Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms

Inamasu, Joji; Watabe, Takeya; Ganaha, Tsukasa; Yamada, Yoshihiko; Nakae, Shunsuke; Ohmi, Tatsuo; Imizu, Shuei; Kaito, Takafumi; Ito, Keisuke; Nishiyama, Yuya; Hayashi, Takuro; Sano, Hirotoshi; Kato, Yōkō; Hirose, Yuichi

doi:10.1016/j.jocn.2012.09.024

Cited by 27 publications

(52 citation statements)

References 8 publications

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“…In our dataset, 9.3 % of the patients had a radiologic abnormality after surgery, even ACA anterior cerebral artery, ICA internal cerebral artery, MCA middle cerebral artery though only one fourth of the patients had clinically evident neurologic symptoms. Also 2.8 % of the patients were affected by anosmia, and 3.0 % of the patients had to receive additional operation for chronic subdural hemorrhage which was similar with previous studies [9,17,19]. Therefore, the overall surgery-related complication rate was 15.1 % which was not so low.…”

Section: Discussionsupporting

confidence: 83%

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Kim

Yeon

et al. 2015

Neurosurg Rev

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Recently, the treatment of intracranial aneurysms entered a new phase due to safe surgical tool such as neurophysiologic monitoring and challenged by endovascular treatment. To determine the safety of clipping surgery in the modern era, we reviewed our experiences of simple unruptured anterior circulation aneurysm surgery which is commonly performed in many places. We retrospectively reviewed 610 consecutive patients who were treated with surgical clipping under motor evoked potential (MEP) monitoring for a tiny to large anterior circulation aneurysm in a single institute between 2008 and 2012. MEP changes were identified in 40 cases (6.6 %). MEP deterioration was associated with remote site epidural hematoma (n = 1), anesthesia (n = 2), temporary clipping (n = 21), and permanent clipping (n = 16). Despite that no persistent MEP deterioration was noted after prompt corrective measures, 56 (9.2 %) patients showed symptomatic (n = 14) and asymptomatic (n = 42) radiologic abnormalities. Anterior cerebral artery (ACA) aneurysm was associated with a higher radiologic complication rate (Fisher's exact test, P < 0.05). Two (0.3 %) patients showed severe morbidity (mRS >2) at latest follow-up. MEP monitoring can be helpful in preventing postoperative motor deterioration but seems to have some limitations. Although the permanent morbidity rate was low, a significant clinical (2.3 %) or radiologic (9.2 %) abnormality rate was identified even in simple aneurysm clipping that should be taken into account when performing interdisciplinary treatment planning and patient counseling. Also, direct vascular monitoring or new neurophysiologic monitoring techniques are needed to reduce surgical complications, especially in ACA aneurysm surgery.

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Section: Discussionsupporting

confidence: 83%

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Kim

Yeon

et al. 2015

Neurosurg Rev

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“…7,15,17,24 In contrast, the present study investigated postoperative subdural complications, such as subdural hygromas and CSDHs, as a continuum and identified independent risk factors, including an aneurysm location requiring extensive dissection of the arachnoid membrane covering the sylvian fissure (MCA aneurysms, as well as multiple aneurysms at the MCA and ACoA), in addition to advanced age and male sex. Furthermore, aneurysms requiring extensive arachnoid dissection, including ACoA and MCA aneurysms, with the exception of ICA aneurysms, reached near significance (0.05 < p < 0.1) as risk factors for an operative CSDH in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 97%

“…7,15,17,24 Although most subdural hygromas resolve spontaneously, they can persist for a while and even convert to a CSDH. Such persistence of subdural hygromas can become more problematic in patients with medical conditions requiring antiplatelet or anticoagulant medication.…”

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confidence: 99%

Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors

Park¹,

Cho²,

Goh³

et al. 2016

JNS

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“…Several studies showed older age as a risk factor for CSDH in patients with UIA treated by conventional clipping surgery. 20,31,37 Recently, the incidence of CSDH formation in patients with anterior circulation UIAs treated using keyhole clipping was reported as 9.3%, and the incidence of CSDH requiring bur hole drainage as 4.7%, with male sex and advanced age (> 60 years) as significant risk factors. 40 A traumatic arachnoid tear with CSF entering the subdural space, especially in elderly males with brain atrophy, is a known causative factor for the formation of CSDH after head injury.…”

Section: Discussionmentioning

confidence: 99%

Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms

Mori

Wada

Otani

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Advanced age is known to be associated with a poor prognosis after surgical clipping of unruptured intracranial aneurysms (UIAs). Keyhole clipping techniques have been introduced for less invasive treatment of UIAs. In this study, the authors compared the complications and clinical and radiological outcomes after keyhole clipping between nonfrail elderly patients (≥ 70 years) and nonelderly patients. METHODS Keyhole clipping (either supraorbital or pterional) was performed to treat 260 cases of relatively small (≤ 10 mm) anterior circulation UIAs. There were 62 cases in the nonfrail elderly group (mean age 72.9 ± 2.6 years [± SD]) and 198 cases in the nonelderly group (mean age 59.5 ± 7.6 years). The authors evaluated mortality and morbidity (modified Rankin Scale score > 2 or Mini-Mental State Examination [MMSE] score < 24) at 3 months and 1 year after the operation, the general cognitive function by MMSE at 3 months and 1 year, anxiety and depression by the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D) at 3 months, and radiological abnormalities and recurrence at 1 year. RESULTS Basic characteristics including comorbidities, frailty, and BDI and HAM-D scores were not significantly different between the 2 groups, whereas the MMSE score was slightly but significantly lower in the elderly group. Aneurysm location, largest diameter, type of keyhole surgery, neck clipping rate, and hospitalization period were not significantly different between the 2 groups. The incidence of chronic subdural hematoma was not significantly higher in the elderly group than in the nonelderly group (8.1% vs 4.5%, p = 0.332); rates of other complications including stroke and epilepsy were not significantly different. Lacunar infarction occurred in 3.2% of the elderly group and 3.0% of the nonelderly group. No patient in the elderly group required re-treatment or demonstrated recurrence of clipped aneurysms. The MMSE score at 3 months significantly improved in the nonelderly group but did not change in the elderly group. The BDI and HAM-D scores at 3 months were significantly improved in both groups. No patient died in either group. The morbidity at 3 months and 1 year in the elderly group (1.6% and 4.8%, respectively) was not significantly different from that in the nonelderly group (2.0% and 1.5%, respectively). CONCLUSIONS Keyhole clipping for nonfrail elderly patients with relatively small anterior circulation UIAs did not significantly increase the complication, mortality, or morbidity rate; hospitalization period; or aneurysm recurrence compared with nonelderly patients, and it was associated with improvement in anxiety and depression. Keyhole clipping to treat UIAs in the nonfrail elderly is an effective and long-lasting treatment.

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Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms

Cited by 27 publications

References 8 publications

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Treatment outcomes of surgical clipping for unruptured anterior circulation aneurysm—single institute experiences in the era of neurophysiologic monitoring and endovascular treatment

Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors

Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms

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