 1977, twist drill (TD) craniostomy was introduced. Closed system drainage after a BH or a TD became the most frequently used surgical method. Although nonsurgical treatment is often successful, trephination has more advantages, such as rapid resolution of the symptoms and short period of hospitalization. Nonsurgical treatment is possible in asymptomatic patients with a small CSDH. For the symptomatic patients with CSDH, trephination is the treatment of choice, either by BH or TD. In gray zone between surgery and medical treatment, shared decision making can be an ideal approach. For the recurrent CSDHs, repeated trephination is still effective for patients with a low risk of recurrence. If the risk of recurrence is high, additional management would be helpful. For the refractory CSDHs, it is necessary to obliterate the subdural space.
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Affiliation(s)
- Kyeong-Seok Lee
- Department of Neurosurgery, Soonchunhyang University Chonan Hospital, Chonan, Korea
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16
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Knopman J, Link TW, Navi BB, Murthy SB, Merkler AE, Kamel H. Rates of Repeated Operation for Isolated Subdural Hematoma Among Older Adults. JAMA Netw Open 2018; 1:e183737. [PMID: 30646255 PMCID: PMC6324600 DOI: 10.1001/jamanetworkopen.2018.3737] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Elderly patients who undergo surgery for an isolated nontraumatic subdural hematoma (SDH) are at major risk for SDH reaccumulation, which can cause further injury and disability. Few population-based studies have examined how often nontraumatic SDH reaccumulates and necessitates repeated operation. OBJECTIVE To determine the rate of repeated operation after evacuation of nontraumatic SDH. DESIGN, SETTING, AND PARTICIPANTS In a cohort study, 2 parallel analyses were performed using data from the National Surgical Quality Improvement Project (NSQIP) from January 1, 2012, through December 31, 2015, and inpatient and outpatient claims data from a 5% nationally representative sample of Medicare beneficiaries from January 1, 2009, to September 30, 2015. In both samples, our cohort comprised patients 65 years or older who underwent surgical evacuation of nontraumatic SDH. Data were analyzed from March 28 to April 13, 2018. MAIN OUTCOMES AND MEASURES The outcome variable was repeated operation for SDH after the index operation. Survival analysis and Kaplan-Meier statistics were used to calculate cumulative rates. RESULTS Among 2 831 274 cases submitted to the NSQIP registry, 515 patients 65 years or older (mean [SD] age, 76.9 [7.4] years; 177 [34.4%] women; 367 [71.3%] white) who underwent craniotomy or craniectomy for nontraumatic SDH were identified. Within 30 days after the index surgery, 37 patients underwent a repeated operation for SDH. The cumulative 30-day mortality rate was 13.8% (95% CI, 11.0%-17.1%), and the repeated operation rate was 7.8% (95% CI, 5.7%-10.7%). Among a cohort of 1 952 305 Medicare beneficiaries, 1534 patients (mean [SD] age, 77.7 [7.0] years; 498 [32.5%] women; 1244 [81.1%] white) who underwent evacuation of nontraumatic SDH were identified. A total of 103 patients underwent a repeated operation within 90 days. The cumulative 30-day mortality rate was 11.6% (95% CI, 10.1%-13.3%), and the repeated operation rate was 4.9% (95% CI, 3.9%-6.2%); the cumulative 90-day mortality rate was 17.6% (95% CI, 15.7%-19.6%), and the repeated operation rate was 7.5% (95% CI, 6.2%-9.0%). The study found no evidence of a significant difference in cumulative repeated operation rates at 90 days between patients whose index surgery was a burr-hole procedure for chronic SDH (11.7%; 95% CI, 6.3%-21.3%) vs a craniotomy or craniectomy (7.2%; 95% CI, 6.0%-8.8%) (P = .14 by the log-rank test). CONCLUSIONS AND RELEVANCE In 2 large cohorts of US patients, approximately 5% to 10% of patients who underwent surgery for nontraumatic SDH were required to undergo repeated operation within 30 to 90 days. These results may inform the design of future prospective studies and trials and help practitioners calibrate their index of suspicion to ensure that patients are referred for timely surgical care.
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Affiliation(s)
- Jared Knopman
- Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Thomas W. Link
- Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Babak B. Navi
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Santosh B. Murthy
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | | | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, New York
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17
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Liu JKC. Neurologic Deterioration Due to Brain Sag After Bilateral Craniotomy for Subdural Hematoma Evacuation. World Neurosurg 2018. [PMID: 29524703 DOI: 10.1016/j.wneu.2018.02.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Intracranial hypotension from cerebrospinal fluid (CSF) hypovolemia resulting in cerebral herniation is a rare but known complication that can occur after neurosurgical procedures, usually encountered in correlation with perioperative placement of a lumbar subarachnoid drain. Decrease in CSF volume resulting in loss of buoyancy results in downward herniation of the brain without contributing mass effect, causing a phenomenon known as brain sag. Unreported previously is brain sag occurring without concomitant occult CSF leak or lumbar drainage. CASE DESCRIPTION This case report describes a patient who underwent bilateral craniotomies for subacute on chronic subdural hematoma with successful decompression but experienced acute neurologic deterioration secondary to brain sag. Despite an initial improvement in neurologic function, he subsequently experienced progressive neurologic deterioration with evidence of cerebral herniation on neuroimaging, without evidence of continued mass effect on the brain parenchyma. After a diagnosis of brain sag was determined based on imaging criteria, the patient was placed in a flat position, which resulted in rapid improvement in his neurologic function without any further intervention. CONCLUSIONS This case is unique in comparison with previous reports of intracranial hypotension after craniotomy in that the symptoms were completely reversed with positioning alone, without any evidence of active or occult CSF drainage. This report emphasizes that the diagnosis of brain sag should be taken into consideration when there is an unknown reason for neurologic decline after craniotomy, particularly bilateral craniotomies, if the imaging indicates herniation with imaging findings consistent with intracranial hypotension, without evidence of overlying mass effect.
