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Lv E, Xue X, Xu Z. Endovascular Embolization and Atorvastatin Therapy for Recurrent Chronic Subdural Hematoma. J Craniofac Surg 2024:00001665-990000000-01750. [PMID: 38958956 DOI: 10.1097/scs.0000000000010465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024] Open
Abstract
Recurrent chronic subdural hematoma poses a significant clinical challenge. While craniotomy effectively removes the hematoma membrane, it is an invasive procedure associated with significant trauma. Recently, endovascular embolization of the middle meningeal artery has emerged as a promising minimally invasive alternative, demonstrating efficacy and a low recurrence rate in treating chronic subdural hematoma. Furthermore, postoperative administration of oral atorvastatin calcium may enhance hematoma absorption, thereby improving patient outcomes during the early recovery phase.
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Affiliation(s)
- Enzhen Lv
- Dezhou Seventh People's Hospital, Dongfeng Zhong Lu, Decheng, Dezhou, Shandong, China
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Wei Q, Fan G, Li Z, Wang Q, Li K, Wang C, Li Z. Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma. Front Neurol 2021; 12:651362. [PMID: 34777190 PMCID: PMC8582486 DOI: 10.3389/fneur.2021.651362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bilateral chronic subdural hematoma (bCSDH) is a frequent condition commonly linked to the need for retreatment; however, the reason for this high retreatment rate remains unclear. The middle meningeal artery (MMA) was found to have a relationship with the occurrence and development of chronic subdural hematomas. This study examines a possible method to reduce bCSDH recurrence using bilateral MMA embolization combined with bilateral burr-hole drainage. Materials and Methods: Ten patients with bCSDH who underwent bilateral MMA embolization combined with bilateral burr-hole drainage at our hospital between June 2018 and May 2020, were retrospectively analyzed. Patients' clinical information, prognoses, imaging results, as well as surgical results were documented and analyzed. Results: Ten patients were diagnosed with bCSDH with no comorbid brain diseases. They underwent bilateral MMA embolization combined with bilateral burr-hole drainage. We embolized the MMA immediately before burr hole drainage successfully and employed angiography to validate these results. All the patients attained relief of symptoms without adverse events, and no re-expansion or relapse was reported in the follow-up computed tomography. Conclusion: Bilateral MMA embolization combined with bilateral burr-hole drainage is an available treatment for patients with bCSDH and may have the potential for preventing recurrence.
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Affiliation(s)
- Qi Wei
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Gangxian Fan
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China.,Department of Neurosurgery, Linyi People's Hospital, Linyi, China
| | - Zhenzhu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China.,Department of Neursosurgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Qingbo Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Ke Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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Zolfaghari S, Bartek J, Djärf F, Wong SS, Strom I, Ståhl N, Jakola AS, Nittby Redebrandt H. Risk factors for need of reoperation in bilateral chronic subdural haematomas. Acta Neurochir (Wien) 2021; 163:1849-1856. [PMID: 33796888 PMCID: PMC8195919 DOI: 10.1007/s00701-021-04811-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is one of the most common neurosurgical diseases. A subtype of CSDH is bilateral chronic subdural haematoma (bCSDH) which represents 20-25% of patients with CSDH and has a higher recurrence rate. There is no clear consensus on how bCSDH should be treated regarding upfront unilateral- or bilateral evacuation of both haematomas. The purpose of this study was to identify risk factors associated with reoperation of bCSDH. METHODS A total of 326 patients with radiological evidence of bCSDH were included in this retrospective cohort study where 133 (40.8%) patients underwent primary bilateral evacuation and 193 (59.2%) primary unilateral evacuation. The two centres operated using different surgical approaches. Analyses were performed to identify risk factors associated with reoperation of bCSDH. Reoperation rate was defined as reoperation of CSDH on either side of the hemisphere within 3 months after primary evacuation. RESULTS The cohort had a total reoperation rate of 26.4%. Patients which underwent unilateral evacuation had a reoperation rate of 32.1%, and the bilateral group had a reoperation rate of 18.0% (p=0.005). Multivariable logistic regression identified unilateral evacuation (OR 1.91, p=0.022) and complications according to Ibanez (OR 2.20, p=0.032) to be associated with the need of reoperation of bCSDH. One-burr hole craniostomy with active subgaleal drain was primarily performed in bilateral approach (69.4%) whereas patients operated with minicraniotomy with passive subdural drain were primarily operated by unilateral evacuation of the larger symptomatic side (92.8%). CONCLUSIONS Unilateral evacuation of bCSDH was associated with a higher risk for reoperation than upfront bilateral evacuations in this study. There is a need to further discuss the criteria for uni- or bilateral evacuation since patients are treated differently at different centres.
