A Reliable Grading System for Prediction of Chronic Subdural Hematoma Recurrence Requiring Reoperation After Initial Burr-Hole Surgery

Stanišić, Milo; Pripp, Are Hugo

doi:10.1093/neuros/nyx090

Cited by 106 publications

(101 citation statements)

References 18 publications

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“…In 2017, Stanisic et al proposed a grading system for prediction of chronic subdural hematoma recurrence requiring reoperation called the Oslo score, 2 of the 5 maximum possible points being attributed for certain types of the Nakaguchi classification (laminar, separated, isodense and hyperdense). [30] In our study we found a much higher reoperation rate (42,86%) associated to bilateral chronic subdural hematomas, compared to the overall 25%. The fact that bilateral CSDHs associate a much higher recurrence rate compared to unilateral ones has been confirmed by numerous other studies.…”

Section: Relationship Between Csdh's Rrr and Ct Characteristicssupporting

confidence: 40%

Recurrence of Chronic Subdural Hematomas Requiring Reoperation: Could Small Trephination Be a Valid Alternative to Conventional Approaches?

Adam¹,

Iftimie²,

Moisescu³

2018

Romanian Neurosurgery

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Background: Chronic subdural hematomas (CSDHs) are one of the most common intracranial lesions treated in a neurosurgical department. They associate significant morbidity and mortality that increase in the case of recurrences requiring reoperation. Despite extensive published literature, there is still significant debate regarding optimal management of CSDHs and their potential recurrence. Objective: Identify factors for recurrence requiring reoperation of CSDHs in order to adjust our management strategies. Methods: A retrospective review of 64 cases harbouring 71 CSDHs that were surgically treated in the Neurosurgery Department of “Saint Pantelimon” Clinical Emergency Hospital over a period of two years (January 2016 - December 2017). Two main surgical techniques were used: small trephine and large bone flap craniotomy, according to the operating surgeon’s preference. CT scans were performed at admission and 24 hours postoperatively. Postoperative management was similar in all cases. Results: Recurrence requiring reoperation (RrR) was encountered in 16 (25%) of the reviewed cases. Reoperation was found to be significantly more often encountered in particular preoperative CT characteristics: laminar type (RrR=38,10%, p=0.027) and maximal thickness above 22 mm (43,75%, p = 0,013). Surgical technique had a substantial impact on recurrence: in trephinated cases, reoperation was required in only 8 of 51 patients (RrR=15,69%, p = 0.007), while large bone flap craniotomy associated a RrR of 61,54% (p = 0.008), which increased when associated with inner membranectomy (RrR=87,5%, p = 0,007) or subdural drain placement (88,89%, p = 0.007). Reoperations not only doubled the neurosurgical hospital length of stay, but also associated higher perioperative mortality rates (18.75% versus 14,58%). Conclusions: In our series, surgical technique had a decisive impact on the rate of recurrence. CSDH surgery is another example of “in medio stat virtus”, where finding the right balance between the least and most aggressive technique has the potential of providing the best outcomes, and thus small trephination could be taken into consideration.

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Section: Relationship Between Csdh's Rrr and Ct Characteristicssupporting

confidence: 40%

Recurrence of Chronic Subdural Hematomas Requiring Reoperation: Could Small Trephination Be a Valid Alternative to Conventional Approaches?

Adam¹,

Iftimie²,

Moisescu³

2018

Romanian Neurosurgery

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“…Although the commonly used techniques are relatively safe and simple (1), cSDH have a mortality rate as high as 42% (5,6) and a recurrence rate up to 76% (1,7,8). Prediction models so far have been inconsistent (9)(10)(11)(12) and are not routinely implemented in clinical practice. In addition, questions regarding postoperative OAC and APD management remain unanswered (1).…”

