Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment, and Outcome

Feghali, James; Yang, Wuyang; Huang, Judy

doi:10.1016/j.wneu.2020.06.140

Cited by 163 publications

(193 citation statements)

References 64 publications

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“…In addition, men had a significantly higher recurrence rate than women. 6 23 Sex is a class II risk factor correlated with postoperative recurrence. Men have a higher incidence of chronic diseases, including diabetes 24 and liver damage, 25 and are more frequently treated with dual antibodies, 26 which is a high-risk factor of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses

Zhu

Wang

et al. 2022

eClinicalMedicine

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Summary Background Chronic subdural hematoma (CSDH) is a common neurological disease, and the surgical evacuation of subdural collection remains the primary treatment approach for symptomatic patients. Postoperative recurrence is a serious complication, and several factors are correlated with postoperative recurrence. Methods We searched Embase, Web of Science, PubMed, and Cochrane Library from their establishment to September 2020. Reports on randomized, prospective, retrospective, and overall observational studies on the management of surgical patients with CSDH were searched, and an independent reviewer performed research quality assessment. Factors that affect the postoperative recurrence of CSDH were extracted: social demographics, drugs (as the main or auxiliary treatment), surgical management, imaging, and other risk factors. We evaluated the recurrence rate of each risk factor. A random effect model was used to perform a meta-analysis, and each risk factor affecting the postoperative recurrence of CSDH was then evaluated and graded. Findings In total, 402 studies were included in this analysis and 32 potential risk factors were evaluated. Among these, 21 were significantly associated with the postoperative recurrence of CSDH. Three risk factors (male, bilateral hematoma, and no drainage) had convincing evidence. The classification of evidence can help clinicians identify significant risk factors for the postoperative recurrence of CSDH. Interpretation Only few associations were supported by high-quality evidence. Factors with high-quality evidence may be important for treating and preventing CSDH recurrence. Our results can be used as a basis for improving clinical treatment strategies and designing preventive methods. Funding No funding was received.

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Section: Discussionmentioning

confidence: 99%

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses

Zhu

Wang

et al. 2022

eClinicalMedicine

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“…overall incidence is 1.7 to 20.6 per 100,000 population (1)(2)(3). This is a common neurosurgical problem and it has been estimated that it will likely be the most common cranial neurosurgical procedure by the year 2025 (4,5).…”

Section: Figure 2 |mentioning

confidence: 99%

“…Chronic subdural hematomas are becoming increasingly common worldwide as the population ages and are more frequently on anticoagulants. It has been estimated that the overall incidence is 1.7 to 20.6 per 100,000 population ( 1 – 3 ). This is a common neurosurgical problem and it has been estimated that it will likely be the most common cranial neurosurgical procedure by the year 2025 ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

The Mini-Craniotomy for cSDH Revisited: New Perspectives

Chen

Malkasian

et al. 2021

Front. Neurol.

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Background: Chronic subdural hematomas (cSDH) are increasingly prevalent worldwide with the increased aging population and anticoagulant use. Different surgical, medical, and endovascular treatments have had varying success rates. Primary neurosurgical interventions include burr hole drainage of the cSDH and mini-craniotomies/craniotomies with or without fenestration of the inner membrane. A key assessment of the success or failure of cSDH treatments has been symptomatic recurrence rates which have historically ranged from 5 to 30%. Pre-operative prediction of the inner subdural membrane by CT scan was used to guide our decision to perform mini-craniotomies. Release of the inner membrane facilitates the expansion of the brain and likely improves glymphatic flow.Methods: Consecutive mini-craniotomies (N = 34) for cSDH evacuation performed by a single neurosurgeon at a quaternary academic medical center/Level I trauma center from July 2018-September 2020 were retrospectively reviewed. Patient characteristics [age, gender, presenting GCS, GOS, initial CTs noting the inner subdural membrane, midline shift (MLS), cSDH width, inner membrane fenestration, cSDH recurrence, post-operative seizures, infections, length of stay] were extracted from the EMR.Results: Twenty nine patients had mini-craniotomies as primary treatment of the cSDH. Mean age = 68.9 ± 19.7 years (range 22–102), mean pre-operative GCS = 14.5 ± 1.1, mean MLS = 6.75 ± 4.2 mm, and mean maximum thickness of cSDH = 17.7 ± 6.0 mm. Twenty four were unilateral, five bilateral, 34 total craniotomies were performed. Thirty three had inner membrane signs on pre-operative head CTs and an inner subdural membrane was fenestrated in all cases except for the one craniotomy that didn't show these characteristic CT findings. Mean operating time = 79.5 ± 26.0 min. Radiographic and clinical improvement occurred in all patients. Mean improvement in MLS = 3.85 ± 2.69. There were no symptomatic recurrences, re-operations, surgical site infections, or deaths during the 6 months of follow-up. One patient was treated for post-operative seizures with AEDs for 6 months.Conclusion: Pre-operative CT scans demonstrating inner subdural membranes may guide one to target the treatment to allow release of this tension band. Mini-craniotomy with careful fenestration of the inner membrane is very effective for this. Brain re-expansion and re-establishment of normal brain interstitial flow may be important in long term outcomes with cSDH and may be related to the recent interests in brain glymphatics and dural lymphatics.

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“…[24,36] Morbidity and mortality in patients with cSDH may range anywhere between 0-25 and 0-32%, respectively. [7] Neurological outcomes are often poor in up to 20% of patients, resulting in significant disability. [3] Although surgical evacuation is the mainstay of treatment in symptomatic cases, consensus for an optimal surgical strategy is commonly debated.…”

Section: Introductionmentioning

confidence: 99%

Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis

2021

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Introduction There is a clinical equipoise between burr hole drainage (BHD) or twist drill craniotomy (TDC) as initial surgical intervention in patients with chronic subdural hematoma (cSDH). Moreover, the impact of type of postoperative drainage is not well elucidated. We performed a systematic review and meta-analysis comparing outcomes following BHD and TDC for initial surgical management in cSDH and to understand the impact of negative suction drainage with TDC. Methods A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that directly compared TDC and BHD. The following outcomes were compared between TDC and BHD: mortality, recurrence, reoperations, complications, and cure rates. Subgroup analysis was performed to determine impact of negative suction drainage with TDC.

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Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment, and Outcome

Cited by 163 publications

References 64 publications

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses

The Mini-Craniotomy for cSDH Revisited: New Perspectives

Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis

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