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Affiliation(s)
- Shaian Zolfaghari
- Department of Neurosurgery, Institution of Clinical Sciences, Lund University, Lund, Sweden.
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Neuroscience and Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Felix Djärf
- Department of Neurosurgery, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - San-San Wong
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience and Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Isabelle Strom
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience and Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nils Ståhl
- Department of Neurosurgery, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Asgeir S Jakola
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
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Honda M, Maeda H. Intraoperative hematoma volume can predict chronic subdural hematoma recurrence. Surg Neurol Int 2021; 12:232. [PMID: 34221563 PMCID: PMC8247721 DOI: 10.25259/sni_97_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background: We routinely measured the exact chronic subdural hematoma (CSDH) volume during single burr hole surgery. To date, several risk factors have been reported for CSDH recurrence, including sex, hematoma volume and degree of midline shift calculated from computed tomography, use of anticoagulants or antiplatelet medications, and alcohol consumption habits. The aim of this study was to clarify whether hematoma volume, in conjunction with other factors, can predict recurrence. Methods: We retrospectively reviewed the clinical data of 194 consecutive patients with CSDH who underwent single burr hole surgery. The risk factors for recurrence were analyzed based on patients’ sex, age, bilaterality, existence of apparent trauma history, exact intraoperative hematoma volume, and various clinical factors, including preoperative anticoagulant/antiplatelet intake. Results: Recurrence occurred in 22 patients (11.3%). Multivariate logistic regression analysis revealed that intraoperative hematoma volume was an independent risk factor for CSDH recurrence (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.01–1.02, P < 0.001), in addition to sex (male) (OR 9.25; 95% CI, 1.00–84.8; P = 0.049) and diabetes mellitus (DM) (OR: 3.97, 95% CI, 1.34–11.7, P = 0.013). Based on receiver operating characteristics analysis, the cutoff value of the hematoma volume predicting CSDH recurrence was 150 ml (sensitivity and specificity of 72.7% and 72.1%, respectively; area under the curve: 0.7664, 95% CI: 0.654–0.879, P < 0.001). Of these, a hematoma volume ≥150 mL was the strongest independent risk factor for recurrence according to multiple regression (OR: 8.98, 95% CI: 2.73–29.6, P < 0.001) and Cox regression analysis (hazard ratio: 3.05, 95% CI: 1.18–7.87, log-rank P = 0.0046, P = 0.021). Follow-up periods after surgery were significantly longer for cases with recurrence than for non-recurrence cases (24.8 ± 11.5 vs. 15.9 ± 9.7 days), and the recurrence prediction cutoff value was 17 days, with a sensitivity and specificity of 83.1% and 68.2%, respectively (AUC: 0.7707, 95% CI: 0.6695–0.8720, P < 0.001). Conclusion: Intraoperative hematoma volume could be a predictive value for CSDH recurrence.
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Affiliation(s)
- Masaru Honda
- Department of Neurosurgery, Shunan Memorial Hospital, Kudamatsu, Yamaguchi, Japan
| | - Hajime Maeda
- Department of Neurosurgery, Shunan Memorial Hospital, Kudamatsu, Yamaguchi, Japan
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Development of a prognostic scoring system to predict risk of reoperation for contralateral hematoma growth after unilateral evacuation of bilateral chronic subdural hematoma. J Clin Neurosci 2020; 78:79-85. [DOI: 10.1016/j.jocn.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/30/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
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Recurrent Bilateral Chronic Subdural Hematoma After Interventional Embolization Combined With Drilling and Drainage Treatment. J Craniofac Surg 2020; 31:e171-e173. [PMID: 31895851 DOI: 10.1097/scs.0000000000006128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The main treatment for chronic subdural hematoma (CSDH) is surgical drilling and drainage. Meanwhile, the most accepted treatment strategy for bilateral CSDHs (bCSDHs) is unilateral evacuation only on the larger or symptomatic side because the contralateral hematoma is generally either small or asymptomatic. However, the probability of recurrence is high. To effectively reduce this recurrence rate, embolization has been proposed. Because middle meningeal artery embolization may effectively block the blood supply of the CSDH, its combination with drilling and drainage could be an effective treatment strategy for addressing unilateral CSDH (uCSDH). In addition, the recurrence mechanism of bCSDH may be not completely same as that of the uCSDH. Hence, the authors need find a more effective treatment for it.
