Postoperative Management and Follow-Up Strategies for Chronic Subdural Hematoma

2021 ◽  
pp. 437-450
Author(s):  
Meryem Himmiche ◽  
Mohammed Benzagmout ◽  
Faycal Lakhdar
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Management

scholarly journals Twist drill aspiration of chronic subdural hematoma at the Ignace Deen hospital of Conakry

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Alpha Boubacar Bah ◽  
Seylan Diawara ◽  
Ibrahima Sory Souare ◽  
Abdoulaye Barry ◽  
Ansoumane Donzo ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Outcome Data ◽  
Twist Drill ◽  
Suitable Alternative ◽  
Female Ratio ◽  
Tertiary Centre ◽  
Male Female Ratio ◽  
Reasonable Approach

Bedside percutaneous twist drill aspiration (TDA) is described as a surgical method of management of Chronic subdural hematoma (CSDH) and appear to be a reasonable approach in low medical resources environment. We report the results of TDA of CSDH in a single tertiary centre in Conakry Republic of Guinea in West Africa, for the period March 2015 to October 2017. The charts and medical record of 38 cases of CSDH treated with TDA were collected retrospectively, with a mean follow-up of 84.2 days. The outcome data assessed were neurologic status evaluated by the follow-up Markwalder grading scale (MGS: 0=normal to 4=coma), recurrence, infection and mortality. The Male-Female ratio was 1.3:1. Mean age at diagnosis was 78.2+/-12 years. Traumatic brain injury (TBI) was identified as causal in 28.2% of cases studied. All patients were operated on under local anesthesia and had a postoperative drain left in place for 3 days. The mean postoperative MGS was 1.06, up from a mean preoperative MGS of 3.7. Two cases of recurrence occurred subsequent to TDA causing death and three other patients died from unknown causes during the follow-up period. No cases of post-operative infection were diagnosed during the follow-up. Our study shows that Bedside TDA appears to be a suitable alternative to burr hole craniotomies in urgent cases of CSDH in the low socio-economic setting, where a surgical theatre is not always available.

Chronic subdural hematoma in the elderly: not a benign disease

2011 ◽  
Vol 114 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Lucas Bernardes Miranda ◽  
Ernest Braxton ◽  
Joseph Hobbs ◽  
Matthew R. Quigley
Keyword(s):  
Mortality Rate ◽  
Median Survival ◽  
Subdural Hematoma ◽  
Excess Mortality ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Benign Disease ◽  
Twist Drill ◽  
Chi Square Analysis

Object Chronic subdural hematoma (CSDH) is perceived to be a “benign,” easily treated condition in the elderly, but reported follow-up periods are brief, usually limited to acute hospitalization. Methods The authors conducted a retrospective review of data obtained in a prospectively identified consecutive series of adult patients admitted to their institution between September 2000 and February 2008 and in whom there was a CT diagnosis of CSDH. Survival data were compared to life-table data. Results Of the 209 cases analyzed, 63% were men and the mean age was 80.6 years (range 65–96 years). Primary surgical interventions performed were bur holes in 21 patients, twist-drill closed-system drainage in 44, and craniotomies in 72. An additional 72 patients were simply observed. Reoperations were recorded in 5 patients—4 who had previously undergone twist-drill drainage and 1 who had previously undergone a bur hole procedure (p = 0.41, chi-square analysis). Thirty-five patients (16.7%) died in hospital, 130 were discharged to rehabilitation or a skilled care facility, and 44 returned home. The follow-up period extended to a maximum of 8.3 years (median 1.45 years). Six-month and 1-year mortality rates were 26.3% and 32%, respectively. In the multivariate analysis (step-wise logistic regression), the sole factor that predicted in-hospital death was neurological status on admission (OR 2.1, p = 0.02, for each step). Following discharge, the median survival in the remaining cohort was 4.4 years. In the Cox proportional hazards model, only age (hazard ratio [HR] 1.06/year, p = 0.02) and discharge to home (HR 0.24, p = 0.01) were related to survival, whereas the type of intervention, whether surgery was performed, size of subdural hematoma, amount of shift, bilateral subdural hematomas, and anticoagulant agent use did not affect the long- or short-term mortality rate. Comparison of postdischarge survival and anticipated actuarial survival demonstrated a markedly increased mortality rate in the CSDH group (median survival 4.4 vs 6 years, respectively; HR 1.94, p = 0.0002, log-rank test). This excess mortality rate was also observed at 6 months postdischarge with evidence of normalization only at 1 year. Conclusions In this first report of the long-term outcome of elderly patients with CSDH the authors observed persistent excess mortality up to 1 year beyond diagnosis. This belies the notion that CSDH is a benign disease and indicates it is a marker of other underlying chronic diseases similar to hip fracture.