Section: Introductionmentioning

confidence: 99%

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

et al. 2020

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The aging of the western population and the increased use of oral anticoagulation (OAC) and antiplatelet drugs (APD) will result in a clinical dilemma on how to balance the recurrence risk of chronic subdural hematoma (cSDH) with the risk of withholding blood thinners. Objective: To identify features that predicts recurrence, thromboembolism (TEE), hospital stay and mortality. To identify the optimal window for resuming APD or OAC. Methods: We performed a retrospective multivariate analysis of a prospectively collected database. We then build machine learning models for outcomes prediction. Results: We identified 596 patients. The rate of recurrence was 22.17%, that of thromboembolism was 0.9% and that of mortality was 14.78%. Smoking, platelet dysfunction, CKD, and alcohol use were independent predictors of higher recurrence, while resolution of the SDH was protective. OAC use had higher odds of developing TEEs. CKD, developing a new neurological deficit or a TEEs were independent predictors of higher mortality. We find the optimal time of resuming OAC to be after 2 days but before 21 days as these patients had the lowest recurrence of bleeding associated with a low risk of stroke. The ML model achieved an accuracy of 93, precision of 0.84 and recall of 0.80 for recurrence prediction. ML models for hospital stay performed poorly (R 2 = 0.33). ML model for stroke was overfitted given the low number of events. Conclusion: ML modeling is feasible. However, large well-designed prospective multicenter studies are needed for accurate ML so that clinicians can balance the risks of recurrence with the risk of TEEs, especially for high-risk anticoagulated patients.

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“…The reported rate ranges from 9.2% to 26.5%. 1,2,[10][11][12]15 Moreover, in bcSDHs the retreatment rate reaches almost 30%. 7,13,19 Noted retreatment rates for bcSDHs in the literature depict both surgery for ipsilateral recurrence and surgery for contralateral progression after initial unilateral hematoma evacuation.…”

mentioning

confidence: 96%

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

Scheichel¹,

Popadic²,

Ungersboeck³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEUnilateral evacuation of bilateral chronic subdural hematomas (bcSDHs) is associated with higher retreatment rates than an initial bilateral intervention. One reason for that is a possible progression in the size of the contralateral side after unilateral treatment. Thus, the authors focused their study on finding predictors of the need for contralateral retreatment.METHODSAll patients who had undergone unilateral or bilateral evacuation of bcSDHs in the Department of Neurosurgery at the University Hospital of St. Poelten during a 5-year period (7/2012 to 6/2017) were retrospectively identified. The preoperative hematoma volume was calculated using the XYZ/2 method.RESULTSOf a total of 103 patients with bcSDHs, 61 patients underwent bilateral evacuation and 42 patients underwent unilateral evacuation. The retreatment rate after bilateral evacuation was significantly lower than that after unilateral evacuation (14.8% vs 31%, respectively; p = 0.049). Contralateral retreatment after unilateral evacuation was necessary in 9 patients (21.4%). The preoperative contralateral hematoma volume was significantly higher in those patients who needed contralateral retreatment after initial unilateral evacuation (68.4 cm3 vs 27.4 cm3, respectively; p < 0.001). Furthermore, the so-called volume relation ratio created by dividing the smaller by the larger hematoma volume was significantly higher when contralateral retreatment became necessary (0.56 vs 0.21, respectively; p < 0.001).CONCLUSIONSPatients needing evacuation of bcSDHs should be considered for primary bilateral evacuation if the hematoma volume on the smaller side is greater than 40 cm3 and the subsequent volume relation ratio is greater than 0.4.

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A Reliable Grading System for Prediction of Chronic Subdural Hematoma Recurrence Requiring Reoperation After Initial Burr-Hole Surgery

Cited by 106 publications

References 18 publications

Recurrence of Chronic Subdural Hematomas Requiring Reoperation: Could Small Trephination Be a Valid Alternative to Conventional Approaches?

Recurrence of Chronic Subdural Hematomas Requiring Reoperation: Could Small Trephination Be a Valid Alternative to Conventional Approaches?

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

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