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Affiliation(s)
- James K C Liu
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
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18
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Bartek J, Sjåvik K, Ståhl F, Kristiansson H, Solheim O, Gulati S, Sagberg LM, Förander P, Jakola AS. Surgery for chronic subdural hematoma in nonagenarians: A Scandinavian population-based multicenter study. Acta Neurol Scand 2017; 136:516-520. [PMID: 28382656 DOI: 10.1111/ane.12764] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (cSDH) is a prevalent condition often seen in the elderly, with surgery being the treatment of choice when symptomatic. So far, few have explored the surgical outcomes in patients 90 years or older. The aim of this study was to investigate outcome after cSDH surgery in nonagenarians (≥90 y/o group) compared to younger adult patients (<90 y/o group). MATERIALS In a Scandinavian population-based cohort we conducted a retrospective review of 1,254 patients undergoing primary burr-hole procedures for cSDH between January 1, 2005 and December 31, 2010 at three neurosurgical centers. In a comparative analysis, the primary end-point was difference in hematoma recurrence rates between the ≥90 y/o and <90 y/o groups. The secondary end-points were differences in perioperative morbidity and mortality between groups. RESULTS 75 patients were 90 years or older. There was no significant difference in recurrences resulting in reoperation between the age groups (10.7% vs 13.6%, P=.47). There was also no significant difference in overall complication rate (4.1% vs 8.1%, P=.21) or severe complications (1.4% vs 2.0%, P=.68). There were three (4.0%) perioperative deaths within 30 days in the ≥90 y/o group and 40 (3.4%) in the <90 y/o group (P=.78). CONCLUSION Patients 90 years or older had similar rates of recurrence, perioperative morbidity and perioperative mortality as compared to younger patients. Age alone should not be a contraindication for surgery in patients with cSDH.
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Affiliation(s)
- J. Bartek
- Department of Clinical Neuroscience; Section for Neurosurgery; Karolinska Institutet and Department of Neurosurgery; Karolinska University Hospital; Stockholm Sweden
- Department of Neurosurgery; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - K. Sjåvik
- Department of Neurosurgery; University Hospital of North Norway; Tromsø Norway
| | - F. Ståhl
- Department of Clinical Neuroscience; Section for Neurosurgery; Karolinska Institutet and Department of Neurosurgery; Karolinska University Hospital; Stockholm Sweden
| | - H. Kristiansson
- Department of Clinical Neuroscience; Section for Neurosurgery; Karolinska Institutet and Department of Neurosurgery; Karolinska University Hospital; Stockholm Sweden
| | - O. Solheim
- Department of Neurosurgery; St.Olav University Hospital; Trondheim Norway
- Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
- Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy; St.Olav Hospital; Trondheim Norway
| | - S. Gulati
- Department of Neurosurgery; St.Olav University Hospital; Trondheim Norway
- Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
| | - L. M. Sagberg
- Department of Neurosurgery; St.Olav University Hospital; Trondheim Norway
- Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
- Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy; St.Olav Hospital; Trondheim Norway
| | - P. Förander
- Department of Clinical Neuroscience; Section for Neurosurgery; Karolinska Institutet and Department of Neurosurgery; Karolinska University Hospital; Stockholm Sweden
| | - A. S. Jakola
- Department of Neurosurgery; St.Olav University Hospital; Trondheim Norway
- Department of Neurosurgery; Sahlgrenska Univerity Hospital; Gothenburg Sweden
- Institute of Neuroscience and Physiology; University of Gothenburg; Sahlgrenska Academy; Gothenburg Sweden
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19
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Kim SU, Lee DH, Kim YI, Yang SH, Sung JH, Cho CB. Predictive Factors for Recurrence after Burr-Hole Craniostomy of Chronic Subdural Hematoma. J Korean Neurosurg Soc 2017; 60:701-709. [PMID: 29142630 PMCID: PMC5678055 DOI: 10.3340/jkns.2016.1010.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/20/2016] [Accepted: 03/10/2017] [Indexed: 12/15/2022] Open
Abstract
Objective Chronic subdural hematoma is a common and relatively benign disease. However, recurrence is common after surgical treatment, and the recurrence rate varies from 5% to 33%. The aim of this study was to investigate the predictive factors for recurrence of chronic subdural hematoma. Methods We analyzed data from 248 patients with chronic subdural hematoma who were treated by burr-hole craniostomy with a closed drainage system for hematoma evacuation in this five-year retrospective study. Results Thirty-one (12.6%) patients underwent re-operation for recurrence of chronic subdural hematoma. Univariate analysis revealed that anticoagulation (p=0.0279), headache (p=0.0323), and preoperative midline shifting (p=0.0321) showed significant differences with respect to recurrent chronic subdural hematoma. We performed a multivariate logistic regression analysis and found that diabetes mellitus (odds ratio [OR], 2.618; 95% confidence interval [CI], 1.0899-6.2898; p=0.0314), anticoagulation (OR, 6.739; 95% CI, 1.1287-40.2369; p=0.0364), headache (OR, 2.951; 95% CI, 1.1464-7.5964; p=0.0249), and preoperative midline shifting (OR, 1.0838; 95% CI, 1.0040-1.1699; p=0.0391) were independent predictive factors for recurrence of chronic subdural hematoma. Conclusion We showed that diabetes mellitus, anticoagulation, headache, and preoperative midline shifting were independent predictors of recurrence of chronic subdural hematoma.
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Affiliation(s)
- Sang Uk Kim
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Young Il Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seung Ho Yang
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chul Bum Cho
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Predictors of Recurrence and Complications After Chronic Subdural Hematoma Surgery: A Population-Based Study. World Neurosurg 2017; 106:609-614. [PMID: 28735129 DOI: 10.1016/j.wneu.2017.07.044] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/09/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate predictors of recurrence and moderate to severe complications after burr-hole surgery for chronic subdural hematoma (cSDH). METHODS A retrospective review was conducted in a Scandinavian single-center population-based cohort of 759 adult patients with cSDH operated with burr-hole surgery between January 1, 2005 and December 31, 2010. Possible predictors of recurrence and complications, assessed using a standardized reporting system of adverse events, were identified and analyzed in univariable analyses. Variables with a P value < 0.10 were included in a multivariable regression model. RESULTS Recurrence was observed in 85 patients (11.2%), whereas moderate to severe complications were observed in 35 patients (4.6%). Bilateral hematoma (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.25-3.35; P < 0.01) and largest hematoma diameter in millimeters (OR, 1.05; 95% CI, 1.01-1.09; P < 0.01) were independent predictors of recurrence in the multivariable model analysis. Glasgow Coma Scale (GCS) score of <13 (OR, 6.06; 95% CI, 2.72-13.51; P < 0.01) and Charlson Comorbidity Index (CCI) >1 (OR, 2.28; 95% CI, 1.10-4.75; P = 0.03) were independent predictors of moderate to severe complications. CONCLUSIONS Recurrence after cSDH surgery is more often encountered in patients with radiologically more extensive disease reflected by bilateral hematoma and large hematoma diameter. On the other hand, moderate to severe complications are more often seen in patients in a worse clinical condition, reflected by decreased level of consciousness and more comorbidities.