scholarly journals Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature

2015 ◽  
Vol 21 (3) ◽  
pp. 366-371 ◽  
Author(s):  
Akira Tempaku ◽  
Shigeru Yamauchi ◽  
Hidetoshi Ikeda ◽  
Nobuyuki Tsubota ◽  
Hironori Furukawa ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Interventional Treatment ◽  
Careful Attention ◽  
Review Of The Literature ◽  
Hematoma Formation ◽  
Polyvinyl Alcohol Particles ◽  
Meningeal Artery

Purpose Although several strategies against recurrent chronic subdural hematoma (CSDH) have been proposed, no consensus has been established. Recently, middle meningeal artery (MMA) embolization has been proposed as radical treatment for recurrent CSDH. We wanted to estimate the usefulness of MMA embolization for recurrent CSDH. Methods From February 2012 to June 2013, 110 patients with CSDH underwent single burr-hole surgery with irrigation and drainage. Among these patients, 13 showed recurrent hematoma formation and were retreated surgically. Furthermore, repeated recurrence of CSDH was observed in six patients. Five of these six patients underwent middle meningeal artery (MMA) embolization with polyvinyl alcohol particles. All five patients with interventional treatment were observed for four to 60 weeks. Results No more recurrence of CSDH was observed in any of the patients. During the follow-up period, no patients suffered from any side effects or complications from the interventional treatment. Conclusion MMA embolization with careful attention paid to the procedure might be a treatment of choice for recurrent CSDH.

scholarly journals Endoscopic evacuation of septated chronic subdural hemorrhage – Technical considerations, results, and outcome

2022 ◽  
Vol 13 ◽  
pp. 8
Author(s):  
Harnarayan Singh ◽  
Rana Patir ◽  
Sandeep Vaishya ◽  
Rahul Miglani ◽  
Anurag Gupta ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Subdural Hemorrhage ◽  
Subdural Space ◽  
Subdural Bleeding ◽  
Endoscopic Evacuation ◽  
Clinically Significant ◽  
Burr Holes

Background: Chronic subdural hematoma (cSDH) is a common entity in the elderly. Homogeneous or well-liquefied CSDH has a standard line of treatment through burr hole and irrigation. However, the management of septated chronic subdural hematoma (sCSDH) with multiple membranes does not have a well-defined surgical approach. The neomembranes forming septations prevent evacuation of clots through burr holes, and the small remaining loculi with clots will enlarge overtime to cause recurrence. Methods: Patients with sCSDH were operated through a minicraniotomy (2.5 cm × 2.5 cm) using rigid endoscopes for visualization of the subdural space. Using endoscope, the entire subdural space can be visualized. The neomembranes are removed with standard neurosurgical microinstruments. The entire cavity is irrigated under vision to remove all clots and ensures hemostasis. Results: Eighty-three endoscope-assisted evacuations were done in 68 patients from January 2016 to April 2020. Fifty (73.5%) patients had unilateral and 18 (26.5%) had bilateral subdural. Only 1 patient (1.47%) had a clinically significant recollection of subdural bleeding 1 month after the procedure. Over a mean follow-up period of 25.3 months (range 1–53 months), rest of patients did not show any recollection. Conclusion: Endoscopic evacuation of sCSDH is a safe and effective method and can be used to improve clot evacuation, and remove neomembranes under direct vision to reduce the rates of recollection. This method also obviates the need for larger craniotomies to remove membranes.

