Chronic Subdural Hematoma Management

Almenawer, Saleh A.; Farrokhyar, Forough; Hong, Chris J.; Alhazzani, Waleed; Manoranjan, Branavan; Yarascavitch, Blake; Arjmand, Parnian; Baronia, Benedicto C.; Reddy, Kesava; Murty, Naresh K.; Singh, Sheila K.

doi:10.1097/sla.0000000000000255

Cited by 360 publications

(150 citation statements)

References 28 publications

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“…Our numbers fall within the previously reported numbers of recurring CSDH’s of approximately 10–20% but are within the higher margin [2, 9]. The use of anticoagulants and antiplatelet medication prior to the first operation did not increase the risk for a re-operation.…”

Section: Discussionsupporting

confidence: 86%

Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?

2018

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BackgroundChronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Patients diagnosed with CSDH’s are often planned for subacute surgery. This means that time from diagnostic CT scan until actual surgery might often be prolonged. There are no previous studies that highlight the effect of delayed intervention in this population.MethodPatients that underwent surgical evacuation for a CSDH at Skåne University Hospital between 1 January 2015 and 31 December 2016 were included in this retrospective cohort study (n = 179). The primary aim was to determine if time from initial diagnosis by head-CT until surgical evacuation had a significant effect on outcome. The following was assessed by mortality, re-operation, number of days spent in hospital, discharge to home/institution, and functional outcome assessed by GOS. Secondary aims were to evaluate the effect of NOAC, vitamin K antagonists, and antiplatelet drugs on time from CT to surgery and re-operation frequency.ResultsMean time from diagnostic CT scan until surgery was 76 h. No significant relationship was found between time from CT to surgical evacuation and number of days spent in hospital, discharge to own home/institution, 1-year mortality, or outcome assessed by GOS at discharge from hospital. The clear majority (95.5%) of the patients were GCS ≥ 13 pre-operatively. No correlation could be seen between use of NOAC, vitamin K antagonists, or antiplatelet drugs regarding the risk for reoperation within 6 months, and no correlation between the use of these agents and time from CT to surgery. The 30-day mortality was too low to draw any statistically significant conclusions (n = 4).ConclusionIn this retrospective cohort study, we could conclude that a delay from initial diagnosis confirming a CSDH to surgical evacuation had no negative effect on outcome when surgery was performed within the time frames and on patients with pre-operatively favorable GCS scores (≥ 13) outlined in our study.

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Section: Discussionsupporting

confidence: 86%

Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?

2018

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“…In a recent article, from 16 randomized trials, the calculated overall estimates following management of CSDH patients per 100 individuals per year were 4% (95% CI, 2-7) mortality, 11% (95% CI, 5-19) morbidity, 82% (95% CI, 75-89) 'cure', and 11% (95% CI, 9-14) recurrence1). Conventional medical treatment, especially the use of mannitol alone, is not effective for CSDH management2).…”

Section: Discussionmentioning

confidence: 99%

“…Given that CSDHs are more frequent among the elderly, these treatments also diverge in terms of the perioperative risks related to general anesthesia, because BHDs are frequently performed under general sedation, whereas a local anesthetic is usually sufficient for TDC. Moreover, the amount of tissue cut and the size of skull hole favor TDC as the less invasive procedure1). TDC at the pre-coronal point is simple and easy surgical procedures compared with BHD at the maximal thickness area.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Indications and Treatment Results of Burr-Hole Drainage at the Maximal Thickness Area versus Twist-Drill Craniostomy at the Pre-Coronal Point for the Evacuation of Symptomatic Chronic Subdural Hematomas

Kim

et al. 2014

J Korean Neurosurg Soc

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ObjectiveTo analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point.MethodsWe analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed.ResultsOf the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC.ConclusionBoth BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.

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“…Because there are no significant differences in the effectiveness of these two techniques,112) the surgeon's preference determines their use. Thus, the present study aimed to determine the safety and feasibility of TDC at the PCSEP as a first-choice treatment option for CSDHs using 86 prospectively enrolled patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although chronic subdural hematomas (CSDHs) are a frequently encountered neurological condition, there has yet to be a firm consensus regarding the optimal surgical technique for the treatment of this disorder 1121820). However, based on the disease-prevalent population, surgical morbidities, and recurrence after surgery, less-invasive surgical techniques have become the initial procedures of choice 912171923).…”

Section: Introductionmentioning

confidence: 99%

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

Lee

Hwang

2016

Korean J Neurotrauma

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ObjectiveAlthough twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option.MethodsCSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed.ResultsOf the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC.ConclusionWhen the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.

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Chronic Subdural Hematoma Management

Abstract: Percutaneous bedside twist-drill drainage is a relatively safe and effective first-line management option. These findings may result in potential health cost savings and eliminate perioperative risks related to general anesthetic.

Cited by 360 publications

References 28 publications

Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?

Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?

Comparison of the Indications and Treatment Results of Burr-Hole Drainage at the Maximal Thickness Area versus Twist-Drill Craniostomy at the Pre-Coronal Point for the Evacuation of Symptomatic Chronic Subdural Hematomas

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

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