Incidence and Risk Factors of Chronic Subdural Hematoma After Aneurysmal Clipping

Ohno, Takamasa; Iihara, Koji; Takahashi, Jun; Nakajima, Norio; Satow, Tetsu; Hishikawa, Tomohito; Nagata, Izumi; Yamada, Kazuo; Miyamoto, Susumu

doi:10.1016/j.wneu.2012.09.025

Cited by 28 publications

(62 citation statements)

References 12 publications

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“…7,15,17,24 In contrast, the present study investigated postoperative subdural complications, such as subdural hygromas and CSDHs, as a continuum and identified independent risk factors, including an aneurysm location requiring extensive dissection of the arachnoid membrane covering the sylvian fissure (MCA aneurysms, as well as multiple aneurysms at the MCA and ACoA), in addition to advanced age and male sex. Furthermore, aneurysms requiring extensive arachnoid dissection, including ACoA and MCA aneurysms, with the exception of ICA aneurysms, reached near significance (0.05 < p < 0.1) as risk factors for an operative CSDH in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 96%

“…Mori and Maeda 15 reported the following incidences of CSDHs after neurosurgical procedures: 0.4% following the removal of a brain tumor, 2.4% after clipping an aneurysm, and 5.9% after superficial temporal artery-to-MCA anastomosis. Also, Ohno et al 17 reported a significantly higher incidence of CSDHs after surgery for unruptured aneurysms than after surgery for ruptured aneurysms. The brain swelling following an SAH is considered to decrease the subdural space and resist the accumulation of CSF.…”

Section: Discussionmentioning

confidence: 99%

“…7,15,17,24 Although most subdural hygromas resolve spontaneously, they can persist for a while and even convert to a CSDH. Such persistence of subdural hygromas can become more problematic in patients with medical conditions requiring antiplatelet or anticoagulant medication.…”

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confidence: 99%

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Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors

Park¹,

Cho²,

Goh³

et al. 2016

JNS

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors

Park¹,

Cho²,

Goh³

et al. 2016

JNS

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“…Chronic subdural hematoma (CSDH) is a rare complication of unruptured aneurysm clipping surgery 5 , 12) . Because CSDH signs and symptoms may appear slowly, development of postoperative CSDH is often not recognized immediately.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of Chronic Subdural Hematoma after Surgical Clipping for Unruptured Anterior Circulation Aneurysms

Lee

Yeon

et al. 2015

J Korean Neurosurg Soc

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ObjectiveChronic subdural hematoma (CSDH) is a rare complication of unruptured aneurysm clipping surgery. The purpose of this study was to identify the incidence and risk factors of postoperative CSDH after surgical clipping for unruptured anterior circulation aneurysms.MethodsThis retrospective study included 518 patients from a single tertiary institute from January 2008 to December 2013. CSDH was defined as subdural hemorrhage which needed surgical treatment. The degree of brain atrophy was estimated using the bicaudate ratio (BCR) index. We used uni- and multivariate analyses to identify risk factors correlated with CSDH.ResultsSixteen (3.1%) patients experienced postoperative CSDH that required burr hole drainage surgery. In univariate analyses, male gender (p<0.001), size of aneurysm (p=0.030), higher BCR index (p=0.004), and the use of antithrombotic medication (p=0.006) were associated with postoperative CSDH. In multivariate analyses using logistic regression test, male gender [odds ratio (OR) 4.037, range 1.287-12.688], high BCR index (OR 5.376, range 1.170-25.000), and the use of antithrombotic medication (OR 4.854, range 1.658-14.085) were associated with postoperative CSDH (p<0.05). Postoperative subdural fluid collection and arachnoid plasty were not showed statistically significant difference in this study.ConclusionThe incidence of CSDH was 3.1% in unruptured anterior circulation aneurysm surgery. This study shows that male gender, degree of brain atrophy, and the use of antithrombotic medication were associated with postoperative CSDH.

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“…Kristof et al (12) reported that βTP, a highly specific CSF marker, was shown to be present in the subdural fluid of the vast majority of CSDH patients (94%) in his study, and suggested that CSF leakage into the subdural space could be involved in the pathogenesis of CSDH. Ohno et al (21) reported that an increase in postoperative subdural fluid collection over the course of 1 week was a significant risk factor for CSDH after aneurysm clipping. And, Tanaka and Ohno (29) reported that nearly 50% of patients with asymptomatic subdural fluid collection after head trauma developed CSDH.…”

Section: █ Discussionmentioning

confidence: 99%

Chronic subdural hematoma preceded by high-impact trauma: does the intensity of trauma influence the pathogenesis of traumatic chronic subdural hematoma?

Park¹,

Lee²,

Park³

et al. 2015

Turkish Neurosurgery

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ABSTRACTof the meninges and the neo-membrane of hematoma have been recently clarified. Additionally, the roles of inflammatory, fibrinolytic, angiogenic, and coagulation-system factors in the CSDH have been investigated (3,7,8,12,22,32). Currently, CSDH is considered a chronic self-perpetuating inflammatory process involving the dura mater.Trauma is probably the most important risk factor for CSDH. Rupture of transversing veins by trauma is commonly known █ INTRODUCTION C hronic subdural hematoma (CSDH) is a commonly encountered neurosurgical disease that is more likely to occur under certain conditions, including advanced age, alcoholism, abnormal coagulation, dementia, seizure disorder, or after cerebrospinal fluid (CSF) diversion (13,17,18). Although the pathophysiology of CSDH has been controversial over the last several years, the ultrastructural anatomy AIm: The purpose of this study was to investigate whether the intensity of trauma influences the pathogenesis of traumatic chronic subdural hematoma (CSDH). mATERIAl and mEThODS: Thirty-one patients treated surgically for traumatic CSDH were divided into high-impact and lowimpact groups according to the intensity of trauma. They were respectively evaluated with respect to clinical and radiological findings at presentation, and the subdural concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor, and beta-trace protein (βTP) [a highly specific protein in the cerebrospinal fluid (CSF)] related to the pathogenesis of CSDH. If βTP (subdural fluid/serum) was >2, an admixture of CSF to the subdural fluid was indicated. RESUlTS:The βTP (subdural fluid/serum) was >2 in all patients with a traumatic CSDH. The mean concentration of subdural βTP in the high-impact group was higher than in the low-impact group (6.1 mg/L versus 3.9 mg/L), and the difference was statistically significant (p=0.02). In addition, mean concentrations of IL-6, IL-8 and VEGF were higher in the high-impact group, as compared to the low-impact group, though the differences did not reach statistical significance.CONClUSION: Trauma may be related to CSF leakage into the subdural space in CSDH, and the intensity of trauma may influence the amount of CSF leakage. Although there is no direct correlation between the amount of CSF leakage and other subdural molecules, the intensity of trauma may be associated with larger concentrations of molecules in traumatic CSDH.

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Incidence and Risk Factors of Chronic Subdural Hematoma After Aneurysmal Clipping

Cited by 28 publications

References 12 publications

Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors

Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors

Incidence and Risk Factors of Chronic Subdural Hematoma after Surgical Clipping for Unruptured Anterior Circulation Aneurysms

Chronic subdural hematoma preceded by high-impact trauma: does the intensity of trauma influence the pathogenesis of traumatic chronic subdural hematoma?

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