scholarly journals Delayed brain reexpansion in schizophrenic patient affected by trabecular type chronic subdural hematoma

2021 ◽  
Vol 12 ◽  
pp. 442
Author(s):  
Salvatore Marrone ◽  
Roberta Costanzo ◽  
Gianluca Scalia ◽  
Giuseppe Emmanuele Umana ◽  
Carmelo Riolo ◽  
...  
Keyword(s):  
Schizophrenic Patient ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Management ◽  
Maximum Diameter ◽  
High Morbidity ◽  
Normal Brain ◽  
Factors Affecting ◽  
Brain Ct ◽  
Gcs Score

Background: Chronic subdural hematoma (cSDH) represents a complex and unpredictable disease, characterized by high morbidity and mortality, especially in elderly patients. Factors affecting the postoperative brain reexpansion along to cSDH recurrence have not been yet adequately investigated. The authors presented the case of a schizophrenic patient affected by trabecular type cSDH that presented a delayed brain reexpansion despite a craniotomy and membranotomy. Case Description: A 51-year-old female patient with diagnosis of schizophrenia was admitted to the emergency department with GCS score of 5/15 and right anisocoria. An urgent brain CT revealed a trabecular right cSDH (35 mm in maximum diameter) with recent bleeding. After surgery, a brain CT scan showed a markedly reduced brain reexpansion and pneumocephalus. Nevertheless, postoperative 7-day brain CT documented a progressive brain reexpansion with reduced midline shift. Conclusion: According to our opinion, anatomopathological alterations in schizophrenia reduce normal brain compliance and increasing elastance, thus modifying the normal timing of reexpansion after cSDH drainage, also after craniotomy and membranotomy. Although postoperative pneumocephalus is a well-known cause of hindered reexpansion, this could be due to anatomical alterations in schizophrenia. Such factors must be considered in the preoperative planning but mostly in the postoperative management.

scholarly journals Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations

Neurosurgery ◽  
2020 ◽  
Author(s):  
Peter Kan ◽  
Georgios A Maragkos ◽  
Aditya Srivatsan ◽  
Visish Srinivasan ◽  
Jeremiah Johnson ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Anticoagulation Therapy ◽  
Surgical Techniques ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Primary Treatment ◽  
Thickness Reduction ◽  
Hematoma Expansion ◽  
Meningeal Artery

Abstract BACKGROUND Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE To determine the safety and efficacy of MMA embolization. METHODS Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P > .05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.

Novel use of dual-lumen catheter for irrigation and drainage after evacuation of chronic subdural hematoma

2019 ◽  
pp. 1-3
Keyword(s):  
Subdural Hematoma ◽  
Perioperative Management ◽  
External Ventricular Drain ◽  
Chronic Subdural Hematoma ◽  
Memory Deficits ◽  
The United States ◽  
Lumen Catheter ◽  
Substantial Risk ◽  
Dual Lumen Catheter

Chronic subdural hematoma (cSDH) is an intracranial pathology most commonly affecting elderly patients. Patients may present with worsening headache, seizures, weakness, balance and gait problems, and memory deficits. Even in patients undergoing hematoma evacuation, there is a substantial risk for recurrence. The authors present the first use of an irrigating external ventricular drain (EVD) in the United States in the perioperative management of a patient with chronic subdural hematoma treated with craniotomy (IRRAS Stockholm Sweden). An 82-year-old male presented with right sided weakness, confusion, and right-sided neglect with expressive aphasia was found to have a large 2.5 cm chronic subdural with 9 mm left to right midline shift. The patient was treated with a mini craniotomy to evacuate the hematoma and placement of an irrigating drain in the subdural space. The patient was discharged home on post-operative day 3 without complication. Patient was at neurological baseline two weeks later upon follow-up. The use of an irrigating drain for perioperative management of cSDH is a novel means to prevent recurrence and warrants further exploration.

Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization

2021 ◽  
pp. 159101992110651
Author(s):  
Zachary S Hubbard ◽  
Sami Al Kasab ◽  
Guilherme B Porto ◽  
Alejandro Spiotta
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Diagnostic Investigation ◽  
Neurologically Intact ◽  
Radiographic Result ◽  
Radiographic Improvement ◽  
Meningeal Artery

Introduction Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a technique for the management of CSDH that has elicited promising results. Despite the encouraging results of MMAE, recurrence does occur. One uncommon mechanism for recurrence of CSDH is by means of neovascularization of the contralateral middle meningeal artery (MMA). We describe two cases of CSDH recurrence by means of contralateral middle meningeal artery neovascularization treated with contralateral MMAE. Methods We identified two cases of recurrent subdural hematoma secondary to neovascularization following treatment with contralateral MMAE. Results Two patients initially treated with MMAE were identified with CSDH recurrence secondary to contralateral MMA neovascularization. There was no traumatic or coagulopathic contribution to CSDH recurrence. In both cases, patients underwent contralateral MMAE. Both patients were neurologically intact with radiographic improvement of CSDH at follow up. Conclusions Re-accumulation of SDH following MMAE by means of contralateral MMA neovascularization is a rare subtype of subdural hematoma (SDH) recurrence following MMAE. Within the context of re-accumulation of SDH following MMAE, catheter angiography is an important diagnostic investigation to elucidate the etiology of the recurrence. Furthermore, when angiography reveals neovascularization of the contralateral MMA, embolization of the contralateral MMA achieves good clinical and radiographic result.

scholarly journals Chronic Subdural Hematoma Spontaneous Resolution

2017 ◽  
Vol 36 (02) ◽  
pp. 096-100 ◽  
Author(s):  
Nícollas Rabelo ◽  
Vitor Pereira ◽  
George Santos dos Passos ◽  
Luciano Silveira Filho ◽  
André Cicilini ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Elderly Population ◽  
Temporal Evolution ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Spontaneous Resolution ◽  
Exclusion Criteria ◽  
Outer Capsule ◽  
Bidirectional Flow

Introduction Chronic subdural hematoma (CSH) is a hemorrhagic brain injury that persists for more than 21 days after its initial formation. The incidence is predominantly among the elderly population (> 65 years), and varies from 58 to 74/100,000 inhabitants. Spontaneous resolution is considered variable; in the literature series, it is < 1–20% of cases. Objectives To expose the CSH pathophysiological mechanisms of spontaneous resolution and some treatments that lead to hematoma volume reduction. Methods Literature review between 1971 to 2016, using the PubMed, Medline, Embase, Scielo, LILACS and Cochrane databases using key-words, with inclusion and exclusion criteria. Discussion Spontaneous resolution of the CSH pathophysiology is controversial; however, it can be attributed to four basic mechanisms: 1) outer capsule membrane maturation; 2) decreased fibrinolysis; 3) bidirectional flow of blood vessels; and 4) platelet plug. Some drugs, such as mannitol, corticosteroids, tranexamic acid and atorvastatin, contribute to CSH resolution, since they change the capsule membrane permeability, and inhibit the fibrinolytic and inflammatory systems. Conclusion Spontaneous resolution is unpredictable; in some cases, it has a large temporal evolution (of up to 6 years). It occurs in small or laminar collections, asymptomatic or with transient neurological symptoms, and the pathophysiology is still controversial to this day. Therefore, surgical treatment should remain the first option, even though the conservative management is adopted for some patients. Rigorous outpatient and radiological follow-up are recommended.

scholarly journals 118. Follow-up Studies on Burr Hole Operation of Chronic Subdural Hematoma

1965 ◽  
Vol 7 ◽  
pp. 254b-255
Author(s):  
Hisashi OSHIRO ◽  
Kiyohiko DOHI ◽  
Yoshihumi NAKAGAWA
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Follow Up Studies
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