Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

Ko, Byung-Soo; Lee, Jung Kil; Seo, Bo Ra; Moon, Sungjun; Kim, Jae Hyoo; Kim, Soo Han

doi:10.3340/jkns.2008.43.1.11

Cited by 131 publications

(136 citation statements)

References 16 publications

(40 reference statements)

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“…CSDH was more common on the left side in this study as CSDHs occurred more frequently on the left side 2,5,8,16,18,21) . Even in strokes, the left hemispheric events was more com- mon than the right 4) .…”

Section: Discussionmentioning

confidence: 81%

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What Determines the Laterality of the Chronic Subdural Hematoma?

Kim

Lee

Shim

et al. 2010

J Korean Neurosurg Soc

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Objective : Chronic subdural hematomas (CSDH) are more common on the left hemisphere than on the right. We verified this left predilection of CSDH and tried to explain the reason for this discrepancy. Methods : We investigated the laterality of CSDH in 182 patients who were treated from January 2005 to December 2009. We examined the symmetry of the cranium and the location of the lesion. Results : CSDH was more common on the left-side. The cranium was symmetric in 63 patients, asymmetric in 119 patients. The asymmetric crania were flat on the right-side in 77 patients, on the left-side in 42 patients. The density of the CSDHs was hypodense in 29 patients, isodense 132 patients, and the others in 21 patients. Bilateral hematomas were more common in the hypodense group. In the right flat crania, the hematoma was more commonly located on the opposite side of the flat side. While in the left flat crania, the hematoma was more common on the same side. Conclusion : CSDHs occurred more frequently on the left side. The anatomical asymmetry of the cranium influences the left predilection of CSDH.

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Section: Discussionmentioning

confidence: 81%

“…However, actual distribution of CSDH is not equal in both sides. CSDHs are more commonly found on the left than on the right in many reports 2,5,8,16,18,21) . There was no statistically significant difference in terms of laterality in the acute or subacute subdural hematomas 16) .…”

Section: Introductionmentioning

confidence: 99%

What Determines the Laterality of the Chronic Subdural Hematoma?

Kim

Lee

Shim

et al. 2010

J Korean Neurosurg Soc

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“…Occasionally, advanced age has been considered to be a risk factor for recurrence and reoperation 19,20) . However, most studies have demonstrated no relationship between recurrence rate and age 8,9,11,17,23) . In the current study of 317 surgically treated patients, the mean ages of patients in the reoperation and nonreoperation groups were not significantly different, implying no relationship between age and reoperation rate.…”

Section: Discussionmentioning

confidence: 99%

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

Kim

Kang

Kim

et al. 2011

J Korean Neurosurg Soc

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mostly liquefied CSDH. Conversely, craniotomy is generally accepted as the optimal approach for reaccumulation of a CSDH, existence of a solid hematoma, failure of brain reexpansion, or marked swelling subjacent to the hematoma 5,14) . The purpose of this study was to analyze the efficacy of small or large craniotomy with membranectomy as the initial treatment for CSDH. MATERIALS AND METHODSA retrospective study was performed using the medical records retained by our hospital. computed tomography (CT) scans were the primary imaging method for the evaluation of CSDH in all patients. The technique of a burr-hole with closed system drainage for 24 to 72 hours was chosen for cases of nonseptated and mostly liquefied CSDH. However, on the basis of CT and/or magnetic resonance imaging (MRI) findings, cases of CSDH demonstrating either mixed density or hyperdense lesions ( Fig. 1), intrahematomal membranes or web-like structures (Fig. 2), or an organized/calcified CSDHs (Fig. 3) were selected for craniotomy. We classified 317 patients with CSDH into three groups according to the extent of surgery required : group I, burr hole with drainage (n=259); group II, small crani- INTRODUCTIONChronic subdural hematoma (CSDH) represents one of the most frequent intracranial hemorrhages encountered in neurosurgical department, with elderly citizens being more frequently affected. The reasons why this type of hematoma occurs frequently among the elderly include an increase in antithrombotic medications, venous fragility, augmentation of the subdural space, and an increased exposure to traumatic injury resulting from frequent falls 1) . For the initial management of CSDH, numerous surgical treatments have been proposed 5,14,15,18,21) . However, the extent of surgical treatment required for CSDH is still controversial 2,24) , and the optimal treatment for CSDH is not well defined 16) . The choice of surgical technique for CSDH must be dictated by the degrees of organization of the hematoma. Burr-hole with drainage is mandatory for non-septated and Department of Neurosurgery, Seoul Medical Center, Seoul, KoreaObjective : There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods : Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results : The mean ages were 69.4±12.1 a...

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“…Old age, brain atrophy, poor health status at the time of admission, high bleeding tendency, accompanying kidney and liver diseases, chronic alcoholism, diabetes mellitus, epilepsy, dementia and intracranial hypotension due to cerebrospinal fluid shunt are reported to be relevant factors of CSDH re-currence (8,14,52). Especially anti-platelet agents and poor reexpansion of the brain have been suggested risk factors for recurrence of CSDH (52,55,56). As compatible with the literature, coagulopathy and brain atrophy are defined as two major risk factors for recurrence in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…However, craniotomy is best performed under general anesthesia and is the most invasive option for the treatment of CSDH, encompassing the greatest operative time as well as the greatest volume of the blood loss. Despite the increased risks, craniotomy remains the best option for evacuation of organized, calcified, solid CSDH with numerous thick membranes or the cases with multiple recurrences (5,15,16,(28)(29)(30)39,41,47,52,53).…”

Section: Discussionmentioning

confidence: 99%