Coagulation and Fibrinolysis in Chronic Subdural Hematoma

Kawakami, Yasuto; Chikama, Masanori; Tamiya, Takashi; Shimamura, Yasunori

doi:10.1227/00006123-198907000-00005

Cited by 75 publications

(20 citation statements)

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“…Thus, selecting the most suitable treatment must focus on reducing complications and minimising recurrence. It is well known that brain atrophy, causative trauma and coagulopathy begin a cycle of bleeding, hemostasis, fibrinolysis and rebleeding that leads to a progressive enlargement of the cSDH [7,10,12]. If this cycle is not stopped, haematoma persistence or recurrence is likely.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases

et al. 2012

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“…59 60 The high concentration of vascular endothelium derived growth factor (VEGF), for example, could be involved in the formation of the haematoma membranes. Furthermore, the haematoma fluid contains inflammatory mediators [61][62][63] and fibrinolytic factors [64][65][66][67][68][69][70][71][72][73][74][75][76] which all may play a role in the further development of the haematoma. The risk of recurrence is increased when the concentration of fibrinolytic factors remains high in the postoperative drainage fluid.…”

Section: Discussionmentioning

confidence: 99%

“…80 During this period, about 90 ml of haematoma fluid on average have to be buffered by the cranial reserve capacity without a detrimental rise in intracranial pressure. 67 Postoperative drainage for several days might be useful to support re-expansion of the brain into the space which had been occupied by the haematoma. Nakaguchi and colleagues thought that the lower risk of recurrence when placing the tip of a drain in the frontal convexity was due to the removal of subdural air.…”

Section: Discussionmentioning

confidence: 99%

Outcome of contemporary surgery for chronic subdural haematoma: evidence based review

Weigel

2003

Journal of Neurology, Neurosurgery & Psychiatry

528

375

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Objective: To evaluate the results of surgical treatment options for chronic subdural haematoma in contemporary neurosurgery according to evidence based criteria. Methods: A review based on a Medline search from 1981 to October 2001 using the phrases "subdural haematoma" and "subdural haematoma AND chronic". Articles selected for evaluation had at least 10 patients and less than 10% of patients were lost to follow up. The articles were classified by three classes of evidence according to criteria of the American Academy of Neurology. Strength of recommendation for different treatment options was derived from the resulting degrees of certainty. Results: 48 publications were reviewed. There was no article that provided class I evidence. Six articles met criteria for class II evidence and the remainder provided class III evidence. Evaluation of the results showed that twist drill and burr hole craniostomy are safer than craniotomy; burr hole craniostomy and craniotomy are the most effective procedures; and burr hole craniostomy has the best cure to complication ratio (type C recommendation). Irrigation lowers the risk of recurrence in twist drill craniostomy and does not increase the risk of infection (type C recommendation). Drainage reduces the risk of recurrence in burr hole craniostomy, and a frontal position of the drain reduces the risk of recurrence (type B recommendation). Drainage reduces the risk of recurrence in twist drill craniostomy, and the use of a drain does not increase the risk of infection (type C recommendation). Burr hole craniostomy appears to be more effective in treating recurrent haematomas than twist drill craniostomy, and craniotomy should be considered the treatment of last choice for recurrences (type C recommendation). Conclusions: The three principal techniques-twist drill craniostomy, burr hole craniostomy, and craniotomy-used in contemporary neurosurgery for chronic subdural haematoma have different profiles for morbidity, mortality, recurrence rate, and cure rate. Twist drill and burr hole craniostomy can be considered first tier treatment, while craniotomy may be used as second tier treatment. A cumulative summary of data shows that, overall, the postoperative outcome of chronic subdural haematoma has not improved substantially over the past 20 years. C hronic subdural haematoma of the elderly is nowadays often considered to be a rather benign entity, ignoring its relatively high mortality and morbidity. When Virchow first described "pachymeningitis haemorrhagica interna," however, it was considered a fatal disorder.1 Over the past 150 years, a dramatic improvement in outcome was achieved following better understanding of the pathophysiology, the introduction of modern imaging methods, and refinement of operative techniques.2 However, mortality of up to 13% is still reported in contemporary literature, [3][4][5][6] which may reflect the fact that up to four deaths a year are related to this condition in a typical neurosurgical department. Although this is one of the most frequent...

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“…The hematoma is enlarged due to bleeding from the outer membrane and incurrent mechanisms of the cerebrospinal fluid (CSF) from the inner membrane (2,3,7,8,10).…”

Section: Peer-review Reportsmentioning

confidence: 99%

Incidence and Risk Factors of Chronic Subdural Hematoma After Aneurysmal Clipping

et al. 2013

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Coagulation and Fibrinolysis in Chronic Subdural Hematoma

Cited by 75 publications

References 0 publications

Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases

Minimally invasive decompression of chronic subdural haematomas using hollow screws: efficacy and safety in a consecutive series of 320 cases

Outcome of contemporary surgery for chronic subdural haematoma: evidence based review

Incidence and Risk Factors of Chronic Subdural Hematoma After Aneurysmal Clipping

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