Risk factors for recurrence of chronic subdural hematoma after burr hole surgery: potential protective role of dexamethasone

Zhou, Qian; Yang, Danni; Sun, Fei; Sun, Zengqi

doi:10.1080/02688697.2016.1260686

Cited by 60 publications

(40 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It was not possible to observe a significant difference in the recurrence rate between the sexes, which is in agreement with other studies 12,13 .…”

Section: Discussionsupporting

confidence: 92%

Analysis of predisposing factors for chronic subdural hematoma recurrence

Santos

Xander

Rodrigues

et al. 2019

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

SUMMARY OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of 595 patients with an initial diagnosis of Chronic Subdural Hematoma (CSDH) who underwent surgical treatment at a Reference Hospital of São Paulo. METHODS: A retrospective descriptive study, in which the medical records of all patients with a CSDH diagnosis submitted to surgical treatment from 2000 to 2014 were analyzed. RESULTS: The final study population consisted of 500 patients with a diagnosis of CSDH (95 patients with a diagnosis of Cystic Hygroma were excluded), of which 27 patients presented recurrence of the disease (5.4%). There were no statistically significant differences in relapses when cases were stratified by gender, laterality of the first episode or surgical procedure performed in the first episode (trepanning vs. craniotomy). It was possible to demonstrate an age-related protective factor, analyzed as a continuous variable, regarding the recurrence of the CSDH, with a lower rate of recurrence the higher the age. CONCLUSIONS: The results indicate that, among possible factors associated with recurrence, only age presented a protective factor with statistical significance. The fact that no significant difference between the patients submitted to trepanning or craniotomy was found favors the preferential use of burr-hole surgery as a procedure of choice due to its fast and less complex execution.

show abstract

“…It was not possible to observe a significant difference in the recurrence rate between the sexes, which is in agreement with other studies 12,13 .…”

Section: Discussionsupporting

confidence: 92%

Analysis of predisposing factors for chronic subdural hematoma recurrence

Santos

Xander

Rodrigues

et al. 2019

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

show abstract

“…Further to this, 25 out of 26 patients had complete resolution of the CSDH following conservative management with dexamethasone only. Several other studies have supported these findings with reductions in recurrence in surgical patients or successful conservative management of CSDH with dexamethasone therapy [89–92]. By reducing recurrence, dexamethasone could significantly reduce mortality, particularly if given for longer time periods pre-operatively; however, further level 1 data is needed to support this therapy [93, 94].…”

Section: Pharmacotherapymentioning

confidence: 97%

Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy

Edlmann

Giorgi-Coll

Whitfield

et al. 2017

J Neuroinflammation

422

360

View full text Add to dashboard Cite

Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and fluid on the surface of the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. This review focuses on several key processes involved in CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic membrane surrounding the CSDH has been identified as a source of fluid exudation and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels within membrane walls, whilst fibrinolytic processes prevent clot formation resulting in continued haemorrhage. An abundance of inflammatory cells and markers have been identified within the membranes and subdural fluid and are likely to contribute to propagating an inflammatory response which stimulates ongoing membrane growth and fluid accumulation. Currently, the mainstay of treatment for CSDH is surgical drainage, which has associated risks of recurrence requiring repeat surgery. Understanding of the underlying pathophysiological processes has been applied to developing potential drug treatments. Ongoing research is needed to identify if these therapies are successful in controlling the inflammatory and angiogenic disease processes leading to control and resolution of CSDH.

show abstract

“…Similar rationale and conclusion were reached by another recently published study advocating the use of steroids following the surgical evacuation of CSDH to prevent recurrence. 22 The role of steroids in CSDH remains a controversial topic; nonetheless, an ongoing trial in the UK is currently addressing this and hopefully will put an end to this debate. 41 Most recently the British Neurosurgical Trainee Research Collaborative (BNTRC) published the largest multicenter, prospective, observational cohort study looking at the management and outcome for patients with chronic subdural haematomas.…”

Section: 38mentioning

confidence: 99%

Chronic Subdural Haematoma: Systematic Review Highlighting Risk Factors for Recurrent Bleeds

Abdelsadg¹,

Kanodia²,

Abbas³

et al. 2017

Neuro – Open Journal

View full text Add to dashboard Cite

Citation Systematic ReviewPage 16 ABSTRACTIntroduction: Chronic subdural haematoma (CSDH) is one of the commonest forms of intracranial haemorrhage. Surgical drainage of CSDH is a routine operation in the modern neurosurgical practice which has shown to be the most effective way in treating this entity; however, the incidence of recurrence of the haematoma post operatively remains as high as 26.5%. The risk factors for CSDH recurrence remains an area of ongoing research. Objective: We have conducted a systematic review to evaluate the available literature addressing the risk factors for CSDH recurrence, aiming to minimise or at least identify patients at higher risk of recurrence in order to decrease associated morbidity. Methods: Ovid via Medline, PubMed, and Google scholar databases were searched for eligible studies, search results were then limited to studies in English language, Humans and studies published within the last 5 years. The included studies were critically appraised using the Critical Appraisal Skills Programme (CASP) tool, and each study has then been ranked using the Harbour and Miller hierarchy of ranking.Results: Based on available evidence, we classified the risk factors associated with recurrence to patients', radiological, and surgical factors. Patient factors include history of seizures, trauma, alcoholism, brain atrophy, and presence of CSF shunts, while the role of diabetes in relation to the recurrence is controversial. Radiologically the presence of air in the subdural space post-operatively, the width of the haematoma, and the presence of bilateral CSDHs are associated with increased risk of recurrence. While the predictive value of multiple membranes in the CSDH remains controversial. Surgically, the risk of recurrence was noted to be higher in patients with parietal or occipital compared to those who had frontal burr hole drainage, also placing a subdural drain decreases the chance of recurrence and some evidence showed better outcomes for frontally placed drains. The role of anti-inflammatory agents (including steroids) remains an area of ongoing debate. Conclusions: Risk factors for CSDH can be divided into patients', radiological, and surgical factors. We encourage health care providers to minimize if not prevent potentially avoidable factors. Patients with increased risks for recurrence should be identified early by the treating team and when possible should be informed about their higher than usual risk of recurrence. Moreover this review highlights the general lack of a sufficiently powered class I evidence addressing this topic and that further research is required in this topic.

show abstract

Risk factors for recurrence of chronic subdural hematoma after burr hole surgery: potential protective role of dexamethasone

Abstract: These findings indicated that advanced age, midline displacement, and mixed density hematoma are independent factors for unilateral CSDH recurrence. When the above factors are detected in patients, additional DX administration should be recommended after operation.

Cited by 60 publications

References 24 publications

Analysis of predisposing factors for chronic subdural hematoma recurrence

Analysis of predisposing factors for chronic subdural hematoma recurrence

Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy

Chronic Subdural Haematoma: Systematic Review Highlighting Risk Factors for Recurrent Bleeds

Contact Info

Product

Resources

About