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Yan K, Gao H, Zhou X, Wu W, Xu W, Xu Y, Gong K, Xue X, Wang Q, Na H. A retrospective analysis of postoperative recurrence of septated chronic subdural haematoma: endoscopic surgery versus burr hole craniotomy. Neurol Res 2017; 39:803-812. [PMID: 28502216 DOI: 10.1080/01616412.2017.1321709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Kaixuan Yan
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Heng Gao
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Xinmin Zhou
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Wei Wu
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Weidong Xu
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Yu Xu
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Kai Gong
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Xinchen Xue
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Qipin Wang
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
| | - Hanrong Na
- Department of Neurosurgery, The Affiliated Jiangyin Hospital, School of Medicine, Southeast University, Jiangyin, China
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Desai VR, Scranton RA, Britz GW. Management of Recurrent Subdural Hematomas. Neurosurg Clin N Am 2017; 28:279-286. [DOI: 10.1016/j.nec.2016.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Kuwabara M, Sadatomo T, Yuki K, Migita K, Imada Y, Shimizu K, Hara T, Oba H, Kurisu K. The Effect of Irrigation Solutions on Recurrence of Chronic Subdural Hematoma: A Consecutive Cohort Study of 234 Patients. Neurol Med Chir (Tokyo) 2017; 57:210-216. [PMID: 28367840 PMCID: PMC5447812 DOI: 10.2176/nmc.oa.2016-0228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chronic subdural hematomas (CSDHs) occur often in elderly persons and can occur with mild head trauma. With burr-hole irrigation as standard treatment, symptoms usually improve and can be cured, and outcomes are good, but postoperative recurrences are a common problem. This study investigated the effectiveness and recurrence rates when using artificial cerebrospinal fluid (ACF) instead of normal saline (NS) as an irrigation solution for burr-hole irrigation in patients with CSDH. This prospective study included 234 consecutive patients who underwent initial surgical treatment by burr-hole irrigation for a CSDH between April 2008 and June 2015. The irrigation solution used was changed from NS to ACF in June 2011. Factors examined with regard to recurrence included age, sex, unilateral or bilateral surgery, computed tomography (CT) findings, antiplatelet or anticoagulant drug use, past history, and irrigation solution (NS or ACF). These were analyzed by univariate and multivariate analyses. Univariate analyses (chi-square test) with a significance level <5% showed that recurrence rates were significantly lower in the ACF group than in the NS group (P = 0.003). Multivariate analysis (multiple logistic regression analysis) showed that the risk of recurrence was reduced 3.14-fold in the ACF group compared to the NS group (odds ratio, 3.143; 95% confidence interval, 0.1504–0.6733; P = 0.0028). None of the other factors were significantly different. In burr-hole irrigation for CSDH, the use of ACF instead of NS as an irrigation solution significantly reduces recurrence rates.
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Affiliation(s)
| | | | - Kiyoshi Yuki
- Department of Neurosurgery, Higashihiroshima Medical Center
| | - Keisuke Migita
- Department of Neurosurgery, Higashihiroshima Medical Center
| | - Yasutaka Imada
- Department of Neurosurgery, Higashihiroshima Medical Center
| | | | - Takeshi Hara
- Department of Neurosurgery, Higashihiroshima Medical Center
| | - Hideo Oba
- Department of Neurosurgery, Higashihiroshima Medical Center
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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Sivaraju L, Moorthy RK, Jeyaseelan V, Rajshekhar V. Routine placement of subdural drain after burr hole evacuation of chronic and subacute subdural hematoma: a contrarian evidence based approach. Neurosurg Rev 2017; 41:165-171. [DOI: 10.1007/s10143-017-0831-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
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Won SY, Konczalla J, Dubinski D, Cattani A, Cuca C, Seifert V, Rosenow F, Strzelczyk A, Freiman TM. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure 2017; 45:28-35. [DOI: 10.1016/j.seizure.2016.11.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/10/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022] Open
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Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ. Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg 2016; 127:1117-1125. [PMID: 27982768 DOI: 10.3171/2016.8.jns16867] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals. METHODS Kaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up. RESULTS This study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03-2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m2), and a bilateral operation. CONCLUSIONS This study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul; and
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Andersen-Ranberg NC, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. Bilateral chronic subdural hematoma: unilateral or bilateral drainage? J Neurosurg 2016; 126:1905-1911. [DOI: 10.3171/2016.4.jns152642] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEBilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors are associated with the retreatment of bCSDH with a focus on surgical laterality.METHODSIn a national database of CSDHs (Danish Chronic Subdural Hematoma Study) the authors retrospectively identified all bCSDHs treated in the 4 Danish neurosurgical departments over the 3-year period from 2010 to 2012. Univariate and multivariate analyses were performed to determine the relationship between retreatment of bCSDH and clinical, radiological, and surgical variables.RESULTSTwo hundred ninety-one patients with bCSDH were identified, and 264 of them underwent unilateral (136 patients) or bilateral (128 patients) surgery. The overall retreatment rate was 21.6% (57 of 264 patients). Cases treated with unilateral surgery had twice the risk of retreatment compared with cases undergoing bilateral surgery (28.7% vs 14.1%, respectively, p = 0.002). In accordance with previous studies, the data also showed that a separated hematoma density and the absence of postoperative drainage were independent predictors of retreatment.CONCLUSIONSIn bCSDHs bilateral surgical intervention significantly lowers the risk of retreatment compared with unilateral intervention and should be considered when choosing a surgical procedure.
