Organized Subdural Hematoma with Thick Membrane in Chronic  Subdural Hematoma

Shrestha, Prabin; Pant, Basant; Rajbhandari, Pravesh

doi:10.31729/jnma.6

Cited by 10 publications

(12 citation statements)

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“…Although we used endoscopic surgery in all types of CSDH, patients with a higher risk of recurrence could be good candidates for such procedures. Patients on antiplatelet therapy, 51,52 organized hematoma, 53 solid clot, [53][54][55] large size hematomas, 56 CSDH with thick membrane, 57,58 septate hematomas, 52,59,60 a lesser percentage of hematoma drainage, 52,55 more postoperative air in the hematoma cavity, 61,62 and recurrent CSDH 21 are at high risk of recurrences. Such patients could benefit more by endoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Chronic Subdural Hematoma

Yadav

Ratre

Parihar

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Twist drill evacuation, burr hole aspiration, mini-craniotomy, and craniotomy are some of the surgical methods to remove chronic subdural hematoma (CSDH). Endoscopic treatment was also recently found to be useful. Methods We conducted a prospective study of 72 hematomas in 68 patients. Computed tomography was performed in all cases. Endoscopic surgery was performed in all CSDH patients. Surgical procedure A 4-cm skin incision was performed at the most curved part of skull with the CSDH. A mini-craniotomy or enlarged burr hole was made. The inner and outer table of the burr hole margin was drilled to provide a straight trajectory to the hematoma cavity. An endoscope supported by a telescope holder was used. A modified silicone brain retractor was used in five patients. A subgaleal drain was left in all patients for 3 to 5 days. Results There were 42 male and 26 female patients. The age ranged from 45 to 79 years (average: 69 years). All patients had a history of head trauma. Preoperative average Glasgow Coma Scale Score was 14. The procedure was effective in hematoma evacuation and a good visualization of the whole cavity in all patients. The endoscopic technique helped in complete hematoma removal in organized/solid clot, septations, and bridging vessels in 17, 2, and 2 cases, respectively. Duration of surgery ranged from 35 to 80 minutes. One death occurred. There was no recurrence, infection, fresh bleed, or injury to the brain or membrane. Conclusion The endoscopic technique is an effective alternative technique for treating CSDH. Although the study has limitations because of the small number of patients with a short follow-up, the study indicated that thick and vascular membranes, septations, and organized and solid clots can be removed effectively using this technique.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Chronic Subdural Hematoma

Yadav

Ratre

Parihar

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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“…Recurrences have been reported from as low as 2.3% to as high as 33% with various surgical approaches. 2,5,19 Surgical approaches to CSDH vary from minimally invasive twist drill craniostomy and burr hole drainage to more aggressive craniotomies and membranectomies. However, burr hole drainage has been found to be superior amongst the other approaches in terms of lower recurrence rate and complications.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors predicting recurrence of chronic subdural hematoma

Yogi¹,

Nepal²,

Gongal³

et al. 2018

Nep J Neurosci

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Recurrences after evacuation of chronic subdural hematoma are seen in 2-33% of cases with various surgical approaches. Various demographical, clinical, radiological, surgical and postoperative management strategies have been explored as the possible predictors of recurrence. We performed a retrospective analysis in 160 patients with chronic subdural hematoma with an aim to analyze the post-operative recurrences and factors associated with it. Various socio demographic and clinico-radiological parameters were studied against the rate of recurrence after surgery using Chi square/Fischer Exact Test. Factors showing significant association on univarate analysis were then analysed using binary logistic regression. The rate of recurrence of CSDH in our study was 5% and the mean duration of recurrence was 33 days. Chronic alcohol use (p=0.007) and intraoperative brain expansion ((p=0.001) were the two factors associated with recurrence of CSDH. On binary logistic regression chronic alcohol use (wald-6.467, p=0.011) and intraoperative brain expansion (wald=6.674, p=0.010) were both associated significantly with recurrence of CSDGH with an odds of 7.804 and 0.058 respectively.

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“…28 With time CSDH tends to organize and form capsulated thick membranes which either cover or lead to multiple loculations. 29 The membrane then tends to neovascularize leading to repeated bleeding and further expansion of the hematoma. The other causes of expansion of CSDH could be due to development of an osmotic gradient drawing more fl uid, active coagulation and fi brinolysis within the hematoma or elevated levels of tissue plasminogen activator.…”

Section: Discussionmentioning

confidence: 99%

“…Older age group, preexisting cerebral infarction, presence of subdural air after surgery correlated with poor brain expansion and higher recurrence. 29 The presence of comorbidities (dementia, history of ischemic stroke), psychiatric disorders, patient age, reoperation for recurrence, and preoperative mRS score were also associated with poorer outcome. 1 The size of CSDH, use of anticoagulants, hematoma thickness / radiological fi ndings does not affect the outcome.30 Nonoperative management is another option for the high risk cases or those whom are asymptomatic.…”

Section: Chronic Subdural Hematomamentioning

confidence: 96%

Single Burr Hole and Drainage in Chronic Subdural Hematoma: Outcome in Consecutive 333 Cases

Roka¹,

Firoj²,

Alok³

et al. 2016

Nep J Neurosci

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Chronic subdural hematoma (CSDH) is a common neurosurgical disease with incidence 3 in 100,000 in general population. Recorded or trivial head injury is the most common cause of CSDH with several predisposing factors like alcoholism, coagulopathy, seizure disorder, cerebrospinal fluid shunts, metastases and vascular malformations. Bilateral CSDH are common in infants and interhemispheric subdural hematomas are often associated with child abuse. Coagulopathy and intracranial tumors have been associated with spontaneous CSDH. 86 % were males with 47% of CSDH on left followed by 35% in right and 61 cases (18%) were bilateral. The most common age group was 61 to 80 years (45%) followed by the 41 to 60 year group. During admission headache was the most common symptom followed by neurological deficits that include, loss of speech (65%), mono or hemiparesis (20%), quadreparesis (5%), bowel and bladder dysfunction and loss of memory or altered sensorium. Statistical analysis did not show any significant p value between the Age group, Sex, Side of CSDH or chronic alcoholism as independent variables affecting outcome. GCS at admission was the only factor that had significant p value in terms of outcome prediction. Although there are multiple comorbidities associated with CSDH this study found that except GCS there was no relation to age, side, sex, alcoholism, hypertension or diabetes in the outcome after surgery. Meticulous care to remove all the CSDH followed by use of drain is the most efficient way to manage CSDH.Nepal Journal of Neuroscience 13:35-42, 2016

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Organized Subdural Hematoma with Thick Membrane in Chronic Subdural Hematoma

Cited by 10 publications

References 0 publications

Endoscopic Management of Chronic Subdural Hematoma

Endoscopic Management of Chronic Subdural Hematoma

Analysis of risk factors predicting recurrence of chronic subdural hematoma

Single Burr Hole and Drainage in Chronic Subdural Hematoma: Outcome in Consecutive 333 Cases

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