Analysis of predisposing factors for chronic subdural hematoma recurrence

Abstract

SUMMARY OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of 595 patients with an initial diagnosis of Chronic Subdural Hematoma (CSDH) who underwent surgical treatment at a Reference Hospital of São Paulo. METHODS: A retrospective descriptive study, in which the medical records of all patients with a CSDH diagnosis submitted to surgical treatment from 2000 to 2014 were analyzed. RESULTS: The final study population consisted of 500 patients with a diagnosis of CSDH (95 patients with a diagnosis of Cystic Hygroma were excluded), of which 27 patients presented recurrence of the disease (5.4%). There were no statistically significant differences in relapses when cases were stratified by gender, laterality of the first episode or surgical procedure performed in the first episode (trepanning vs. craniotomy). It was possible to demonstrate an age-related protective factor, analyzed as a continuous variable, regarding the recurrence of the CSDH, with a lower rate of recurrence the higher the age. CONCLUSIONS: The results indicate that, among possible factors associated with recurrence, only age presented a protective factor with statistical significance. The fact that no significant difference between the patients submitted to trepanning or craniotomy was found favors the preferential use of burr-hole surgery as a procedure of choice due to its fast and less complex execution.

Predictive Factors for Chronic Subdural Hematoma Recurrence

“…In contrast, the presence of thick one prevents neural tissue expansion. Previous literatures suggest removing the neomembrane to decrease chances of recurrence [4,5,8,10]. However, Sahyouni and colleagues [19] found no superior outcomes from removing the neomembrane in comparison with traditional burrhole craniostomy as regard outcome and complications.…”

“…THE definition of Chronic Subdural Hematoma (CSDH) is an abnormal collection of liquefied blood in subdural space that may lead to neurologically consequences [1,2]. The incidence is ranging from 1.72-20.6/100,000 per year [3][4][5]. The incidence in elderly age is more evident.…”

“…The recurrence rate is ranging from 5% to 30% [7,12,13]. Prediction of recurrence was extensively investigated previously in many literature [3][4][5]7,8,10,14]. In our study, we aimed to investigate the predictive factors that may be responsible for CSDH recurrence in patients who underwent surgical evacuation at our center.…”

A Prospective Randomized Study on the Preventive Effect of Japanese Herbal Kampo Medicine Goreisan for Recurrence of Chronic Subdural Hematoma

“…3,4) Although a relatively simple surgical treatment usually consisting of burr hole opening and drainage of the hematoma is effective, recurrence occurs postoperatively at 5.4-18.1%. [5][6][7][8][9][10][11][12][13][14][15][16] In symptomatic reaccumulation of hematoma, repetitive drainage or craniotomy is often required, but redo surgery may have a negative impact on the neurological status and patients' quality of life. Several retrospective analyses have reported the benefit of adjuvant medical treatment, such as corticosteroid, 17,18) atorvastatin, 19,20) tranexamic acid, 21) etizolam, 22) and angiotensin-converting enzyme (ACE) inhibitor, 23) to lower the recurrence rate.…”

Can routine biochemical tests be a short-term prognostic biomarker in patients operated for chronic subdural hematoma?

“…It has been suggested in some studies that midline shift thickness and volume of fluid accumulated in the subdural space may be prognostic markers. [5] In addition, it has been emphasized that the lower the modified Rankin Scale scores may make the prognosis worse. [6,7] It has been also demonstrated in studies in which CSDH cases were evaluated immunologically that interleukin-6 and "Vascular Endothelial Growth Factor (VEGF)" values measured in hematoma fluid were found to be higher than serum values.…”