Intraoperative hematoma volume can predict chronic subdural hematoma recurrence

Honda, Masaru; Maeda, Hajime

doi:10.25259/sni_97_2021

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…Some studies believe that middle meningeal artery embolization can prevent hematoma expansion and recurrence in patients with recurrence after multiple surgical treatments [ 28 ]. At present, bilateral drilling drainage is recommended for most patients with bilateral CSDH [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Bilateral Chronic Subdural Hematoma

Zhuang

Jiang

Zhou

et al. 2022

Computational Intelligence and Neuroscience

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Background. Chronic subdural hematoma (CSDH) is one of the common clinical intracranial hemorrhagic disorders, accounting for 16%–20% of bilateral CSDH. At present, the surgical treatment of bilateral CSDH mainly includes drilling drainage and neuroendoscopic assistance. The main objective of this paper was to compare the effects of two surgical methods on CSDH. Methods. 153 patients who were diagnosed with CSDH were included in this study. 79 patients were treated with bilateral drilling drainage, and the other 74 patients were treated with neuroendoscope-assisted drainage. The clinical data of the two groups were compared, and the surgical indexes, neurological function, cure rate, and recurrence rate of the two groups were compared. The operation indexes of patients include operation time, postoperative hematoma volume, hospital stay, extubation time, misplacement of drainage tube, recurrence, and hematoma clearance rate. Results. All patients underwent CT examination one day after operation. The CT imaging detection of the two groups was generally good. The cranial CT was reexamined before discharge. The bilateral hematoma disappeared in 114 patients, the unilateral hematoma disappeared in 29 patients, a small amount of compensatory crescent very low-density shadow subdural effusion was observed on the other side, and a small amount of compensatory crescent very low-density shadow subdural effusion was observed on both sides in 10 patients. There was no space occupying effect and intracranial gas disappeared. Compared with neuroendoscopic assisted drainage, the operation time of drilling drainage patients was significantly shorter. The extubation time, drainage tube dislocation, recurrence rate, postoperative hematoma volume, and hematoma clearance rate of patients receiving neuroendoscopic assisted drainage were significantly better than those receiving drilling drainage. The Markwalder score and hospital stay between the two groups were not significant. Conclusions. Drilling drainage and neuroendoscopic assisted surgery have good therapeutic effects on bilateral CSDH. The operation time of drilling drainage is shorter. Neuroendoscopic assisted surgery has more advantages in extubation time, misplacement of drainage tube, recurrence, postoperative hematoma volume, and hematoma clearance rate.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Bilateral Chronic Subdural Hematoma

Zhuang

Jiang

Zhou

et al. 2022

Computational Intelligence and Neuroscience

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“…Studies have identified demographic, comorbid, preoperative, and postoperative factors associated with CSDH recurrence. [ 1 , 3 , 5 , 8 , 10 - 13 , 16 - 18 , 21 , 24 , 25 , 29 , 32 - 34 , 37 , 41 , 42 , 44 ] Examples include advanced age, bleeding tendency, brain atrophy, alcohol abuse, bilateral hematoma, hematoma density, size or volume of the hematoma, midline shift, diabetes mellitus, postoperative posture, postoperative subdural air accumulation, inflammatory cytokines, and some technical aspects of surgery. Identifying these factors allow clinicians to better manage patients deemed to be at high risk for recurrence.…”

Section: Introductionmentioning

confidence: 99%

Puerto Rico Recurrence Scale: Predicting chronic subdural hematoma recurrence risk after initial surgical drainage

Mignucci-Jiménez

Matos-Cruz

Abramov

et al. 2022

Surgical Neurology International

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Background: Chronic subdural hematoma (CSDH) commonly affects older individuals and is associated with a relatively high rate of recurrence after surgery. Many studies have created grading systems to identify patients at high risk of CSDH recurrence after the initial surgery. However, no system has been adopted widely. The authors present the first CSDH grading system created from a population-based single-center data set. Methods: A single-center Puerto Rican population-based retrospective analysis was performed on consecutive patients treated for a CSDH at a designated institution from July 1, 2017 to December 31, 2019. Univariate and multivariate analyses were used to create a CSDH recurrence grading scale. Retrospective validation was conducted on this sample population. Results: The study included 428 patients. Preoperative midline shift, postoperative midline shift, and size of postoperative subdural space differed between the recurrence and nonrecurrence groups (P = 0.03, 0.002, and 0.002, respectively). A multivariate analysis was used to create a 10-point grading scale comprising four independent variables. Recurrence rates progressively increased from the low-risk (0–3 points) to high-risk (8–10 points) groups (2.9% vs. 20.3%; P < 0.001). Conclusion: A 10-point grading scale for CSDH recurrence was developed with four components: preoperative midline shift (≤1 and >1 cm), laterality (bilateral, unilateral-right, and unilateral-left), size of postoperative subdural space (≤1.6 and >1.6 cm), and pneumocephalus (present or absent). Patients who scored higher on the scale had a higher risk of recurrence. This CSDH grading scale has implications for Puerto Rico and the general population as the elderly population increases worldwide.

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