The role of exudation in chronic subdural hematomas

Tokmak, Mehmet; İplikçioğlu, A. Celal; Bek, Şirzat; Gökduman, C. A.; Erdal, Mustafa

doi:10.3171/jns-07/08/0290

Cited by 54 publications

(46 citation statements)

References 21 publications

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“…30 On the other hand capillary vasculopathy including haemorrhage (e.g., retinal haemorrhage) is one of the major complications in diabetic patients, and the exudation from the capillaries in the membrane of CSDH plays an important role in its enlargement. 31,32 Moreover, similar study showed increased but non-significant risk for recurrence in patients with DM, it was also found that patients with bilateral CSDH tend to have DM. 17 With regards to multiplicity of the hematoma cavity conflicting reports were published.…”

Section: -22mentioning

confidence: 78%

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

Abdelsadg¹,

Kanodia²,

Abbas³

et al. 2017

Neuro – Open Journal

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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.

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Section: -22mentioning

confidence: 78%

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

Abdelsadg¹,

Kanodia²,

Abbas³

et al. 2017

Neuro – Open Journal

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“…It is also believed that exudation from the macrocapillaries in the outer membrane plays an important role in the enlargement of hematoma. 14 It is not clear why those processes would be different for parafalcial and tentorial SDH, although a smaller number of bridging veins and less tension on them may explain the difference. Furthermore, the fact that there is less counterpressure from the brain in the convexity could predispose to the growth of SDH in that particular location.…”

Section: Discussionmentioning

confidence: 99%

Nonsurgical acute traumatic subdural hematoma: what is the risk?

Bajsarowicz

Prakash²,

Lamoureux

et al. 2015

JNS

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T raumaTic subdural hematomas (SDHs) are a common pathological entity in neurosurgical practice. Between 12% and 29% of patients admitted with a severe traumatic brain injury (TBI) have an acute SDH. When combining all patients with TBI, 11% present with an SDH. 10 Acute traumatic SDH has been traditionally considered a lesion that should be treated surgically, although some might be approached conservatively. In a study by Wong, 17 a midline shift greater than 5 mm in patients with a Glasgow Coma Scale (GCS) score below 15 was associated with deterioration and the need for surgical evacuation. In another study, 11 it was the initial thickness of the SDH that was predictive of the need for surgery, with all SDHs greater than 10 mm in thickness requiring surgical evacuation. Based on these findings, Servadei et al.12 attempted to establish a treatment protocol for comatose patients with SDH. They selected 15 comatose patients with abbreviatioNs AUC = area under the curve; BCR = bicaudate ratio; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; ISS = Injury Severity Score; ROC = receiver operating characteristic; SDH = subdural hematoma; SFR = sylvian fissure ratio; TBI = traumatic brain injury. obJect The Brain Trauma Foundation has published guidelines on the surgical management of traumatic subdural hematoma (SDH). However, no data exist on the proportion of patients with SDH that can be selected for conservative management and what is the outcome of these patients. The goals of this study were as follows: 1) to establish what proportion of patients are initially treated conservatively; 2) to determine what proportion of patients will deteriorate and require surgical evacuation; and 3) to identify risk factors associated with deterioration and delayed surgery. methods All cases of acute traumatic SDH (869 when inclusion criteria were met) presenting over a 4-year period were reviewed. For all conservatively treated SDH, the proportion of delayed surgical intervention and the Glasgow Outcome Scale score were taken as outcome measures. Multiple factors were compared between patients who required delayed surgery and patients without surgery. results Of the 869 patients with acute traumatic SDH, 646 (74.3%) were initially treated conservatively. A good outcome was achieved in 76.7% of the patients. Only 6.5% eventually required delayed surgery, and the median delay for surgery was 9.5 days. Factors associated with deterioration were as follows: 1) thicker SDH (p < 0.001); 2) greater midline shift (p < 0.001); 3) location at the convexity (p = 0.001); 4) alcohol abuse (p = 0.0260); and 5) history of falls (p = 0.018). There was no significant difference in regard to age, sex, Glasgow Coma Scale score, Injury Severity Score, abnormal coagulation, use of blood thinners, and presence of cerebral atrophy or white matter disease. coNclusioNs The majority of patients with SDH are treated conservatively. Of those, only 6.5% later required surgery, for raised intracranial pressure or SDH pr...

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“…Akt, VEGF, and VE-cadherin were localized to the endothelial cells of vessels within the membranes. Abnormally permeable capillaries in the outer membranes of cSDHs have been thought to be responsible for exudation into the fluid collection, especially in patients with more severe disease [10].…”

Section: Discussionmentioning

confidence: 99%

Resolution of Chronic Subdural Hematoma after Treatment with Tumor Necrosis Factor Alpha Inhibitor

Ross¹

2011

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The role of exudation in chronic subdural hematomas

Cited by 54 publications

References 21 publications

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

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

Nonsurgical acute traumatic subdural hematoma: what is the risk?

Resolution of Chronic Subdural Hematoma after Treatment with Tumor Necrosis Factor Alpha Inhibitor

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