Fibrin and Fibrinogen Degradation Products in Chronic Subdural Hematoma

Ito, Hiroki; Komai, Toshio; Yamamoto, Shinjiro

doi:10.2176/nmc.15pt1.51

Cited by 28 publications

(8 citation statements)

References 7 publications

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“…[11] found that, parallel to very low fibrinogen and high FDP concentrations in the haematoma [10], also FPBI] 15-42 was markedly elevated in CSDH, marking highly sensitive fibrinolysis by plasmin. When fibrinolytic activity is characteristic for CSDH, it is possible that rinsing additionally supports insufficient clot formation due to preponderance of the plasminogen system.…”

Section: Discussionmentioning

confidence: 97%

“…In our opinion, the reason for this aggressive surgical regimen may be substantiated by the presence of ongoing repeated microhaemorrhages from the neocapillary network in the outer neomembrane with aggravation by the fibrinolytic activity of fibrinogen degradation products [10], thus placing the patient at risk for clinical deterioration due to rebleeding.…”

Section: Follow-upmentioning

confidence: 99%

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Chronic subdural haematoma ? a comparison of two different treatment modalities

1997

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Burr-hole craniotomy (BHC) and closed-system drainage undoubtedly is currently the most accepted treatment offered in chronic subdural haematoma (CSDH). Although twist-drill trephination (TDT) techniques have been available for years, now a special subdural catheter kit has been launched for treatment of CSDH. In a prospective study, 33 patients with 36 CSDH were treated with a 5-mm TDT regimen and insertion of a CORDIS subdural catheter (CORDIS Corp., Miami, USA). The results are compared with a consecutive series of 33 patients treated previously with an 11-mm BHC and closed-system drainage for 40 CSDH: Recurrence and persistence rate of CSDH treated with TDT necessitating a second intervention was 18.1%, no further surgical intervention was necessary. In BHC treated patients, 33.3% of haematomas had to be reoperated on, another 6.0% had to be re-operated on a third time. Infection rate in BHC treated patients was 18.1% as compared with a 0% infection rate in patients treated with the TDT technique. Mortality rate for the BHC method was 9.0% as compared with 6.0% in the TDT treatment regimen. Significantly better clinical results are achieved using the TDT technique with insertion of a special subdural catheter, making this procedure superior to the BHC regimen.

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Section: Discussionmentioning

confidence: 97%

Section: Follow-upmentioning

confidence: 99%

Chronic subdural haematoma ? a comparison of two different treatment modalities

1997

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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

530

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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“…[2][3][4] Treatment for this entity has longtime remained controversial regarding the use of postoperative subdural drain. [4][5][6] Although several authors have advocated the use of drainage to reduce the recurrence of cSDH, there have been only few attempts to clarify this question with prospective studies. Hence, this study attempts to compare the recurrence of a cSDH after burr hole drainage with and without the use of a postoperative subdural drain.…”

mentioning

confidence: 99%

Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

Sapkota

Niraula

Lohani

et al. 2020

Eastern Green Neurosurg.

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Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

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Fibrin and Fibrinogen Degradation Products in Chronic Subdural Hematoma

Cited by 28 publications

References 7 publications

Chronic subdural haematoma ? a comparison of two different treatment modalities

Chronic subdural haematoma ? a comparison of two different treatment modalities

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

Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

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