Coagulopathy in Chronic Subdural Hematoma

Kawakami, Yasuto; Tanimoto, Takaho; Shimamura, Yasunori

doi:10.2176/nmc.31.32

Cited by 17 publications

(3 citation statements)

References 10 publications

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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%

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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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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“…CSDH acts differently from ICHs in multiple pathophysiologic aspects. Chronic and ongoing bleeding, clot formation and haematoma degradation release numerous systemic mediators associated with procoagulant and AC features of CSDH 12–14 . However, many remain unknown about the exact pathobiology, and thus more fundamental studies are required.…”

Section: Discussionmentioning

confidence: 99%

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

et al. 2023

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AimPatients with chronic subdural haematoma (CSDH) are at a significant risk for venous thromboembolism (VTE). Surgeons should weigh the advantages versus disadvantages of anticoagulants in the postoperative period.Patients and MethodsThis study was a randomized clinical trial conducted in Isfahan, Iran, from May 2016 to April 2021. Patients with CSDH eligible for bur‐hole craniostomy were primarily enrolled. All of them underwent bilateral lower limb Doppler ultrasonography (DUS) for deep venous thrombosis (DVT) screening. The patients were randomized into the case (n = 66, enoxaparin initiation 24 h after operation) and control (n = 70, enoxaparin initiation 72 h after operation) groups. Routine postoperative brain computed tomography scans were obtained 1 and 3 days after surgery. A second DUS was performed 96 h after operation to screen newly developed venous thrombosis; P value <.05 was defined significant.ResultsA total of 73 patients (59.8%) were female and 49 (40.2%) were male. The mean age was 65.1 ± 10.19 years; 9.9% of the patients had previously used antiplatelets. One patient had asymptomatic preoperative DVT. The mean values for enoxaparin dosage were 40.4918 ± 5.43 mg/day. Postoperative DVT or rebleeding prevalence was 0% in both groups. The mean follow‐up duration was 19.139 ± 2.2 months. Long‐term recurrence rate was 2.4% (n = 3). Postoperative pneumocephalus was associated with a higher recurrence rate (P = .031).ConclusionIn terms of VTE chemoprophylaxis, following bur‐hole craniostomy for CSDH, enoxaparin will effectively prevent VTE development without any clinically significant rebleeding.

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“…Zum einen konnte er eine deutlich verzögerte Prothrombinzeit feststellen und außerdem eine verlängerte aktivierte partielle Thromboplastinzeit. Des Weiteren fand er eine Reduktion von Prothrombin und Thrombin (Kawakami et al 1989;Kawakami et al 1991). Suzuki et al stellten außerdem eine hyperfibrinolytische Aktivität innerhalb des Hämatoms fest.…”

Section: Auch Durch Störung Der Gerinnungsmechanismen Kommt Es Zur We...unclassified

Bettseitige Bohrlochtrepanation als Therapie des subakuten und chronischen Subduralhämatoms

Dechend¹

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Coagulopathy in Chronic Subdural Hematoma

Cited by 17 publications

References 10 publications

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

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

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

Bettseitige Bohrlochtrepanation als Therapie des subakuten und chronischen Subduralhämatoms

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