Proposal of treatment strategies for bilateral chronic subdural hematoma based on laterality of treated hematoma

Takahashi, Satoru; Yamauchi, Takahiro; Yamamura, Toshihiro; Ogishima, Takahiro; Arai, Toshinari

doi:10.4103/ajns.ajns_124_18

Cited by 12 publications

(12 citation statements)

References 22 publications

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“…Although a previous research found no significant differences in postoperative outcomes between the bilateral and unilateral CSDH groups (4), in more recent studies, outcomes were poorer in the bCSDH group (3,5,29,30), with bilateral hematoma cited as having an elevated risk of acute aggravation of clinical manifestation due to downward herniation. Therefore, early and rapid surgical drainages of bilateral hematomas are needed to achieve better outcomes and recovery of neurological function and may be performed with success rates similar to those in unilateral hematomas (5,31,32).…”

Section: Discussionmentioning

confidence: 99%

Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma

Fan

et al. 2021

Front. Neurol.

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Background: Bilateral chronic subdural hematoma (bCSDH) is a frequent condition commonly linked to the need for retreatment; however, the reason for this high retreatment rate remains unclear. The middle meningeal artery (MMA) was found to have a relationship with the occurrence and development of chronic subdural hematomas. This study examines a possible method to reduce bCSDH recurrence using bilateral MMA embolization combined with bilateral burr-hole drainage.Materials and Methods: Ten patients with bCSDH who underwent bilateral MMA embolization combined with bilateral burr-hole drainage at our hospital between June 2018 and May 2020, were retrospectively analyzed. Patients' clinical information, prognoses, imaging results, as well as surgical results were documented and analyzed.Results: Ten patients were diagnosed with bCSDH with no comorbid brain diseases. They underwent bilateral MMA embolization combined with bilateral burr-hole drainage. We embolized the MMA immediately before burr hole drainage successfully and employed angiography to validate these results. All the patients attained relief of symptoms without adverse events, and no re-expansion or relapse was reported in the follow-up computed tomography.Conclusion: Bilateral MMA embolization combined with bilateral burr-hole drainage is an available treatment for patients with bCSDH and may have the potential for preventing recurrence.

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Section: Discussionmentioning

confidence: 99%

Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma

Fan

et al. 2021

Front. Neurol.

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Section: Discussionmentioning

confidence: 99%

“…Contralateral hematoma progression after the unilateral evacuation of bCSDH is usually encountered in neurosurgical practice 20–23. Some patients even experienced an increase in the volume of the contralateral hematoma within one day after unilateral surgery 23. One explanation for this phenomenon is that an increase in the volume of the contralateral hematoma is due to a reduction in intracranial pressure after a unilateral operation (i.e., the larger the ipsilateral hematoma is, the higher the pressure relief on the untreated side, followed by contralateral hematoma expansion) 22.…”

Section: Discussionmentioning

confidence: 99%

“…Although the XYZ/2 method has been demonstrated to be reliable for CSDH by Sucu et al24 and others,22,23 it is not suitable for the measurement of the PostHV and PostPV because the postoperative hematoma and air are often irregular and mixed together. To quantitatively analyze the PostHV and PostPV, we measured the area of the postoperative hematoma and pneumocephalus at each layer, added the area of all layers, and multiplied by the layer thickness, thus obtaining the volume.…”

Section: Discussionmentioning

confidence: 99%

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<p>A Grading System For The Prediction Of Unilateral Chronic Subdural Hematoma Recurrence After Initial Single Burr Hole Evacuation</p>

Shen¹,

Yang²,

Li³

et al. 2019

RMHP

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Background and purposePrevious studies have identified many risk factors related to the recurrence of chronic subdural hematomas (CSDHs). Among these factors, there may be deviations in measuring the midline shift, preoperative hematoma volume (PreHV), postoperative hematoma residual volume, and postoperative pneumocephalus in bilateral CSDHs. The aims of this study were to eliminate the impact of complicated situations on parameter measurement and to identify actual predictors for CSDH recurrence, and finally, to develop a grading system to predict unilateral CSDH (uCSDH) recurrence.Patients and methodsA total of 342 patients with uCSDH were identified. Predictors of uCSDH recurrence were obtained from univariable and multivariable logistic regression models. A prognostic grading system was developed based on the results of multivariable logistic regression and receiver operating characteristic (ROC) analyses. All patients were scored according to the grading system, and differences in the recurrence rate were reanalyzed according to the scores.ResultsAge, antiplatelet or anticoagulant use, midline shift, severe brain atrophy, drainage volume, and the ratio of the postoperative pneumocephalus volume (PostPV) to the postoperative hematoma cavity volume (PostHCV) were identified as independent risk factors for predicting the recurrence of uCSDH. The cut-off values of age, drainage volume, midline shift, and the ratio of the PostPV to the PostHCV were 67 years, 101 mL, 11.2 mm, and 31.61%, respectively. The recurrence rates were 1.7%, 12.4%, 19.4%, 53.3%, and 58.3% for scores of 0–1, 2, 3, 4, and 5–6, respectively, which significantly increased as the score increased (P<0. 001).ConclusionThe prognostic grading system for uCSDH on the basis of multivariable logistic regression and ROC analyses is applicable and reliable.

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“…There has recently been a surge in research concerning bCSDH in order to find evidence for standardised treatment guidelines [ 3 , 16 , 19 , 24 ]. It has previously been highlighted that bCSDHs themselves are risk factors for recurrence [ 3 , 5 , 10 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for need of reoperation in bilateral chronic subdural haematomas

et al. 2021

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Background Chronic subdural haematoma (CSDH) is one of the most common neurosurgical diseases. A subtype of CSDH is bilateral chronic subdural haematoma (bCSDH) which represents 20–25% of patients with CSDH and has a higher recurrence rate. There is no clear consensus on how bCSDH should be treated regarding upfront unilateral- or bilateral evacuation of both haematomas. The purpose of this study was to identify risk factors associated with reoperation of bCSDH. Methods A total of 326 patients with radiological evidence of bCSDH were included in this retrospective cohort study where 133 (40.8%) patients underwent primary bilateral evacuation and 193 (59.2%) primary unilateral evacuation. The two centres operated using different surgical approaches. Analyses were performed to identify risk factors associated with reoperation of bCSDH. Reoperation rate was defined as reoperation of CSDH on either side of the hemisphere within 3 months after primary evacuation. Results The cohort had a total reoperation rate of 26.4%. Patients which underwent unilateral evacuation had a reoperation rate of 32.1%, and the bilateral group had a reoperation rate of 18.0% (p=0.005). Multivariable logistic regression identified unilateral evacuation (OR 1.91, p=0.022) and complications according to Ibanez (OR 2.20, p=0.032) to be associated with the need of reoperation of bCSDH. One-burr hole craniostomy with active subgaleal drain was primarily performed in bilateral approach (69.4%) whereas patients operated with minicraniotomy with passive subdural drain were primarily operated by unilateral evacuation of the larger symptomatic side (92.8%). Conclusions Unilateral evacuation of bCSDH was associated with a higher risk for reoperation than upfront bilateral evacuations in this study. There is a need to further discuss the criteria for uni- or bilateral evacuation since patients are treated differently at different centres.

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Proposal of treatment strategies for bilateral chronic subdural hematoma based on laterality of treated hematoma

Cited by 12 publications

References 22 publications

Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma

Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma

<p>A Grading System For The Prediction Of Unilateral Chronic Subdural Hematoma Recurrence After Initial Single Burr Hole Evacuation</p>

Risk factors for need of reoperation in bilateral chronic subdural haematomas

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