Surgical Treatment of Chronic Subdural Hematoma Based on Intrahematomal Membrane Structure on MRI

Tanikawa, Motoki; Mase, Mitsuhito; Yamada, Kazuo; Yamashita, Nobuko; Matsumoto, Takashi; Banno, Tomohiro; Miyati, Tosiaki

doi:10.1007/s007010170067

Cited by 85 publications

(63 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17 With regards to multiplicity of the hematoma cavity conflicting reports were published. While previous studies reported multiplicity to be positively correlated with recurrence of CSDH, 2,33 other concluded it is associated with lower rates of recurrence. 13 This conflicting evidence could be attributed at least partially to the discrepancy in defining "multiplicity of the haematoma".…”

Section: -22mentioning

confidence: 84%

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

Section: -22mentioning

confidence: 84%

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

show abstract

“…Tanikawa et al 22) reported that a multilayer intrahematomal structure led to a high recurrence rate and that these structures were well visualized on T2-weighted MRI. They found that a significant number of these cases did not achieve complete recovery using initial burr-hole surgery.…”

Section: Resultsmentioning

confidence: 99%

“…The causes of treatment failure include the presence of nonliquefied hematomas with various bleeding foci 14) ; multilayer loculations within the hematoma, which produce noncommunicating compartments 22) ; and excessive formation of a solid membranes 5) . Occasionally, advanced age has been considered to be a risk factor for recurrence and reoperation 19,20) .…”

Section: Discussionmentioning

confidence: 99%

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

Kim

Kang

Kim

et al. 2011

J Korean Neurosurg Soc

View full text Add to dashboard Cite

mostly liquefied CSDH. Conversely, craniotomy is generally accepted as the optimal approach for reaccumulation of a CSDH, existence of a solid hematoma, failure of brain reexpansion, or marked swelling subjacent to the hematoma 5,14) . The purpose of this study was to analyze the efficacy of small or large craniotomy with membranectomy as the initial treatment for CSDH. MATERIALS AND METHODSA retrospective study was performed using the medical records retained by our hospital. computed tomography (CT) scans were the primary imaging method for the evaluation of CSDH in all patients. The technique of a burr-hole with closed system drainage for 24 to 72 hours was chosen for cases of nonseptated and mostly liquefied CSDH. However, on the basis of CT and/or magnetic resonance imaging (MRI) findings, cases of CSDH demonstrating either mixed density or hyperdense lesions ( Fig. 1), intrahematomal membranes or web-like structures (Fig. 2), or an organized/calcified CSDHs (Fig. 3) were selected for craniotomy. We classified 317 patients with CSDH into three groups according to the extent of surgery required : group I, burr hole with drainage (n=259); group II, small crani- INTRODUCTIONChronic subdural hematoma (CSDH) represents one of the most frequent intracranial hemorrhages encountered in neurosurgical department, with elderly citizens being more frequently affected. The reasons why this type of hematoma occurs frequently among the elderly include an increase in antithrombotic medications, venous fragility, augmentation of the subdural space, and an increased exposure to traumatic injury resulting from frequent falls 1) . For the initial management of CSDH, numerous surgical treatments have been proposed 5,14,15,18,21) . However, the extent of surgical treatment required for CSDH is still controversial 2,24) , and the optimal treatment for CSDH is not well defined 16) . The choice of surgical technique for CSDH must be dictated by the degrees of organization of the hematoma. Burr-hole with drainage is mandatory for non-septated and Department of Neurosurgery, Seoul Medical Center, Seoul, KoreaObjective : There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods : Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results : The mean ages were 69.4±12.1 a...

show abstract

“…However, whether drainage alone or drainage with irrigation is better for patients with CSDH remains unclear [1,2,4,5,[10][11][12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Treatments for Chronic Subdural Hematoma: Burr Hole Drainage versus Burr Hole Drainage with Irrigation

2011

View full text Add to dashboard Cite

Surgical Treatment of Chronic Subdural Hematoma Based on Intrahematomal Membrane Structure on MRI

Abstract: We concluded that a considerable number of cases appeared to need craniotomy and resection of intrahematomal membrane for complete recovery in CSDH, and that T2*-weighted MR imaging could be used as a basis for selecting the operative procedure for CSDH.

Cited by 85 publications

References 22 publications

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

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

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

A Comparative Study of Treatments for Chronic Subdural Hematoma: Burr Hole Drainage versus Burr Hole Drainage with Irrigation

Contact Info

Product

Resources

About