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Affiliation(s)
| | | | - Bo Bergholt
- 3Department of Neurosurgery, Aarhus University Hospital, Aarhus; and
| | - Torben Hundsholt
- 4Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | - Kåre Fugleholm
- 1Department of Neurosurgery, Rigshospitalet University Hospital, Copenhagen
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Liu H, Luo Z, Liu Z, Yang J, Kan S. Atorvastatin May Attenuate Recurrence of Chronic Subdural Hematoma. Front Neurosci 2016; 10:303. [PMID: 27445673 PMCID: PMC4923224 DOI: 10.3389/fnins.2016.00303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 06/15/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. Atorvastatin may reduce CSDH via its anti-inflammatory and pro-angiogenesis effects, but its effectiveness for preventing recurrent CSDH has never been explored. We hypothesized that atorvastatin is effective in reducing recurrence of CSDH after surgery and identified determining factors predictive of hematoma recurrence. METHODS A prospective study was conducted in 168 surgical cases of CSDH.All patients were randomly assigned to the group treated with atorvastatin or control group. Clinically relevant data were compared between two groups, and subsequently between the recurrence and non-recurrence patients. Multiple logistic regression analysis of the relationship between atorvastatin treatment and the recurrence using brain atrophy, septated and bilateral hematoma was performed. RESULTS Atorvastatin group conferred an advantage by significantly decreasing the recurrence rate (P = 0.023), and patients managed with atorvastatin also had a longer time-to-recurrence (P = 0.038). Admission brain atrophy and bilateral hematoma differed significantly between the recurrence and non-recurrence patients (P = 0.047 and P = 0.045). The results of logistic regression analysis showed that atorvastatin significantly reduced the probability of recurrence; severe brain atrophy and bilateral hematoma were independent risk factors for recurrent CSDH. CONCLUSIONS Atorvastatin administration may decrease the risks of recurrence.Patients with severe brain atrophy and bilateral CSDH are prone to the recurrence.
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Affiliation(s)
- Hua Liu
- Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University Suzhou, China
| | - Zhengxiang Luo
- Department of Neurosurgery, The Affiliated Brain Hospital, Nanjing Medical University Nanjing, China
| | - Zhongkun Liu
- Department of Neurosurgery, The People's Hospital of AnQiu City Weifang, China
| | - Jian Yang
- Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated with Jiangsu University Suzhou, China
| | - Shifeng Kan
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated First People's Hospital Shanghai, China
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Kobayashi A, Nagashima G, Noda M, Kato A, Morishima H, Koike J. A case of organized arachnoid cyst with repeated hemorrhage. Clin Case Rep 2016; 4:250-4. [PMID: 27014445 PMCID: PMC4771866 DOI: 10.1002/ccr3.402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/29/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022] Open
Abstract
Hemorrhage sometimes occurs within arachnoid cysts, however, organized arachnoid cysts has not been reported. We speculate the previous invasive stress or some kind of infection may have triggered the formation of the organized membrane, which may have formed via a similar mechanism to that for organized chronic subdural hematomas.
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Affiliation(s)
- Atsushi Kobayashi
- Department of Neurosurgery St. Marianna University Kawasaki Municipal Hospital 1-30-37 Shukugawara Tama-ku Kawasaki-city Kanagawa 214-8525 Japan
| | - Goro Nagashima
- Department of Neurosurgery t. Marianna University Kawasaki Municipal Hospital 1-30-37 Shukugawara Tama-ku Kawasaki-city Kanagawa 214-8525 Japan; Division of Emergency and Disaster Center St. Marianna University Kawasaki Municipal Hospital 1-30-37 Shukugawara Tama-ku Kawasaki-city Kanagawa 214-8525 Japan
| | - Masayuki Noda
- Department of Neurosurgery St. Marianna University Kawasaki Municipal Hospital 1-30-37 Shukugawara Tama-ku Kawasaki-city Kanagawa 214-8525 Japan
| | - Akihito Kato
- Division of Emergency and Disaster Center St. Marianna University Kawasaki Municipal Hospital 1-30-37 Shukugawara Tama-ku Kawasaki-city Kanagawa 214-8525 Japan
| | - Hiroyuki Morishima
- Department of Neurosurgery St. Marianna University Kawasaki Municipal Hospital 1-30-37 Shukugawara Tama-ku Kawasaki-city Kanagawa 214-8525 Japan
| | - Junki Koike
- Department of Hospital Pathology St. Marianna University Kawasaki Municipal Hospital 1-30-37 Shukugawara Tama-ku Kawasaki-city Kanagawa 214-8525 Japan
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Agawa Y, Mineharu Y, Tani S, Adachi H, Imamura H, Sakai N. Bilateral Chronic Subdural Hematoma is Associated with Rapid Progression and Poor Clinical Outcome. Neurol Med Chir (Tokyo) 2016; 56:198-203. [PMID: 26923835 PMCID: PMC4831946 DOI: 10.2176/nmc.oa.2015-0256] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Chronic subdural hematoma (CSDH) has been recognized as a benign disease, but its clinical outcome is not well documented. This study aims to expand the knowledge base regarding the outcome of CSDH. We retrospectively reviewed clinical characteristics of CSDH operated in the Kobe City Medical Center General Hospital between June 2005 and June 2012. Variants included age at onset, sex, laterality, presence of headache, consciousness level, and risk factors for hemorrhage such as malignancy or intake of anticoagulants. A total of 368 cases were analyzed. Six patients (1.4%) had a poor outcome, defined as any morbidity or mortality at 7 days postoperatively. Bilateral hematoma was significantly associated with a poor outcome (p = 0.041). Warfarin use and malignancy, albeit statistically not significant, were more frequently observed in patients with a poor outcome. Bilateral CSDH was observed in 53 patients (14.4%). Age at onset, sex, history of malignancy, anticoagulant use, and antiplatelet use did not differ between bilateral and unilateral CSDH. Recurrence rate was not different between bilateral and unilateral CSDH (14.2% vs. 11.3%), but poor outcome as a result of brain herniation was significantly higher in bilateral than in unilateral hematomas (5.7% vs. 0.3%, p = 0.01). Bilateral CSDH was associated with rapid progression and showed worse outcome as a result of brain herniation in comparison with unilateral CSDH. Urgent trephination surgery for decompression of hematoma pressure may be recommended for bilateral CSDH.
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Affiliation(s)
- Yuji Agawa
- Department of Neurosurgery, Kobe City Medical Center General Hospital
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Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma. Acta Neurochir (Wien) 2016; 158:135-9. [PMID: 26602235 DOI: 10.1007/s00701-015-2625-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a frequently encountered neurosurgical condition, especially in the elderly. We investigated predictive factors for surgical and functional outcomes after burr-hole drainage (BHD) surgery. METHODS All patients with CSDH treated by BHD between January 2012 and December 2014 were included in this study. All patients were classified by symptom, clinical grade, time, location, hematoma density, midline shift, and other characteristics. Pre- and postoperative CT evaluation was performed at 0, 3, and 6 months. Clinical grades were classified as described in Markwalder et al. Surgical and clinical outcomes were evaluated with the brain expansion rate and modified Rankin Scale (mRS). Brain expansion rate was calculated as the ratio between post- and pre-operative hematoma thickness. Recurrence was defined as the occurrence of symptoms and hematoma on CT within 6 months. RESULTS This study included 130 patients over 2 years. Among the variable parameters, young age (<75), iso-density of hematoma on CT, and short duration from symptom to surgery were correlated with good brain expansion. Patients with good brain expansion had fewer recurrences. In terms of mRS, young age, iso-density, and good clinical grade were correlated with good functional outcomes. CONCLUSIONS Clinicians should be more aware of general conditions and medical problems, especially in elderly patients. Membranectomy should be considered in patients with a long duration of symptoms or hypo-dense hematomas to promote good brain expansion and good mRS scores.
