Risk Factor Analysis for the Recurrence of Chronic Subdural Hematoma: A Review of 368 Consecutive Surgical Cases

Abstract

IntroductionA chronic subdural hematoma (CSDH) is a well-known disease of intracranial hemorrhage in old people. The burr hole trephination is the usual treatment of CSDH with a good outcome and prognosis.Despite the simple treatment of CSDH, the recurrence rate of CSDH is not low. The recurrence rate of CSDH ranged between 10% and 33% in previous studies.26) Many studies have been reported on factors associated with the recurrence of CSDH; however, the results were inconsistent. The purpose of this study was to identify risk factors for the recurrence of CSDH. We hypothesized that some factors including age, sex, underlying disease, radiological images and surgical procedures affect the recurrence of CSDH. Series of 368 surgical patients were retrospectively evaluated and analyzed to support this hypothesis. Materials and Methods Patient selectionWe retrospectively evaluated 368 patients who underwent a surgery with CSDH. The patients visited the department of neurosurgery at Seoul National University Bundang Hospital between January 1993 and December 2013. Objective: Chronic subdural hematoma (CSDH) is a common form of extra axial hemorrhage in the elderly. A surgical procedures such as a burr hole trephination are used for the CSDH treatment. The recurrence rate of CSDH is reported to range from 2.3 to 33%. In the current study, we focused on the determination of risk factors associated with the recurrence of CSDH. Methods: We retrospectively reviewed 368 consecutive patients with CSDH treated by burr hole trephination. Univariate and multivariate analysis were performed to describe the relationships between clinical and radiological factors as well as the recurrence of CSDH. Results: Totally 31 (8.4%) patients experienced a recurrence of CSDH in our study. The male group (10.2%) had a higher recurrence rate than the female group (3.1%). Also patients with malignant neoplasm history showed a high recurrence rate (17.9%). The recurrence rate of single layer CSDH (13.1%) and isodensity CSDH (11.7%) was highly significant also. Conclusion: Sex, history of malignant neoplasm and the hematoma type on computed tomography were factors related with the recurrence of CSDH in our study. These findings may be supportive in the identification of patients at risk for a recurrence of CSDH. CLINICAL ARTICLE Korean

Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation

“…If large or symptomatic, it is addressed surgically through burr hole trephination or craniotomy, with a reported recurrence rate ranging from 2.3% to 38.7% for different surgical techniques. 6,7,10,20,21 Although many investigators have tried to elucidate factors responsible for recurrence and reoperation, there is an ongoing debate about which parameters are relevant in this matter. Among the established factors are presence of coagulopathy or anticoagulant drug use, presence of CSDH loculations, larger preoperative hematoma volume, presence of significant postoperative residual hematoma, and postoperative pneumocephalus.…”

“…Among the established factors are presence of coagulopathy or anticoagulant drug use, presence of CSDH loculations, larger preoperative hematoma volume, presence of significant postoperative residual hematoma, and postoperative pneumocephalus. 3,6,7,10,13,16,20,[23][24][25] In 2 meta-analyses that included 19 randomized clinical trials and 250 studies each, heterogeneity of hematoma on CT, use of intraoperative irrigation, and drain use were identified as factors predictive of the need for reoperation. 2,14 with respect to a few factors, likely missing the interaction between other variables and confounders.…”

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

“…Over numerous studies, the recurrence rate of this disorder is reported to be 9%–33%[ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ] and these studies also analyzed the risk factors for postoperative recurrence. The reported risk factors are laterality of hematomas being bilateral,[ 1 5 16 17 21 22 ] preoperative hematoma width and midline shift being greater,[ 5 10 11 16 18 19 23 ] volume of postoperative residual air and subdural space being greater,[ 2 4 8 13 14 18 19 20 ] preoperative hematoma densities,[ 2 4 6 7 11 13 17 18 19 ] medical history including diabetes mellitus, hypertension, leukemia, liver disease, chronic renal failure and seizure,[ 5 7 17 23 ] and intake of anticoagulant or thrombolytic drugs. [ 7 15 ] However, the findings were not consistent between the studies.…”

A Prospective Randomized Study on the Preventive Effect of Japanese Herbal Kampo Medicine Goreisan for Recurrence of Chronic Subdural Hematoma

“…3,4) Although a relatively simple surgical treatment usually consisting of burr hole opening and drainage of the hematoma is effective, recurrence occurs postoperatively at 5.4-18.1%. [5][6][7][8][9][10][11][12][13][14][15][16] In symptomatic reaccumulation of hematoma, repetitive drainage or craniotomy is often required, but redo surgery may have a negative impact on the neurological status and patients' quality of life. Several retrospective analyses have reported the benefit of adjuvant medical treatment, such as corticosteroid, 17,18) atorvastatin, 19,20) tranexamic acid, 21) etizolam, 22) and angiotensin-converting enzyme (ACE) inhibitor, 23) to lower the recurrence rate.…”