Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis

Tahsim-Oglou, Y.; Beseoglu, Kerim; Hänggi, Daniel; Stummer, Walter; Steiger, Hans‐Jakob

doi:10.1007/s00701-012-1334-0

Cited by 66 publications

(45 citation statements)

References 23 publications

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“…In addition, bilateral CSDH and young age appear to involve a higher risk of recurrence. 8,12,26,27 The current report describes an association of bilateral hematomas, orthostatic headaches, and multiple CSDH recurrences with a proven CSF leak. Based on our current observations, we suggest that criteria such as young age, early or multiple CSDH recurrence, continuing or unexplained clinical deterioration, orthostatic headaches, or the presence of bilateral CSDH should initiate the search for spinal CSF leaks.…”

Section: Patient Profile and Risk Factorsmentioning

confidence: 99%

“…4,7,18,[24][25][26] Our series showed a high rate of first (33.3%), second (11.1%), and third recurrences (3.7%), but no reference group of nongeriatric patients with CSDH is available for comparison. Multiple recurrences occurred significantly more often in patients with proven CSF leaks (categories 4 and 5) as compared with patients without such leaks.…”

Section: Patient Profile and Risk Factorsmentioning

confidence: 99%

“…26 For nonliquified space-occupying blood clots, open craniotomy under general anesthesia was the first procedure or a backup procedure.…”

Section: Surgery For Csdhmentioning

confidence: 99%

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Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Beck¹,

Gralla

Fung³

et al. 2014

JNS

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Object. The etiology of chronic subdural hematoma (CSDH) in nongeriatric patients (≤ 60 years old) often remains unclear. The primary objective of this study was to identify spinal CSF leaks in young patients, after formulating the hypothesis that spinal CSF leaks are causally related to CSDH.Methods. All consecutive patients 60 years of age or younger who underwent operations for CSDH between September 2009 and April 2011 at Bern University Hospital were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: MRI of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT. Spinal pathologies were classified according to direct proof of CSF outflow from the intrathecal to the extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings. The primary outcome was proof of a CSF leak.Results. Twenty-seven patients, with a mean age of 49.6 ± 9.2 years, underwent operations for CSDH. Hematomas were unilateral in 20 patients and bilateral in 7 patients. In 7 (25.9%) of 27 patients, spinal CSF leakage was proven, in 9 patients (33.3%) spinal meningeal cysts in the cervicothoracic region were found, and 3 patients (11.1%) had spinal cysts in the sacral region. The remaining 8 patients (29.6%) showed no pathological findings.Conclusions. The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of nongeriatric CSDH. (http://thejns.org/doi/abs/10.3171/2014.6.JNS14550) key WorDS • chronic subdural hematoma • spinal CSF leak • geriatric • vascular disorders • meningeal cyst Abbreviations used in this paper: CSDH = chronic subdural hematoma; mRS = modified Rankin Scale; SIH = spontaneous intracranial hypotension; SPACE = sampling perfection with application of optimized contrasts using different flip angle evolutions.

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Section: Patient Profile and Risk Factorsmentioning

confidence: 99%

Section: Patient Profile and Risk Factorsmentioning

confidence: 99%

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Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Beck¹,

Gralla

Fung³

et al. 2014

JNS

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“…10,21,22 The predictors of recurrence are highly variable but include patient characteristics such as age and bilateral cSDH, radiographic variables such as preoperative hematoma width and morphology, and surgical and perioperative factors such as operative technique and choice of drainage system. 7,10,[21][22][23]26,28,29 The use of antithrombosis (AT), which is defined here as either antiplatelets or anticoagulants, is expanding with a progressive rise in the prevalence of patients with atherosclerotic risk factors, 12 as well as thrombogenic cardiac arrhythmias which typically affect the elderly.…”

mentioning

confidence: 99%

“…In smaller studies, Tahsim-Oglou et al reported increased recurrence and reoperation rates for patients started on prophylactic dose LMWH (enoxaparin 40 mg daily) on postoperative Day 1, and Forster et al reported increased recurrence in high-risk patients bridged postoperatively with therapeutically dosed nadroparin (also a LMWH). 11,28 No studies assessing the recurrence risk with newer targeted anticoagulants were found.…”

mentioning

confidence: 99%

Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Guha

Coyne

Macdonald

2016

JNS

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C hroniC subdural hematoma (cSDH) is a disease of the elderly and demonstrates an incidence of approximately 3.4 patients per 100,000 persons younger than 65 years of age and 8 to 58 patients per 100,000 persons older than 65 years. 1,4,9 The prevalence of cSDH is expected to rise as the percentage of the United States population older than 65 years grows from 12% in 2003 to a projected 20% by 2030. 17Other identified risk factors for the development of cSDH include male sex, history of falls, chronic alcohol use, and antiplatelet or anticoagulant therapy, with warfarin increasing the relative risk of developing cSDH by aBBreViatiONS ADP = adenosine diphosphate; ASA = acetylsalicylic acid; AT = antithrombosis; CAD = coronary artery disease; cSDH = chronic subdural hematoma; DVT = deep venous thrombosis; INR = international normalized ratio; LMWH = low-molecular-weight heparin; TIA = transient ischemic attack. OBJectiVe Antithrombosis (AT), defined here as either antiplatelets or anticoagulants, is a significant risk factor for the development of chronic subdural hematomas (cSDHs). Resuming AT following the evacuation of cSDH is a highly variable practice, with scant evidence in the literature for guidance. Here, a retrospective analysis of a cohort of patients from a single institution undergoing surgical drainage of cSDH was performed to evaluate postoperative complications and determine the optimal timing of the resumption of common antithrombotic agents. methOdS This retrospective analysis was performed on 479 patients undergoing surgical evacuation of cSDH at St. Michael's Hospital over a 5-year period (2007)(2008)(2009)(2010)(2011)(2012). The collected variables included the type of AT agent, indications for AT, timing and type of postoperative complications, and the restart intervals for the AT agents, when available. Postoperative complications were classified as major hemorrhages, minor hemorrhages, or thromboembolic events. reSultS Among all 479 study patients, 71 experienced major hemorrhage (14.8%), 110 experienced minor hemorrhage (23.0%), and 8 experienced thromboembolism (1.67%) postoperatively. Patients on any type of preoperative AT regimen were at a higher risk of major hemorrhage (19.0% vs 10.9%; OR 1.93; 95% CI 1.15-2.71; p = 0.014). The type of AT agent did not affect the frequency of any postoperative complications. Patients on any preoperative AT regimen experienced earlier postoperative major hemorrhages (mean 16.2 vs 26.5 days; p = 0.052) and thromboembolic events (mean 2.7 vs 51.5 days; p = 0.036) than those patients without a history of AT; the type of AT agent did not affect timing of complications. Patients who were restarted on any AT therapy postoperatively were at decreased risk of major rebleeding following resumption than those patients who were not restarted (OR 0.06; 95% CI 0.02-0.2; p < 0.01). cONcluSiONS Patients with a history of preoperative AT experienced thromboembolic complications significantly earlier than those patients without AT, which peaked at 3 days postoperative...

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Pulmonary Embolism Complicating Neurosurgical Procedures

Ghannam

Choi

Nahed

2023

PERT Consortium Handbook of Pulmonary Embolism

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Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis

Abstract: The investigation provides evidence that copious intraoperative irrigation and avoidance of postoperative low-molecular-weight heparin thromboprophylaxis may reduce the recurrence rate of cSDH.

Cited by 66 publications

References 23 publications

Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Pulmonary Embolism Complicating Neurosurgical Procedures

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