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Jang KM, Kwon JT, Hwang SN, Park YS, Nam TK. Comparison of the Outcomes and Recurrence with Three Surgical Techniques for Chronic Subdural Hematoma: Single, Double Burr Hole, and Double Burr Hole Drainage with Irrigation. Korean J Neurotrauma 2015; 11:75-80. [PMID: 27169069 PMCID: PMC4847514 DOI: 10.13004/kjnt.2015.11.2.75] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/10/2015] [Accepted: 08/28/2015] [Indexed: 12/02/2022] Open
Abstract
Objective Chronic subdural hematoma (CSDH), a disease commonly encountered by neurosurgeons, is treated by burr hole drainage (BHD). However, the optimal surgical technique among the three types of BHD has not been determined. Methods We conducted a retrospective study on BHD performed on 93 patients who were diagnosed with CSDH. The subjects were divided into three groups based on the surgical technique performed: single BHD without irrigation (Group A, n=31), double BHD without irrigation (Group B, n=32), and double BHD with irrigation (Group C, n=30). The clinical factors, radiological factors and recurrences were compared between the three groups. Moreover, independent factors affecting the recurrence were analyzed. Results The change in hematoma thickness was 29.77±7.94%, 49.73±12.87%, and 75.29±4.32% for Group A, B, and C, respectively, while the change in midline shift was 40.81±15.47%, 51.78±10.94%, and 56.16±16.16%, respectively. Thus, Group C showed the most effective for resolution of hematoma and midline shift (p<0.05). Group A, B, and C had 12 cases (38.7%), 8 cases (25.0%), and 3 cases (10.0%) of recurrences, respectively. Group C had a statistically significantly fewer recurrence rate than Group A (p<0.05). Double burr hole, irrigation, and coagulopathy were each identified as independent factors that reduce recurrence (p<0.05). Conclusion Among the three techniques, the double BHD with saline irrigation resulted in the fewest recurrences. It is probably the most effective technique for preventing the recurrence of CSDH.
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Affiliation(s)
- Kyoung-Min Jang
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jeong-Taik Kwon
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Nam Hwang
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yong-Sook Park
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Taek-Kyun Nam
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
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Duret haemorrhage with full recovery. Acta Neurochir (Wien) 2015; 157:1337-8; discussion 1338. [PMID: 26136197 DOI: 10.1007/s00701-015-2486-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Rovlias A, Theodoropoulos S, Papoutsakis D. Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach. Surg Neurol Int 2015; 6:127. [PMID: 26257985 PMCID: PMC4524005 DOI: 10.4103/2152-7806.161788] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/19/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable prognosis. However, because of the advanced age and medical problems of patients, surgical therapy is frequently associated with various complications. This study evaluated the clinical features, radiological findings, and neurological outcome in a large series of patients with CSDH. METHODS A classification and regression tree (CART) technique was employed in the analysis of data from 986 patients who were operated at Asclepeion General Hospital of Athens from January 1986 to December 2011. Burr holes evacuation with closed system drainage has been the operative technique of first choice at our institution for 29 consecutive years. A total of 27 prognostic factors were examined to predict the outcome at 3-month postoperatively. RESULTS Our results indicated that neurological status on admission was the best predictor of outcome. With regard to the other data, age, brain atrophy, thickness and density of hematoma, subdural accumulation of air, and antiplatelet and anticoagulant therapy were found to correlate significantly with prognosis. The overall cross-validated predictive accuracy of CART model was 85.34%, with a cross-validated relative error of 0.326. CONCLUSIONS Methodologically, CART technique is quite different from the more commonly used methods, with the primary benefit of illustrating the important prognostic variables as related to outcome. Since, the ideal therapy for the treatment of CSDH is still under debate, this technique may prove useful in developing new therapeutic strategies and approaches for patients with CSDH.
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Affiliation(s)
- Aristedis Rovlias
- Department of Neurosurgery, Asclepeion General Hospital, Athens, Greece
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Tosaka M, Tsushima Y, Watanabe S, Sakamoto K, Yodonawa M, Kunimine H, Fujita H, Fujii T. Superficial subarachnoid cerebrospinal fluid space expansion after surgical drainage of chronic subdural hematoma. Acta Neurochir (Wien) 2015; 157:1205-14. [PMID: 25948079 DOI: 10.1007/s00701-015-2435-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study examined the computed tomography (CT) findings after surgery and overnight drainage for chronic subdural hematoma (CSDH) to clear the significance of inner superficial subarachnoid CSF space and outer subdural hematoma cavity between the brain surface and the inner skull. METHODS A total of 73 sides in 60 patients were evaluated. Head CT was performed on the day after surgery and overnight drainage (1st CT), within 3 weeks of surgery (2nd CT), and more than 3 weeks after surgery (3rd CT). Subdural and subarachnoid spaces were identified to focus on density of fluid, shape of air collection, and location of silicone drainage tube, etc. Cases with subdural space larger than the subarachnoid CSF space were classified as Group SD between the brain and the skull. Cases with subarachnoid CSF space larger than the subdural space were classified as Group SA. Cases with extremely thin (<3 mm) spaces between the brain and the skull were classified as Group NS. RESULTS Group SA, SD, and NS accounted for 31.9, 55.6 and 12.5% of cases on the 1st CT. No statistical differences were found between Groups SA, SD, and NS in any clinical factors, including recurrence. Group SA were found significantly more on 1st CT than on 2nd and 3rd CT. CONCLUSIONS Subarachnoid CSF space sometimes expands between the brain and skull on CT after surgical overnight drainage. Expansion of the arachnoid space may be a passive phenomenon induced by overnight drainage and delayed re-expansion of the brain parenchyma.
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Mekaj AY, Morina AA, Mekaj YH, Manxhuka-Kerliu S, Miftari EI, Duci SB, Hamza AR, Gashi MM, Xhelaj MR, Kelmendi FM, Morina QS. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012. J Neurosci Rural Pract 2015; 6:186-90. [PMID: 25883478 PMCID: PMC4387809 DOI: 10.4103/0976-3147.153225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008–2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.
