Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma

Kpelao, E; Beketi, Kadanga Anthony; Moumouni, A.K.; Doleagbenou, A.K.; N’timon, B.; Egbohou, Pilakimwé; Mouzou, T; Tomta, K; Samà, Domenico; Abalo, Anani; Walla, A; Dossim, Assang

doi:10.1007/s10143-015-0669-4

Cited by 19 publications

(23 citation statements)

References 15 publications

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“…No definition of CSDH is universally accepted [18]. Subacute SDHs were excluded from this study, because this hematoma subtype is considered to represent an entity of its own [2,12,21]. Additionally, autopsies were not performed on all of the deceased patients, and some of the causes of deaths might not be correct.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Long-term excess mortality after chronic subdural hematoma

et al. 2020

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Objective To assess possible long-term excess mortality and causes of death of patients with chronic subdural hematoma (CSDH). Methods A retrospective study (1990-2015) of adult patients (n = 1133, median age = 76 years old, men = 65%) with CSDH identified by ICD-codes and verified by medical records. All patients were followed until death or the end of 2017. Cumulative relative survival ratios and relative excess risks of death (RER) were estimated by comparing patients' mortality with that in the entire regional matched population. The causes of death were compared with a separate reference group formed by randomly choosing sex, age, and calendar time matched controls (4 controls per each CSDH patient). Results The median follow-up time was 4.8 years (range = 0-27 years), and 710 (63%) of the patients died (median age at death = 84 years old). The cumulative excess mortality was 1 year = 9%, 5 years = 18%, 10 years = 27%, 15 years = 37%, and 20 years = 48%. A subgroup of CSDH patients (n = 206) with no comorbidity had no excess mortality. Excess mortality was related to poor modified Rankin score at admission (RER = 4.93) and at discharge (RER = 8.31), alcohol abuse (RER = 4.47), warfarin (RER = 2.94), age ≥ 80 years old (RER = 1.83), non-operative treatment (RER = 1.56), and non-traumatic etiology (RER = 1.69). Hematoma characteristics or recurrence were unrelated to excess mortality. Dementia was the most common cause of death among the CSDH patients (21%) and the third most common cause in the reference group (15%, p < 0.001). Conclusions Patients with CSDH have continuous excess mortality up to 20 years after diagnosis. Patient-related characteristics have a strong association with excess mortality, whereas specific CSDH-related findings do not. CSDH patients have an increased risk for dementia-related mortality.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Long-term excess mortality after chronic subdural hematoma

et al. 2020

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“…There is currently no standard approach for the treatment of subacute subdural hematomas. 4,10,13 We previously reported that endoscopic removal of intracerebral hematomas arising from spontaneous non-vascular malformations achieved satisfactory results. 9 In this study, endoscopic removal of subacute subdural hematomas was performed.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic assisted key-hole surgery for subacute subdural hematoma evacuation in emergency situations

Sun¹,

Li²,

Tang³

et al. 2020

Preprint

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Background Endoscopic removal of subacute subdural hematoma is seldom performed, but there is no standard technique till date. We investigated whether a simple endoscopic method is effective for the evacuation of subacute subdural hematoma. Methods A total of 51 patients with subacute subdural hematoma requiring surgery were enrolled in this study. Endoscopic hematoma evacuation was performed through a small bone window for 22 patients. Hematoma evacuation by open surgery was performed in 29 patients. Pre- and postoperative Glasgow coma scale (GCS), operation time, displacement of midline, and intraoperative blood loss were recorded and analyzed. Results The median time from incision to suture completion was 40 min (range: 31.25–43.75 min) for endoscopic group, and 70 min (range: 65–80 min) for open surgery group (P<0.01). The average total blood loss was 50(30-50) ml for endoscopic group, and 250(200-300) ml for open surgery group (P<0.01). No patient showed post-operative re-bleeding in both groups. The mean preoperative mid-line displacement for the two groups was 11.51±3.51mm for study group vs 10.47±2.93mm for control group (P>0.05). Mid-line displacement showed significant improvement on the day after surgery to 5.29±1.91mm for study group vs 6.75±1.37mm for control group (P<0.01). At 1-month follow-up, the midline was normal in both groups. Computed tomography revealed almost no residual hematoma, representing an average evacuation rate of 100% in both groups. The mean preoperative GCS score was 13(12.25,15) for study group vs 13(12,14) for control group(P>0.05). GCS score on the day after the operation was improved to 15 for each patient in endoscopic surgery group, while 15(14,15)in the open surgery group (P<0.01). Conclusions Endoscopic subacute subdual hematoma removal through a small bone window achieved a satisfactory hematoma removal with minimally invasive method when compared to open surgery.

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“…In their study, SASDH was considered to differ from CSDH not only based on the characteristic operative and histological findings, but also in that none of the 8 SASDH patients required reoperation. Another study by Kpelao et al 21) defined SASDH as cranial trauma between 8 and 21 days associated with isodensity on CT. In that study, SASDH did not have a neomembrane intraoperatively, unlike CSDH.…”

Section: Discussionmentioning

confidence: 99%

Impact of Time Interval between Trauma Onset and Burr Hole Surgery on Recurrence of Late Subacute or Chronic Subdural Hematoma

Kim

Kang

et al. 2016

J Korean Neurosurg Soc

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ObjectiveAlthough subdural hematoma (SDH) is commonly treatable by burr hole surgery in the late subacute or chronic stage, there is no clear consensus regarding appropriate management and exact predictive factors for postoperative recurrence also remain unclear. The aim of this study was to evaluate risk factors associated with recurrence of SDH that requires burr hole surgery in the late subacute or chronic stage. We also identified the appropriate timing of surgery for reducing the recurrence.MethodsWe retrospectively reviewed 274 patients with SDH in the late subacute or chronic stage treated with burr hole surgery in our hospital between January 2007 and December 2014. Excluding patients with acute intracranial complications or unknown time of trauma onset left 216 patients included in the study.ResultsOf 216 patients with SDH in the late subacute or chronic stage, recurrence was observed in 36 patients (16.7%). The timing of the operation in patients with late subacute stage (15–28 days) resulted in a significant decrease in recurrence (RR, 0.33; 95% CI, 0.17–0.65; p=0.001) compared to chronic stage (>28 days). Otherwise, no significant risk factors were associated with recurrences including comorbidities and surgical details.ConclusionThe results indicated that time from trauma onset to burr hole surgery may be important for decreasing the risk of recurrence. Therefore, unless patients can be treated conservatively without surgery, prompt surgical management is recommended in patients diagnosed as having late subacute or chronic subdural hematoma treatable by burr hole surgery, even when neurological deficits are unclear.

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Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma

Cited by 19 publications

References 15 publications

Long-term excess mortality after chronic subdural hematoma

Long-term excess mortality after chronic subdural hematoma

Endoscopic assisted key-hole surgery for subacute subdural hematoma evacuation in emergency situations

Impact of Time Interval between Trauma Onset and Burr Hole Surgery on Recurrence of Late Subacute or Chronic Subdural Hematoma

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