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Shen J, Xin W, Li Q, Gao Y, Zhang J. A Grading System For The Prediction Of Unilateral Chronic Subdural Hematoma Recurrence After Initial Single Burr Hole Evacuation. Risk Manag Healthc Policy 2019; 12:179-188. [PMID: 31802959 PMCID: PMC6830374 DOI: 10.2147/rmhp.s222144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have identified many risk factors related to the recurrence of chronic subdural hematomas (CSDHs). Among these factors, there may be deviations in measuring the midline shift, preoperative hematoma volume (PreHV), postoperative hematoma residual volume, and postoperative pneumocephalus in bilateral CSDHs. The aims of this study were to eliminate the impact of complicated situations on parameter measurement and to identify actual predictors for CSDH recurrence, and finally, to develop a grading system to predict unilateral CSDH (uCSDH) recurrence. PATIENTS AND METHODS A total of 342 patients with uCSDH were identified. Predictors of uCSDH recurrence were obtained from univariable and multivariable logistic regression models. A prognostic grading system was developed based on the results of multivariable logistic regression and receiver operating characteristic (ROC) analyses. All patients were scored according to the grading system, and differences in the recurrence rate were reanalyzed according to the scores. RESULTS Age, antiplatelet or anticoagulant use, midline shift, severe brain atrophy, drainage volume, and the ratio of the postoperative pneumocephalus volume (PostPV) to the postoperative hematoma cavity volume (PostHCV) were identified as independent risk factors for predicting the recurrence of uCSDH. The cut-off values of age, drainage volume, midline shift, and the ratio of the PostPV to the PostHCV were 67 years, 101 mL, 11.2 mm, and 31.61%, respectively. The recurrence rates were 1.7%, 12.4%, 19.4%, 53.3%, and 58.3% for scores of 0-1, 2, 3, 4, and 5-6, respectively, which significantly increased as the score increased (P<0. 001). CONCLUSION The prognostic grading system for uCSDH on the basis of multivariable logistic regression and ROC analyses is applicable and reliable.
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Affiliation(s)
- Jun Shen
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu City, Anhui241001, People’s Republic of China
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin300052, People’s Republic of China
- Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, People’s Republic of China
| | - Wenqiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin300052, People’s Republic of China
- Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, People’s Republic of China
| | - Qifeng Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin300052, People’s Republic of China
- Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, People’s Republic of China
| | - Yalong Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin300052, People’s Republic of China
- Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, People’s Republic of China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin300052, People’s Republic of China
- Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, People’s Republic of China
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Shen J, Shao X, Gao Y, Li Q, Ge R, Wang Q, Zhou W, Jiang X. Risk Factors for Contralateral Hematoma Progression after Unilateral Evacuation of Bilateral Chronic Subdural Hematomas. World Neurosurg 2019; 126:e773-e778. [PMID: 30853519 DOI: 10.1016/j.wneu.2019.02.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To find risk factors for contralateral hematoma progression (CHP) in bilateral chronic subdural hematomas after initial unilateral evacuation. METHODS We retrospectively analyzed 53 patients with bilateral chronic subdural hematomas who underwent unilateral surgical evacuation in our department. Risk factors for CHP were identified by univariate analysis, a P value <0.05 were entered into multivariate logistic regression model and a predictive receiver operating characteristic curve model. RESULTS The progression rate was 32.08%, the average progression interval was 2.32 months. The progression rate of the homogeneous hypodense group was significantly higher than that of the other density group (P = 0.017). The limited type of contralateral hematoma had a significantly lower progression rate than that of the widespread type (P = 0.001). Both pre- and postoperative volume of contralateral hematoma were significantly more in the CHP group compared with the contralateral hematoma without progression group (P = 0.031 and P = 0.001, respectively). Of the 4 risk factors, only postoperative volume of contralateral hematoma was an independent risk factor in multivariate logistic regression model (P = 0.033; 95% confidence interval, 1.005-1.124). The cut-off values of contralateral hematoma volume before and after operation were 29.27 cm3 and 37.84 cm3, respectively. CONCLUSIONS Contralateral hematoma volume after operation is an independent risk predictor for CHP after unilateral evacuation. An additional surgery on contralateral hematoma or medical treatment should be taken into consideration if the volume is >37.84 cm3 in the first cranial computed tomography scan after surgery.
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Affiliation(s)
- Jun Shen
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
| | - Xuefei Shao
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - YaLong Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Qifeng Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Ruixiang Ge
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Qifu Wang
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Wei Zhou
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - XiaoChun Jiang
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
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