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Affiliation(s)
- Agon Y Mekaj
- Department of Neurosurgery, Univesity Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Arsim A Morina
- Department of Neurosurgery, Univesity Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Ymer H Mekaj
- Institute of Pathophysiology, Faculty of Medicine, University of Prishtina, Prishtina 10000, Kosovo
| | - Suzana Manxhuka-Kerliu
- Institute of Pathology, Faculty of Medicine, University of Prishtina, Prishtina 10000, Kosovo
| | - Ermira I Miftari
- The Hospital and University Clinical Service of Kosovo, Prishtina 10000, Kosovo
| | - Shkelzen B Duci
- Department of Plastic Surgery, Univesity Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Astrit R Hamza
- Department of General Surgery, Univesity Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Musli M Gashi
- Department of Emergency, Univesity Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Mentor R Xhelaj
- The Hospital and University Clinical Service of Kosovo, Prishtina 10000, Kosovo
| | - Fatos M Kelmendi
- Department of Neurosurgery, Univesity Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Qamile Sh Morina
- Department of Anaesthesiology, Univesity Clinical Center of Kosovo, Prishtina 10000, Kosovo
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Lee J, Park JH. Clinical Characteristics of Bilateral versus Unilateral Chronic Subdural Hematoma. Korean J Neurotrauma 2014; 10:49-54. [PMID: 27169033 PMCID: PMC4852599 DOI: 10.13004/kjnt.2014.10.2.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/19/2014] [Accepted: 06/27/2014] [Indexed: 11/15/2022] Open
Abstract
Objective Chronic subdural hematoma (CSDH) is a common intracranial hemorrhage that is associated with significant morbidity. Bilateral lesions are occasionally found in neurosurgical practice. The purpose of this study is to analyze clinical characteristics of bilateral CSDH compared with unilateral CSDH. Methods Between January 2005 and January 2013, the authors treated 114 surgical patients with CSDH. Clinical presentations, precipitating factors, computed tomography (CT) findings, postoperative complications, and outcomes of patients were retrospectively analyzed in the bilateral and unilateral CSDH groups. Results Bilateral CSDH was identified in 28 (24.6%) of the 114 CSDH patients. The mean age was 77.85 years in the bilateral CSDH group. The frequency of altered consciousness as a presenting symptom was significantly higher in the bilateral CSDH, and that of hemiparesis was significantly higher in the unilateral CSDH (p=0.015). Diabetes mellitus was more common in the bilateral CSDH (p=0.001). CT scans revealed significant differences in the degree of midline shift (p=0.001). The mean modified Rankin scale at discharge was 1.5 in the bilateral CSDH group and 0.6 in the unilateral group (p=0.019). Conclusion Bilateral CSDH showed different clinical characteristics from unilateral CSDH. Bilateral CSDH is prone to occurrence in the patient of old and diabetics. The patients of bilateral CSDH seem to reveal worse mental status and neurologic sign than unilateral CSDH in both baseline and postoperative state.
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Affiliation(s)
- Jungjun Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Ilsan, Korea
| | - Jae Hyo Park
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Ilsan, Korea
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Park HS, Park ES, Park JB, Kwon SC, Lyo IU, Kim MH, Sim HB. Chronic Subdural Hematomas: Comparison between Unilateral and Bilateral Involvement. Korean J Neurotrauma 2014; 10:55-9. [PMID: 27169034 PMCID: PMC4852612 DOI: 10.13004/kjnt.2014.10.2.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 11/15/2022] Open
Abstract
Objective Chronic subdural hematoma (CSDH) is a common intracranial hemorrhage, encountered in neurosurgical practice. Most CSDHs are unilateral, but some show bilateral involvement. However, the clinical characteristics of bilateral CSDH remain unclear. In this study, we investigated the clinical differences between bilateral and unilateral CSDH. Methods A retrospective study was performed on 120 patients with CSDH surgically treated at our institute from January 2008 to December 2012. Patients were divided into two groups: the bilateral CSDH and the unilateral CSDH groups. Clinical presentations, precipitating factors, computed tomography (CT) findings, postoperative complications, and outcomes of patients were analyzed. Results Bilateral CSDH was identified in 11 of 120 (10.9%) patients with CSDH. Patients with bilateral CSDH tended to have a lower rate of head injury compared to patients with unilateral CSDH (36.4% vs. 59.6%), but it had no statistical significance (p=0.201). The frequency of marked midline shift on CT scans was significantly greater in unilateral CSDH than in bilateral CSDH (p=0.010). Presenting symptoms, coexisting systemic diseases, postoperative complications, and clinical outcomes were not significantly different between the two groups. Conclusion Bilateral CSDH has comparatively similar clinical features and precipitating factors as unilateral CSDH. Patients with bilateral CSDH have significantly lower incidences of midline shift on CT scans, and most patients with either bilateral or unilateral CSDH have good postoperative outcomes.
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Affiliation(s)
- Hyun Seok Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Uk Lyo
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min-ho Kim
- Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hong Bo Sim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Seifi A, Asadi-Pooya AA, Carr K, Maltenfort M, Emami M, Bell R, Moussouttas M, Yazbeck M, Rincon F. The epidemiology, risk factors, and impact on hospital mortality of status epilepticus after subdural hematoma in the United States. SPRINGERPLUS 2014; 3:332. [PMID: 25077058 PMCID: PMC4112038 DOI: 10.1186/2193-1801-3-332] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
Abstract
Introduction Subdural hematoma (SDH) is a well described risk factor in the development of Status Epilepticus (SE), however the epidemiology of SE after SDH is unknown. In this study, we sought to determine the epidemiology of SE, the prevalence of risk factors, and impact on hospital mortality using a large administrative dataset. Methods Data was derived from the Nationwide Inpatient Sample from 1988 through 2011. We queried the NIS database for patients older than 18 years, with a diagnosis of SDH and SE. Diagnoses were defined by ICD 9 CM codes 432.1, 852.2, 852.3 and 345.3 for SE. Adjusted incidence rates of admission and prevalence proportions were calculated. Multivariate logistic models were then fitted to assess for the impact of status epilepticus on hospital mortality. Results Over the 23-year period, we identified more than 1,583,255 admissions with a diagnosis of SDH. The prevalence of SE in this cohort was 0.5% (7,421 admissions). The population adjusted incidence rate of admissions of SDH increased from 13/100,000 in 1988 to 38/100,000 in 2011. The prevalence of SE in SDH, increased from 0.5% in 1988 to 0.7% in 2011. In hospital mortality of patients with SDH and without SE decreased from 17.9% to 10.3% while in hospital mortality of patients with SDH and SE did not statistically change. Mortality increased over the same period (2.3/100,000 in 1988 to 3.9/100.000 in 2011) and the diagnosis of SE increased mortality in this cohort (OR 2.17, p < 0.0001). The risk of SE remained stable throughout the study period, but was higher among older patients, blacks, and in those with respiratory, metabolic, hematological, and renal system dysfunction. Conclusion Our study demonstrates that the incidence of admissions of SDH is increasing in the United States. Despite a decline in the overall SDH related mortality, SE increased the risk of in-hospital death in patients with a primary diagnosis of SDH.
