Predicting Factors of Chronic Subdural Hematoma Following Surgical Clipping in Unruptured and Ruptured Intracranial Aneurysm

Abstract

ObjectiveThe aim of this study is to analyze the differences in the incidence, predicting factors, and clinical course of chronic subdural hematoma (CSDH) following surgical clipping between unruptured (UIA) and ruptured intracranial aneurysm (RIA).MethodsWe conducted a retrospective analysis of 752 patients (UIA : 368 and RIA : 384) who underwent surgical clipping during 8 years. The incidence and predicting factors of CSDH development in the UIA and RIA were compared according to medical records and radiological data.ResultsThe incidence of postoperative CSDH was higher in the UIA (10.9%) than in the RIA (3.1%) (p=0.000). In multivariate analysis, a high Hounsfield (HF) unit (blood clots) for subdural fluid collection (SFC), persistence of SFC ≥5 mm and male sex in the UIA and A high HF unit for SFC and SFC ≥5 mm without progression to hydrocephalus in the RIA were identified as the independent predicting factors for CSDH development (p<0.05).ConclusionThere were differences in the incidence and predicting factors for CSDH following surgical clipping between UIA and RIA. Blood clots in the subdural space and persistence of SFC ≥5 mm were predicting factors in both UIA and RIA. However, progression to hydrocephalus may have in part contributed to low CSDH development in the RIA. We suggest that cleaning of blood clots in the subdural space and efforts to minimize SFC ≥5 mm at the end of surgery is helpful to prevent CSDH following aneurysmal clipping.

Study of incidence and factors: Risk and preventive, of chronic subdural hematoma/hygroma in clipped patients of unruptured intracranial aneurysms – An institutional experience

“…According to various studies, the incidence of CSDH in unruptured aneurysms clipping is between 2% and 20%. [2][3][4][5][6] In our study, the incidence was 23%, which was almost similar to previous studies that considered both hematoma and hygroma. The findings were confirmed.…”

“…[2] In case of unruptured aneurysm clipping also, studies have confirmed this finding. [2][3][4][5][6] We also found the same observation. Kampo medicine, which includes Gorei-san, is a Japanese herbal medicine that has been used to treat CSDH formation and recurrence.…”

“…[ 2 ] In case of unruptured aneurysm clipping also, studies have confirmed this finding. [ 2 3 4 5 6 ] We also found the same observation.…”

Arachnoid Plasty to Prevent and Reduce Chronic Subdural Hematoma after Clipping Surgery for Unruptured Intracranial Aneurysm : A Meta-Analysis

“…The healing process of the injured membrane induces the one-way valve from the subarachnoid to the subdural space, and results in persistent CSF leakage, eventually leading to CSDH development. Several additional studies also supported the correlation between subdural fluid collection and CSDH 4,5,8,9,14) . Therefore, ARP implementation can likely be considered to inhibit persistent CSF leakage, to essentially reduce postoperative CSDH development.…”

“…The reported incidence rates of CSDH are 2.8% in UIA and 0.9% in RIA 15) . Kwon et al 9) also reported higher incidence rates of CSDH in UIA than RIA (10.9% vs. 3.1%, respectively). To explain this difference, the author suggested two possible mechanisms : one entails the potential subdural space obliteration by the residual hematoma with brain edema, and the other is the osmotic gradient theory of the CSDH likely contributing to lower incidence rates 2) .…”