Predictors for recurrence of chronic subdural hematoma

Hammer, Alexander; Tregubow, Alexander; Kerry, Ghassan; Schrey, M.P.; Hammer, Christian; Steiner, Hans-Herbert

doi:10.5137/1019-5149.jtn.17347-16.1

Cited by 22 publications

(31 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Overall, we found a higher recurrence risk in laminar and separated hematoma than in other hematomas. Several individual studies, however, did not report a high recurrence rate in laminar hematoma [29,43,64], but did report trabecular hematoma, corresponding to hematoma with multiplicity of cavities, to reoccur more often [49,[65][66][67][68][69]. This variation and discrepancy is most likely caused by the many available architecture categories which are applied parallel to the classification of Nakaguchi (i.e., loculated hematoma, hematoma with multiplicity of cavities, layered type hematoma, organized hematoma, and niveau formation), but OAC oral anticoagulation, PAI platelet aggregation inhibitor, reCSDH CSDH recurrence a Four patients died before discharge, therefor analyses were performed in 457 patients b Two patients died before discharge, therefor analyses were performed in 246 patients c Because of rounding, percentages in combined "OAC or PAI" group may differ with one percent from the sum of "OAC" and "PAI" could also be due to difficulties in applying the classification correctly [18,26,45,59,70,71].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Purpose Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. Methods Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. Results Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). Limitations Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. Conclusions Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Nineteen studies reported on uni-and bilaterality with incomplete data in two [43,44], resulting in seventeen studies with a total of 4400 patients for laterality analysis with a high study heterogeneity (I 2 = 70%). Patients with bilateral CSDH had higher hematoma recurrence than patients with a unilateral CSDH (Fig.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The number of recurrences was acceptable – 3.5% required repeated surgery. All patients had control CT 3 to 5 days after initial surgery, however it does not seem necessary [14], and control CT should be performed only in patients, whose clinical status worsens after initial surgical treatment. In 73 (10.5%) patients control CT showed significant pneumocephalus, however no one patient presented clinical symptoms or required surgical treatment due to this complication.…”

Section: Discussionmentioning

confidence: 99%

Chronic subdural hematoma (CSH) is still an important clinical problem. Analysis of 700 consecutive patients

Kotwica

Saracen

Dziuba

2019

Translational Neuroscience

View full text Add to dashboard Cite

BackgroundChronic subdural hematoma (CSH) is still an important neurosurgical problem and the number of patients increases despite the progress in early diagnosis of cerebral lesions.MethodologyWe analyzed a group of 700 consecutive patients treated in neurosurgical departments for CSH. Clinical state on admission was evaluated according to the Markwalder scale, all patients had CT studies and were operated using craniotomy or burr holes with closed system drainage techniques.ResultsMore than 50% had extensive intracranial bleeding, almost half of the patients were treated with oral anticoagulants. The patients with extensive fresh bleeding were in significantly worse states on admission and were treated by craniotomy and external capsulectomy (42%). All the others had burr holes and closed system drainage of the subdural space. Results of treatment were acceptable, 2% died, and 1.5% remained vegetative, due to massive hemorrhage and severe neurological deficits on admission.ConclusionsDespite a progress in diagnosis, CSH still remains an often cause of severe intracranial complications. The rising number of occurrences of this lesion is strictly connected with a wide use of oral anticoagulants. Surgical removal of CSH still remains the best type of treatment for such lesions.

show abstract

“…Hematoma density has also been cited by many authors as a risk factor for recurrence. 12 , 20 , 22 , 23 …”

Section: Discussionmentioning

confidence: 99%

“…Some prospective studies showed no beneficial effect, whereas other authors report lower recurrence rates with the use of postoperative drains because of brain expansion. 3 , 8 , 22 , 24 , 25 A recent meta-analysis concluded that postoperative drainage is clearly useful in the treatment of CSDH and should be recommended. 2 Our findings also corobrate this conclusion as post operative drainage significantly (p<0.05) reduced the CSDH recurrence rate in our study.…”

Section: Discussionmentioning

confidence: 99%

Radiological predictors of recurrence of chronic subdural hematoma

Altaf¹,

Shams

Vohra

2018

Pak J Med Sci

View full text Add to dashboard Cite

Objective:Chronic subdural hematoma is one of the most common clinical entities encountered in daily neurosurgical practice. Considerable recurrence rates have been reported for chronic subdural hematoma following surgical evacuation. Many studies have suggested various radiological factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. This study focuses on determining the radiological factors predictive of chronic subdural hematoma recurrence.Methods:A retrospective analysis of 113 patients diagnosed with chronic subdural hematoma who were surgically treated between August 2013 and December 2014 was performed. The radiological features were analyzed to clarify the correlation between these radiological factors and postoperative recurrence of chronic subdural hematoma.Results:Twenty patients (17.7%) experienced recurrence. Chronic subdural hematoma recurrence was found to be significantly associated (p<0.05) with preoperative hematoma thickness ≥ 20 mm. Midline shift, hematoma density and bilaterality were not significantly associated with recurrence. Post operative drainage also significantly (p<0.05) reduced chronic subdural hematoma recurrence.Conclusion:Preoperative hematoma thickness ≥ 20 mm is an independent predictor of recurrence of chronic subdural hematoma. Postoperative drainage also significantly reduces chronic subdural hematoma recurrence.

show abstract

Predictors for recurrence of chronic subdural hematoma

Cited by 22 publications

References 23 publications

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

Chronic subdural hematoma (CSH) is still an important clinical problem. Analysis of 700 consecutive patients

Radiological predictors of recurrence of chronic subdural hematoma

Contact Info

Product

Resources

About