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Affiliation(s)
- Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health Science Center at San Antonio, Mail Code 7843, 7703 Floyd Curl Drive, Medical School Building 102F, San Antonio, TX 78229-3900 USA
| | - Ali Akbar Asadi-Pooya
- Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA
| | - Kevin Carr
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health Science Center at San Antonio, Mail Code 7843, 7703 Floyd Curl Drive, Medical School Building 102F, San Antonio, TX 78229-3900 USA
| | | | - Mehrdad Emami
- Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Michael Moussouttas
- Division of Neuro Critical Care, Capital Institute for Neurosciences, Trenton, USA
| | - Moussa Yazbeck
- Department of Neurosurgery, John Muir Medical Center, Walnut Creek, USA
| | - Fred Rincon
- Department of Neurology and Neurosurgery, Thomas Jefferson University, Philadelphia, USA
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Subacute and chronic subdural hematoma in young population less than 40 years. INDIAN JOURNAL OF NEUROTRAUMA 2014. [DOI: 10.1016/j.ijnt.2014.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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KAYACI S, KANAT A, KOKSAL V, OZDEMIR B. Effect of inner membrane tearing in the treatment of adult chronic subdural hematoma: a comparative study. Neurol Med Chir (Tokyo) 2014; 54:363-73. [PMID: 24477064 PMCID: PMC4533437 DOI: 10.2176/nmc.oa.2013-0147] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/01/2013] [Indexed: 12/04/2022] Open
Abstract
The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. The study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. In the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 ± 0.2 mm, and for Group 2, 14.3 ± 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p < 0.05). The means were 6.6 ± 0.2 mm for Group 1 and 10.3 ± 0.5 mm for Group 2 on the seventh day (p < 0.05). Recurrence rate was 8.3% in Group 2 and 0 in Group 1. This difference was statistically significant (p = 0001). The length of hospital stay was 7.0 ± 0.1 days for the Group 1 and 8.8 ± 0.2 days for Group 2 and this difference was significant (p < 0.05). These results indicate that the CTIM technique is preferable because it results in earlier re-expansion, lower recurrence, less subdural effusion and pneumocephalus, and shorter hospital stays.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Craniotomy/instrumentation
- Craniotomy/methods
- Female
- Glasgow Coma Scale
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/epidemiology
- Hematoma, Subdural, Chronic/pathology
- Hematoma, Subdural, Chronic/surgery
- Humans
- Length of Stay/statistics & numerical data
- Male
- Membranes/surgery
- Middle Aged
- Pneumocephalus/epidemiology
- Pneumocephalus/etiology
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Recurrence
- Retrospective Studies
- Suction
- Tomography, X-Ray Computed
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Affiliation(s)
- Selim KAYACI
- Department of Neurosurgery, Recep Tayyip Erdogan University, Rize, Turkey
| | - Ayhan KANAT
- Department of Neurosurgery, Recep Tayyip Erdogan University, Rize, Turkey
| | - Vaner KOKSAL
- Department of Neurosurgery, Recep Tayyip Erdogan University, Rize, Turkey
| | - Bulent OZDEMIR
- Department of Neurosurgery, Recep Tayyip Erdogan University, Rize, Turkey
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Lee GY, Oh CH, Shim YS, Yoon SH, Park HC, Park CO, Hyun D. Comparison of drainage volume of chronic subdural hematoma according to drainage catheter type. Yonsei Med J 2013; 54:1091-7. [PMID: 23918556 PMCID: PMC3743203 DOI: 10.3349/ymj.2013.54.5.1091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the therapeutic value of two different drainage catheters in treating chronic subdural hematoma (CSDH). MATERIALS AND METHODS Two types of drainage catheters can be used to treat CSDH according to the position of holes in the catheter: open-type or closed-type catheter. In this retrospective study, 199 total patients with CSDH were reviewed according to catheter type. Among them, 84 patients were and 113 in the closed-type group (holes positioned within the distal- most 1 cm of the catheter). The surgeon selected the catheter type. Total drainage volume, initial drainage volume within 2 days, percentage of initial drainage volume per total drainage volume, duration of catheter insertion, and reoperation rate were compared. RESULTS Total drainage volume was not different between the two groups (p=0.333). The initial drainage volume within 2 days was larger in the open-type group than closed-type group (p=0.024), but the percentage of initial drainage volume per total drainage volume was not different (p=0.354). The duration of catheter insertion was shorter in the open-type group than closed-type group (p=0.015). The reoperation rate of CSDH was also higher in the open-type group than closed-type group (p=0.004). CONCLUSION CSDH drainage with an open-type catheter is faster compared with a closed-type catheter, but total drainage volume is similar and reoperation rate is higher. Therefore, the open-type catheter for CSDH drainage has limited clinical value.
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Affiliation(s)
- Gun-Young Lee
- Department of Neurosurgery, School of Medicine, Inha University, Incheon, Korea
| | - Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea
| | - Yu Shik Shim
- Department of Neurosurgery, School of Medicine, Inha University, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, School of Medicine, Inha University, Incheon, Korea
| | - Hyeong-Chun Park
- Department of Neurosurgery, School of Medicine, Inha University, Incheon, Korea
| | - Chong Oon Park
- Department of Neurosurgery, School of Medicine, Inha University, Incheon, Korea
| | - Dongkeun Hyun
- Department of Neurosurgery, School of Medicine, Inha University, Incheon, Korea
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Hashimoto T, Ohashi T, Watanabe D, Koyama S, Namatame H, Izawa H, Haraoka R, Okada H, Ichimasu N, Akimoto J, Haraoka J. Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas. Surg Neurol Int 2013; 4:104. [PMID: 24032079 PMCID: PMC3766342 DOI: 10.4103/2152-7806.116679] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/10/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is generally treated by burr hole irrigation. However, sometimes repeated recurrence is observed, and treatment may consequently become difficult. We examined the efficacy of embolization of the middle meningeal artery (MMA) for such cases. METHODS We considered embolization of the MMA for three patients who had refractory CSDH with repeated recurrence and two CSDH patients who were at risk of recurrence and showed signs of recurrence after surgery. A microcatheter was advanced through the MMA as peripherally as possible, and embolization was performed with 15-20% n-butyl-2-cyanoacrylate or 200 μm polyvinyl alcohol particles. RESULTS EMBOLIZATION WAS PERFORMED IN THE THREE PATIENTS WHO HAD REFRACTORY CSDH WITH REPEATED RECURRENCE: The procedure was performed after burr hole irrigation of the hematoma in two patients and before the irrigation in one patient. In the two CSDH patients at risk of recurrence, embolization was performed when signs of recurrence appeared. The timing of embolization differed for each patient. However, in all the patients, the hematoma tended to decrease in size, and no recurrence was observed. CONCLUSION Embolization of the MMA is effective for refractory CSDH or CSDH patients with a risk of recurrence, and is considered an effective therapeutic method to stop hematoma enlargement and promote resolution.
