Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Abstract

Background: To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods: A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results: A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions: This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Surgical Treatment of Bilateral Chronic Subdural Hematoma

“…After bleeding, it is secondary to hyperfibrinolysis and the increase of local fibrin degradation products, resulting in the continuous bleeding of new capillaries and the gradual increase of hematoma [ 15 , 16 ]. CSDH accounts for about 10% of all intracranial hematomas, and bilateral CSDH accounts for about 16%–20% [ 17 – 19 ] of all CSDH.…”

The Efficacy of Adjuvant Corticosteroids in Surgical Management of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

“…While there is consensus on the fact that evacuation of hematoma is essential, there is still a debate on what constitutes the best surgical procedure and on the most optimal perioperative and postoperative management protocol (6). Several researchers have focused on delineating non-modifiable factors, such as hyperdense hematoma, bilateral hematomas, separated hematoma, severe brain atrophy, postoperative pneumocephalus, and modifiable factors, such as subdural irrigation and drain placement, that are all associated with recurrence after surgical management of CSDH (27)(28)(29)(30)(31). Therapeutic agents like corticosteroids have also been used in some patients but without clear evidence of their efficacy.…”

“…However, it is also important to note that recurrence rates can be influenced by many other confounding factors like modified Nakaguchi-Classification, volumetric analysis, subdural irrigation, drain placement, etc. (27)(28)(29)(30)(31). While the influence of such confounders may have been minimal in RCTs, these variables could have affected outcomes of non-RCTs.…”

Middle Meningeal Artery Embolization and the Treatment of a Chronic Subdural Hematoma

“…Re-expansion was reduced in larger bilateral hematomas [24]. Poor brain re-expansion in bilateral cSDH, compared with unilateral cSDH, may lead to brain parenchymal shift, damage to blood vessels, postoperative pneumocephalus, and cerebrospinal fluid (CSF) accumulation in the hematoma cavity, resulting in higher recurrence rates [25][26][27].…”