Surgical Management of Chronic Subdural Hematoma in Older Adults: A Systematic Review

Shlobin, Nathan A.; Kedda, Jayanidhi; Wishart, Danielle; García, Roxanna M.; Rosseau, Gail

doi:10.1093/gerona/glaa293

Cited by 14 publications

(15 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They declared that the results should be carefully interpreted due to the heterogeneity of literature in geography, study design and lack of proper clinical trials. 6 We found no association between AP history and higher recurrence rates in a 20-month follow-up period (P = .203). This result could be associated with our patients' lower number of positive AC/AP histories and should be carefully interpreted.…”

Section: Discussioncontrasting

confidence: 54%

“…Higher haematoma evacuation ratio, better surgical manoeuvrability and lower recurrence rate are advantages of BHC over twist-drill craniostomy. 4,6 Haemorrhagic intracranial lesions are known as a hypercoagulable state. Long-term immobilization, impaired level of consciousness, prolonged hospitalization period, multiple existing medical comorbidities, prior coagulopathic conditions, neurosurgical operation, old age and haematoma degradation products themselves are major risk factors for the development of deep venous thrombosis (DVT) and venous thromboembolism (VTE), overemphasizing the importance of proper DVT prophylaxis.…”

mentioning

confidence: 99%

“…8 Many studies have questioned the timing, drug choice and anticoagulation safety. 3,6,8 This study was designed to investigate the safety of enoxaparin as a heparin derivative in the postoperative period in CSDH operated with the BHC technique. All patients with CSDH who were eligible for surgical evacuation of CSDH were enrolled primarily (n = 147; Figure 1).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

et al. 2023

View full text Add to dashboard Cite

AimPatients with chronic subdural haematoma (CSDH) are at a significant risk for venous thromboembolism (VTE). Surgeons should weigh the advantages versus disadvantages of anticoagulants in the postoperative period.Patients and MethodsThis study was a randomized clinical trial conducted in Isfahan, Iran, from May 2016 to April 2021. Patients with CSDH eligible for bur‐hole craniostomy were primarily enrolled. All of them underwent bilateral lower limb Doppler ultrasonography (DUS) for deep venous thrombosis (DVT) screening. The patients were randomized into the case (n = 66, enoxaparin initiation 24 h after operation) and control (n = 70, enoxaparin initiation 72 h after operation) groups. Routine postoperative brain computed tomography scans were obtained 1 and 3 days after surgery. A second DUS was performed 96 h after operation to screen newly developed venous thrombosis; P value <.05 was defined significant.ResultsA total of 73 patients (59.8%) were female and 49 (40.2%) were male. The mean age was 65.1 ± 10.19 years; 9.9% of the patients had previously used antiplatelets. One patient had asymptomatic preoperative DVT. The mean values for enoxaparin dosage were 40.4918 ± 5.43 mg/day. Postoperative DVT or rebleeding prevalence was 0% in both groups. The mean follow‐up duration was 19.139 ± 2.2 months. Long‐term recurrence rate was 2.4% (n = 3). Postoperative pneumocephalus was associated with a higher recurrence rate (P = .031).ConclusionIn terms of VTE chemoprophylaxis, following bur‐hole craniostomy for CSDH, enoxaparin will effectively prevent VTE development without any clinically significant rebleeding.

show abstract

Section: Discussioncontrasting

confidence: 54%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The decision to surgically intervene in cSDH largely depends on its clinical presentation and radiological characteristics, such as hematoma size, midline shift, the presence of membranes and the presence of bilateral hematomas [ 13 , 14 ]. It is generally accepted that patients with neurologic symptoms and relevant radiological findings should undergo surgical evacuation.…”

Section: Discussionmentioning

confidence: 99%

“…First described by Svien and Gelety in 1964, BHC is a minimally invasive technique which involves the drilling of one or two burr holes of 10–20 mm in diameter [ 13 , 14 , 17 , 18 , 89 , 90 ]. If two burr holes are drilled, they usually are placed 5–8 cm apart [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

et al. 2022

View full text Add to dashboard Cite

Chronic subdural hematoma (cSDH) is one of the most common neurosurgical entities, especially in the elderly population. Diagnosis is usually established via a head computed tomography, while an increasing number of studies are investigating biomarkers to predict the natural history of cSDH, including progression and recurrence. Surgical evacuation remains the mainstay of treatment in the overwhelming majority of cases. Nevertheless, many controversies are associated with the nuances of surgical treatment. We performed a systematic review of the literature between 2010 and 2022, aiming to identify and address the issues in cSDH surgical management where consensus is lacking. The results show ambiguous data in regard to indication, the timing and type of surgery, the duration of drainage, concomitant membranectomy and the need for embolization of the middle meningeal artery. Other aspects of surgical treatment—such as the use of drainage and its location and number of burr holes—seem to have been adequately clarified: the drainage of hematoma is strongly recommended and the outcome is considered as independent of drainage location or the number of burr holes.

show abstract

Additional treatment after primary conservative treatment in patients with chronic subdural hematoma—A retrospective study

Fakhry,

Dirven,

Moudrous

et al. 2024

Brain and Behavior

View full text Add to dashboard Cite

ObjectiveChronic subdural hematoma (CSDH) is a common neurological condition and is typically treated with burr hole craniostomy. Nevertheless, conservative treatment may lead to spontaneous hematoma resolution in some patients. This study aims to describe the characteristics of patients who were treated conservatively without the eventual need for additional treatment.MethodsData were retrospectively collected from patients who were primarily treated conservatively in three hospitals in the Netherlands from 2008 to 2018. The Primary outcome was the nonnecessity of additional treatment within 3 months after the initial CSDH diagnosis. We used univariable and multivariable logistic regression analyses to identify factors associated with not receiving additional treatment.ResultsIn this study, 83 patients were included and 61 patients (73%) did not receive additional treatment within 3 months. Upon first presentation, the patients had a Markwalder Grading Scale score (MGS) of 0 (n = 5, 6%), 1 (n = 43, 52%), and 2 (n = 35, 42%). Additional treatment was less often received by patients with smaller hematoma volumes (adjusted odds ratio [aOR] 0.78 per 10 mL; 95% confidence interval [CI] 0.64–0.92). Patients using antithrombotic medication also received less additional treatment, but this association was not significant (aOR 2.02; 95% CI 0.61–6.69).ConclusionsThree quarters of the initially conservatively treated CSDH patients do not receive additional management. Typically, these patients have smaller hematoma volumes. Further, prospective research is needed to distinguish which patients require surgical intervention and in whom primary conservative treatment suffices.

show abstract

Surgical Management of Chronic Subdural Hematoma in Older Adults: A Systematic Review

Cited by 14 publications

References 72 publications

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

Additional treatment after primary conservative treatment in patients with chronic subdural hematoma—A retrospective study

Contact Info

Product

Resources

About