Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas

Schwarz, Falko; Loos, Franz; Dünisch, Pedro; Sakr, Yasser; Safatli, Diaa Al; Kalff, Rolf; Ewald, Christian

doi:10.1016/j.clineuro.2015.08.002

Cited by 75 publications

(61 citation statements)

References 29 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation

Motiei-Langroudi¹,

Stippler²,

Shi³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Chronic subdural hematoma (CSDH) is commonly encountered in neurosurgical practice. However, surgical evacuation remains complicated by a high rate of reoperation. The optimal surgical approach to reduce the reoperation rate has not been determined. In the current study, the authors evaluated the prognostic value of clinical and radiographic factors to predict reoperation in the context of CSDH. METHODS A retrospective review of 325 CSDH patients admitted to an academic medical center in the United States, between 2006 and 2016, was performed. Clinical and radiographic factors predictive of the need for CSDH reoperation were identified on univariable and multivariable analyses. RESULTS Univariable analysis showed that warfarin use, clopidogrel use, mixed hypo- and isointensity on T1-weighted MRI, greater preoperative midline shift, larger hematoma/fluid residual on first postoperative day CT, lesser decrease in hematoma size after surgery, use of monitored anesthesia care (MAC), and lack of intraoperative irrigation correlated with a significantly higher rate of reoperation. Multivariable analysis, however, showed that only the presence of loculation, clopidogrel or warfarin use, and percent of hematoma change after surgery significantly predicted the need for reoperation. Our results showed that 0% (no reduction), 50%, and 100% hematoma maximum thickness change (complete resolution of hematoma after surgery) were associated with a 41%, 6%, and < 1% rate of reoperation, respectively. The use of drains, either large diameter or small caliber, did not have any effect on the likelihood of reoperation. CONCLUSIONS Among many factors, clopidogrel or warfarin use, hematoma loculation on preoperative CT, and the amount of hematoma evacuation on the first postoperative CT were the strongest predictors of reoperation.

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Section: Discussionmentioning

confidence: 99%

Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation

Motiei-Langroudi¹,

Stippler²,

Shi³

et al. 2018

Journal of Neurosurgery

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“…The goal of the treatment is to return the patients to previous daily life regardless of age, and is successful in most patients. However, the recurrence rates are not particularly low,[371721] and the clinical course is not always benign, especially for elderly patients,[12] with greater perioperative risk in patients aged over 85 years. [2] The implications in daily neurosurgical practice are that burr hole surgery does not involve high risk, however, recurrence and reduced daily activity with comorbidity may occur in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, high postoperative recurrence rates of up to 20% have been reported. [371721] Repeat surgery has been effective in most cases of recurrent CSDH, however, refractory cases require further procedures or other interventions. We successfully treated an elderly patient with refractory CSDH by fibrin glue injection into the hematoma cavity.…”

Section: Introductionmentioning

confidence: 99%

Fibrin glue injection into the hematoma cavity for refractory chronic subdural hematoma: A case report

Watanabe

Amagasaki

Shono³

et al. 2016

Surg Neurol Int

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Background:Repeat burr hole irrigation and drainage has been effective in most cases of recurrent chronic subdural hematoma (CSDH), however, refractory cases require further procedures or other interventions.Case Description:An 85-year-old male presented with left CSDH, which recurred five times. The hematoma was irrigated and drained through a left frontal burr hole during the first to third surgery and through a left parietal burr hole during the fourth and fifth surgery. The hematoma had no septation and was well-evacuated during each surgery. Antiplatelet therapy for preventing ischemic heart disease was stopped after the second surgery, the hematoma cavity was irrigated with artificial cerebrospinal fluid at the third surgery, and the direction of the drainage tube was changed to reduce the postoperative subdural air collection at the fourth surgery. However, none of these interventions was effective. He was successfully treated by fibrin glue injection into the hematoma cavity after the fifth surgery.Conclusion:This procedure may be effective for refractory CSDH in elderly patients.

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“…1,2,[10][11][12]15 Moreover, in bcSDHs the retreatment rate reaches almost 30%. 7,13,19 Noted retreatment rates for bcSDHs in the literature depict both surgery for ipsilateral recurrence and surgery for contralateral progression after initial unilateral hematoma evacuation. Because of their different underlying pathomechanisms, ipsilateral recurrence and contralateral progression should be distinguished.…”

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confidence: 99%

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

Scheichel¹,

Popadic²,

Ungersboeck³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEUnilateral evacuation of bilateral chronic subdural hematomas (bcSDHs) is associated with higher retreatment rates than an initial bilateral intervention. One reason for that is a possible progression in the size of the contralateral side after unilateral treatment. Thus, the authors focused their study on finding predictors of the need for contralateral retreatment.METHODSAll patients who had undergone unilateral or bilateral evacuation of bcSDHs in the Department of Neurosurgery at the University Hospital of St. Poelten during a 5-year period (7/2012 to 6/2017) were retrospectively identified. The preoperative hematoma volume was calculated using the XYZ/2 method.RESULTSOf a total of 103 patients with bcSDHs, 61 patients underwent bilateral evacuation and 42 patients underwent unilateral evacuation. The retreatment rate after bilateral evacuation was significantly lower than that after unilateral evacuation (14.8% vs 31%, respectively; p = 0.049). Contralateral retreatment after unilateral evacuation was necessary in 9 patients (21.4%). The preoperative contralateral hematoma volume was significantly higher in those patients who needed contralateral retreatment after initial unilateral evacuation (68.4 cm3 vs 27.4 cm3, respectively; p < 0.001). Furthermore, the so-called volume relation ratio created by dividing the smaller by the larger hematoma volume was significantly higher when contralateral retreatment became necessary (0.56 vs 0.21, respectively; p < 0.001).CONCLUSIONSPatients needing evacuation of bcSDHs should be considered for primary bilateral evacuation if the hematoma volume on the smaller side is greater than 40 cm3 and the subsequent volume relation ratio is greater than 0.4.

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Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas

Cited by 75 publications

References 29 publications

Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation

Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation

Fibrin glue injection into the hematoma cavity for refractory chronic subdural hematoma: A case report

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

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