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Affiliation(s)
- Takao Hashimoto
- Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjyuku Shinjyukuku Tokyo 160-0023, Japan
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Bilateral chronic subdural hematoma: What is the clinical significance? Int J Surg 2013; 11:544-8. [DOI: 10.1016/j.ijsu.2013.05.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/03/2013] [Accepted: 05/03/2013] [Indexed: 11/22/2022]
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Abstract
OBJECTIVE To investigate the reason for and the course of the double-layer appearance in the postoperative computed tomographies (CTs) of chronic subdural hematoma (CSDHs). METHODS We reviewed CSDH cases that were operated on during the last 3 years, between January 2008 and December 2010. We checked the preoperative, early postoperative, and late postoperative CTs of these patients. We investigated the relationship between the formation of a double-layer appearance and the prognoses and demographic characteristics of the patients. RESULTS Our database included 119 cases. A double-layer appearance was found in the postoperative CTs of 34 cases. The mean age of double-layer cases was older (72.5 ± 12.1) than that of the remaining 85 cases (63.1 ± 17.8). We did not find any relationship between the double-layer appearance and the reoperation/recurrence/death rates. CONCLUSIONS The double-layer appearance after evacuation of a CSDH might be caused by enlargement of the subarachnoid space and is not related to the presence of any residual hematoma. This appearance is not considered as a reason for reoperation.
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Affiliation(s)
- Hasan Kamil Sucu
- Department of Neurosurgery, İzmir Atatürk Research and Training Hospital , İzmir , Turkey
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Rabiu TB. Chronic subdural hematoma: A survey of neurosurgeons' practices in Nigeria. Surg Neurol Int 2013; 4:58. [PMID: 23646268 PMCID: PMC3640223 DOI: 10.4103/2152-7806.110657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/29/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and treated by surgical drainage early. Aware of the reported variations in neurosurgeons' practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH. METHODS An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July-December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring. RESULTS Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of the 14 neurosurgeons taking part in the study said they routinely order CT scans postoperatively. CONCLUSION There are several differences in the ways Nigerian neurosurgeons manage CSDH. Future studies may help to streamline the approaches to managing CSDH.
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Affiliation(s)
- Taopheeq B Rabiu
- Division of Neurological Surgery, Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
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GODLEWSKI B, PAWELCZYK A, PAWELCZYK T, CERANOWICZ K, WOJDYN M, RADEK M. Retrospective Analysis of Operative Treatment of a Series of 100 Patients With Subdural Hematoma. Neurol Med Chir (Tokyo) 2013; 53:26-33. [DOI: 10.2176/nmc.53.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bartosz GODLEWSKI
- Department of Neurosurgery and Peripheral Nerves Surgery, WAM University Hospital in Lodz, Medical University of Lodz
| | | | - Tomasz PAWELCZYK
- Department of Affective and Psychotic Disorders, Medical University of Lodz
| | - Katarzyna CERANOWICZ
- Department of Neurosurgery and Peripheral Nerves Surgery, WAM University Hospital in Lodz, Medical University of Lodz
| | - Maciej WOJDYN
- Department of Neurosurgery and Peripheral Nerves Surgery, WAM University Hospital in Lodz, Medical University of Lodz
| | - Maciej RADEK
- Department of Neurosurgery and Peripheral Nerves Surgery, WAM University Hospital in Lodz, Medical University of Lodz
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Effects of Newly Designed Drainage Catheter in Treating Chronic Subdural Hematoma. Korean J Neurotrauma 2013. [DOI: 10.13004/kjnt.2013.9.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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de Araújo Silva DO, Matis GK, Costa LF, Kitamura MAP, de Carvalho Junior EV, de Moura Silva M, Barbosa BJAP, Pereira CU, da Silva JC, Birbilis TA, de Azevedo Filho HRC. Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot! Surg Neurol Int 2012; 3:150. [PMID: 23372967 PMCID: PMC3551521 DOI: 10.4103/2152-7806.104744] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/27/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To present the accumulated experience from treating chronic subdural hematomas (CSDH) in a local hospital of a third world country. METHODS One hundred and twenty-five consecutive patients with CSDH who were surgically treated in the Neurosurgical Department of the Hospital da Restauração, Recife-PE, Brazil, between January 2006 and May 2008, were retrospectively studied. Glasgow Outcome Scale (GOS) was employed to define outcome at 6 months as good (GOS 4 and 5) or poor (GOS ≤ 3). Age, admission Glasgow Coma Scale (GCS), location of hematomas (unilateral/bilateral), drainage system placement and recurrence were all analyzed for potential impact on final outcome. RESULTS The median age was 69 years, with a male/female ratio of 102/23. History of trauma was present in 60.8% of the patients. The median GCS on admission was 14. In 64 patients, the hematoma was on the left side, while in 42 patients it was on the right side. Bilateral hematomas were present in 19 cases (15.2%). Drainage systems were used in 93.6% of the cases. Recurrence occurred in 8.8% of the patients. One hundred and three patients obtained a good outcome at 6 months. The mortality rate was 11.2%. Patients with GCS ≥9 on admission presented better outcome (P < 0.05). Recurrent cases presented a poor outcome (P < 0.05). CONCLUSIONS This study suggests that the main factors associated with outcome in patients harboring CSDH are the admission GCS score and the recurrence status. Advanced age is not a contraindication for surgical treatment. This study, solely focused on the Brazilian population, is the first of its kind in the English literature, and it could serve as a useful introduction to a more complex, multivariate, debate.
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