Clinical Investigation of Refractory Chronic Subdural Hematoma: A Comparison of Clinical Factors Between Single and Repeated Recurrences

Matsumoto, Hiroaki; Hanayama, Hiroaki; Okada, Takashi; Sakurai, Yasuo; Minami, Hiroaki; Masuda, Akira; Tominaga, Shogo; Miyaji, Katsuya; Yamaura, Ikuya; Yoshida, Yasuhisa; Yoshida, Kozo

doi:10.1016/j.wneu.2017.08.101

Cited by 16 publications

(19 citation statements)

References 39 publications

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“…Several individual studies, however, did not report a high recurrence rate in laminar hematoma [29,43,64], but did report trabecular hematoma, corresponding to hematoma with multiplicity of cavities, to reoccur more often [49,[65][66][67][68][69]. This variation and discrepancy is most likely caused by the many available architecture categories which are applied parallel to the classification of Nakaguchi (i.e., loculated hematoma, hematoma with multiplicity of cavities, layered type hematoma, organized hematoma, and niveau formation), but OAC oral anticoagulation, PAI platelet aggregation inhibitor, reCSDH CSDH recurrence a Four patients died before discharge, therefor analyses were performed in 457 patients b Two patients died before discharge, therefor analyses were performed in 246 patients c Because of rounding, percentages in combined "OAC or PAI" group may differ with one percent from the sum of "OAC" and "PAI" could also be due to difficulties in applying the classification correctly [18,26,45,59,70,71]. In addition, complex internal architecture categories might be very informative, but application can lead to significant intra-and interobserver variability compromising generalizability.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative closed drainage as interventional measure is effective in reducing recurrence risk by roughly 50% [1,10,17]. Recurrent CSDH poses a formidable challenge in the treatment of symptomatic patients [18]. Recurring symptoms and additional treatment increase patient burden, prolong hospital admissions leading to higher costs, and contribute to a potential poor outcome [19,20].…”

Section: Introductionmentioning

confidence: 99%

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Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

et al. 2020

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Purpose Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. Methods Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. Results Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). Limitations Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. Conclusions Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

et al. 2020

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“…A significant problem with CSDH surgery was recurrence, and it was estimated that 8%–33% of all patients needed reoperation 12. Recurrence risk factors often included older age, male sex, brain atrophy, use of anticoagulant or antiplatelet drugs, and the presence of a mixed- or high-density hematoma on CT 5. A septated chronic subdural hematoma (SCSDH) is a special type that features hematoma cavities divided into different portions by fibrin septa.…”

Section: Discussionmentioning

confidence: 99%

“…It was estimated that the recurrence rate was ~5%–33% in CSDH, and some patients suffered repeated recurrences, which was troublesome for both neurosurgeons and patients 5. Additionally, the overall outcome of CSDH has not changed substantially during the past three decades,1,6 which has prompted neurosurgeons to look for new approaches.…”

Section: Introductionmentioning

confidence: 99%

<p>Evacuation of chronic and subacute subdural hematoma via transcranial neuroendoscopic approach</p>

Cai¹,

Guo²,

Zhang³

et al. 2019

NDT

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ObjectiveTo evaluate the effectiveness and safety of neuroendoscopic surgery for chronic or subacute subdural hematoma.Patients and methodsBetween September 2016 and September 2018, neuroendoscopic surgery was performed on 25 patients with chronic and subacute subdural hematoma. Hematoma evacuation was performed with a 0°, 4 mm diameter rigid neuroendoscope via a transcranial neuroendoscopic approach.ResultsAll patients successfully underwent neuroendoscopic surgery, and no surgical complications or rebleeding was observed. Postoperative computed tomography scans showed that the hematoma was successfully evacuated. All patients had recovered well at discharge, the observed 30-day mortality rate was 0%, and no patients suffered recurrence for 2–26 months after surgery.ConclusionNeuroendoscopic surgery was a safe and effective approach for the treatment of chronic and subacute subdural hematoma. This approach has the advantages of decent visualization and minimal invasiveness and could reduce recurrence and the mortality rate.

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“…3 Organized CSDH, a special type of CSDH that is composed of organized, rigid, multilayered hematoma and fibrous, thick membrane, 4 has high recurrence rates and bur hole irrigation is not sufficient. 5 Although there have been several investigations on the surgical procedure of organized CSDH, [6][7][8][9][10][11] the optimal procedure has not been established yet. The aim of this study was to present our surgical experience.…”

Section: Introductionmentioning

confidence: 99%

Surgical Procedure in the Treatment of Organized Chronic Subdural Hematoma: A Single-Center Experience

Chen

Wang

Chen

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Organized chronic subdural hematoma (CSDH) is a special type of CSDH. However, the optimal surgical procedure has not been established. We present our experience here to discuss the surgical procedure in treatment of organized CSDH. Methods Thirty-three patients with organized CSDH were admitted between January 1, 2008 and January 1, 2018. Age, gender, clinical symptoms, imaging data, type of surgical procedure, Barthel index (BI), and postoperative complications were collected and retrospectively analyzed. The BI was assessed both pre and postoperatively (1 week and 1 month after surgery). Results Overall, 14 patients underwent large craniotomy and 19 patients underwent small craniotomy. No significant differences in gender, age, initial clinical symptoms, and preoperative BI were found between the groups (p > 0.05). Among the 14 patients who underwent large craniotomy, 2 patients developed epilepsy after the operation, while 1 patient had postoperative aphasia. None of the patients had recurrence in 6 months postoperatively. Among the 19 patients who underwent small craniotomy, 1 patient developed an acute subdural hematoma and 1 patient developed aphasia. No obvious complications were found in the remaining 18 patients and none of the 19 patients had recurrence in 6 months postoperatively. BI scores of the small craniotomy group were significantly better than those of the large craniotomy group at 1 week postoperatively (p < 0.05). However, there was no significant difference in the 1-month results (p > 0.05). Conclusion According to our single-center experience, a small craniotomy for treating organized CSDH can be considered as an alternative to a larger craniotomy.

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Clinical Investigation of Refractory Chronic Subdural Hematoma: A Comparison of Clinical Factors Between Single and Repeated Recurrences

Cited by 16 publications

References 39 publications

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

<p>Evacuation of chronic and subacute subdural hematoma via transcranial neuroendoscopic approach</p>

Surgical Procedure in the Treatment of Organized Chronic Subdural Hematoma: A Single-Center Experience

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