Opening the Internal Hematoma Membrane Does Not Alter the Recurrence Rate of Chronic Subdural Hematomas: A Prospective Randomized Trial

OBJECTIVE Chronic subdural hematoma (CSDH) is commonly encountered in neurosurgical practice. However, surgical evacuation remains complicated by a high rate of reoperation. The optimal surgical approach to reduce the reoperation rate has not been determined. In the current study, the authors evaluated the prognostic value of clinical and radiographic factors to predict reoperation in the context of CSDH. METHODS A retrospective review of 325 CSDH patients admitted to an academic medical center in the United States, between 2006 and 2016, was performed. Clinical and radiographic factors predictive of the need for CSDH reoperation were identified on univariable and multivariable analyses. RESULTS Univariable analysis showed that warfarin use, clopidogrel use, mixed hypo- and isointensity on T1-weighted MRI, greater preoperative midline shift, larger hematoma/fluid residual on first postoperative day CT, lesser decrease in hematoma size after surgery, use of monitored anesthesia care (MAC), and lack of intraoperative irrigation correlated with a significantly higher rate of reoperation. Multivariable analysis, however, showed that only the presence of loculation, clopidogrel or warfarin use, and percent of hematoma change after surgery significantly predicted the need for reoperation. Our results showed that 0% (no reduction), 50%, and 100% hematoma maximum thickness change (complete resolution of hematoma after surgery) were associated with a 41%, 6%, and < 1% rate of reoperation, respectively. The use of drains, either large diameter or small caliber, did not have any effect on the likelihood of reoperation. CONCLUSIONS Among many factors, clopidogrel or warfarin use, hematoma loculation on preoperative CT, and the amount of hematoma evacuation on the first postoperative CT were the strongest predictors of reoperation.

Section: Discussionmentioning

confidence: 67%

Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation

Motiei-Langroudi¹,

Stippler²,

Shi³

et al. 2018

“…1,5 The best evidence, published in the systematic reviews of Malcolm et al and van de Vijfeijken et al, shows a higher failure risk in autologous bone than allografts, which brings to light synthetic implants and favors the decision to use them. 6,7 In this analysis, the significantly higher rates of reoperation in patients with autologous implants are primarily due to bone resorption. The factors that result in clinically relevant bone resorption remain unclear.…”

Section: Responsementioning

confidence: 99%

“…Different series of TN for MS have reported a 5-year pain control rate of up to 54% (Table 1). [1][2][3][4][5][6][7][9][10][11] For Gamma Knife surgery (GKS) in MS, the target point needs to be definitely determined. As the pathophysiology in MS lies inside the brainstem, targeting the conventional points along the cisternal component of the trigeminal nerve (Marseille point) might not always help in the pain control.…”

Section: Responsementioning

confidence: 99%

Letter to the Editor. Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies

Tachibana¹

2019

“…Recently, Li et al have reported that ultra-early stereotactic aspiration can be adopted in patients with ICH and without positive spot sign. 7 Ge et al showed that only craniotomy can benefit patients with positive spot sign, whereas both craniotomy and minimally invasive craniopuncture can be used in patients with negative spot sign. 4 Negative spot sign represents a lower risk of rebleeding, which suggests that early minimally invasive surgery can be conducted in these patients.…”

Section: Imaging Predictor For Rebleeding After Surgery In Intracerebmentioning

confidence: 99%

“…2 Similarly, in chordoma, recent studies have revealed that the tumor-infiltrating lymphocytes within the tumor microenvironment were significant predictors of chordoma outcome, which even displayed stronger prognostic power than the traditional classification system in survival prediction. 7 As analysis of the immune microenvironment is less affected by the intratumoral heterogeneity, 3 researchers have recently recommended to add this microenvironmental component to prognostic analysis in order to improve outcome prediction. 6 However, because previous studies mainly focused on spinal chordomas, data on the immune microenvironment in SBC are still lacking.…”

Section: Prognostic Molecular Panel For Skull Base Chordomamentioning

confidence: 99%

Letter to the Editor. Contralateral transmaxillary approach

Snyderman¹,

Gardner²

2019