Chemokines as markers of local inflammation and angiogenesis in patients with chronic subdural hematoma: a prospective study

Object. To evaluate the role of local inflammation in the pathogenesis and postoperative recurrence of chronic subdural hematoma (CSDH), the authors conducted an investigation in a selected group of patients who could clearly recall a traumatic event and who did not have other risk factors for CSDH. Inflammation was analyzed by measuring the concentration of the proinflammatory and inflammatory cytokines interleukin (IL)-6 and IL-8. The authors also investigated the possible relationship between high levels of local inflammation that were measured and recurrence of the CSDH. Methods. A prospective study was performed between 1999 and 2001. Thirty-five patients who could clearly recall a traumatic event that had occurred at least 3 weeks previously and who did not have risk factors for CSDH were enrolled. All patients were surgically treated by burr hole irrigation plus external drainage. The concentration of inflammatory cytokines was very high in the lesion, whereas it was normal in serum. In five cases in which recurrence occurred, concentrations of both IL-6 and IL-8 were significantly increased (p < 0.01) in comparison with cases without a recurrence. In a layering hematoma, the IL-6 and IL-8 concentrations were significantly higher (p < 0.05). Layering CSDHs were also significantly correlated with recurrence. Trabecular hematoma had the lowest cytokine levels and the longest median interval between trauma and clinical onset. The interval from trauma did not significantly influence recurrence, although it did differ significantly between the trabecular and layering CSDH groups. Concentrations of IL-6 and IL-8 in the CSDHs did not differ significantly in relation to either the age of the hematoma (measured as the interval from trauma) or the age of the patient. Conclusions. Brain trauma causes the onset of an inflammatory process within the dural border cell layer; high levels of inflammatory cytokines were significantly correlated with recurrence and layering CSDH. A prolonged postoperative antiinflammatory medicine given as prophylaxis may help prevent the recurrence of a CSDH.

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Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study

Inflammation Research ◽

10.1007/s00011-012-0476-0 ◽

2012 ◽

Vol 61 (8) ◽

pp. 845-852 ◽

Cited By ~ 42

Author(s):

Milo Stanisic ◽

Ansgar Oddne Aasen ◽

Are Hugo Pripp ◽

Karl-Fredrik Lindegaard ◽

Jon Ramm-Pettersen ◽

...

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Inflammatory Cytokine ◽

Chronic Subdural Hematoma ◽

Anti Inflammatory ◽

A Prospective Study ◽

Anti Inflammatory Cytokine

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Transcranial color-coded duplex sonography for evaluation of midline-shift after chronic-subdural hematoma evacuation (TEMASE): A prospective study

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2017.09.015 ◽

2017 ◽

Vol 162 ◽

pp. 101-107 ◽

Cited By ~ 8

Author(s):

Andrea Cattalani ◽

Vincenzo Maria Grasso ◽

Matteo Vitali ◽

Ivan Gallesio ◽

Lorenzo Magrassi ◽

...

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Duplex Sonography ◽

Midline Shift ◽

Hematoma Evacuation ◽

A Prospective Study ◽

Color Coded Duplex Sonography

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Chronic Subdural Hematoma A Prospective Study

Journal of the Faculty of Medicine Baghdad ◽

10.32007/jfacmedbagdad.v60i1.34 ◽

2018 ◽

Vol 60 (1) ◽

pp. 19-23

Author(s):

Ali K. AL-Shalchy ◽

Wameedh Q. Abdul-hussein ◽

Saif S. AL-Musawy

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Early Recognition ◽

Chronic Subdural Hematoma ◽

Predisposing Factors ◽

Burr Hole ◽

Blood Collection ◽

Age Group ◽

A Prospective Study ◽

Symptoms And Signs

Background: Chronic subdural hematoma is a blood collection in the subdural space for more than 3 weeks from the onset of the bleeding. It is more likely to develop in infancy and after the age of 60 years. The incidence of subdural hematoma is 1- 2 per 100,000 people per year.Objective: To delineate the most common feature aspects of SDH like age, predisposing factors, symptoms and signs and different types of management of the disease.Patients and Methods: A prospective study of 40 patients from the period January 2012 - January 2014, and conducted in Gazi Al-Hariri Hospital of Surgical Specialties, disregarding the age, complaining of chronic subdural hematoma as proved by CT scan. It includes the predisposing factors, the symptoms and signs, the location of hematoma, mode of treatment, complications and the outcome.Results: In this study, the highest incidence of CSDH was above 50 years and the second age group was below 1 year. It was more common in males than females and they were unilateral more than bilateral, as shown by C.T scan which was the most reliable method for diagnosis and assessment.Conclusions: The most suitable treatment was burr hole in the older age group but craniotomy with membranectomy were still performed. In patients below 1 year, subdural peritoneal shunt found to be the method of choice. This study shows that the most common complications are the recurrence and infection. The outcome depends mainly on the early recognition and treatment.Keywords: Chronic subdural hematoma, traumatic brain injury, Burr hole aspiration. ورم دموي تحت الجافية المزمن دراسة مستقبلية د. علي كامل الشالجي د. وميض قيس عبد الحسين د. سيف سعد الموسوي الخلاصه: المقدمة: النزف الدموي تحت الام الجافية المزمن هو تجمع الدم في المجال تحت الام الجافية لأكثر من 3 أسابيع من بداية النزف. من المرجح أن تحصل في مرحلة الطفولة وبعد سن 60 عاما. حدوث الورم الدموي تحت الام الجافية هو 1-2 لكل 100,000 شخص سنويا. الهدف من الدراسة: لتعيين المميزات الأكثر شيوعا في النزف الدموي تحت الام القاسية مثل: العمر، والعوامل المؤهلة والأعراض والعلامات وطرق العلاج. مرضى وطرق: دراسة مستقبلية من 40 مريضا من الفترة يناير 2012 - يناير 2014، وأجريت في مستشفى غازي الحريري للتخصصات الجراحية، بغض النظر عن العمر، والذين يشكون من ورم دموي تحت الام الجافية المزمن مشخص بالاشعة المقطعية. وتشمل العوامل المؤهلة، والأعراض والعلامات، وموقع الورم الدموي، وطريقة العلاج، والمضاعفات والنتيجة. النتائج: في هذه الدراسة كانت أعلى نسبة للمرضى الذين تتجاوز اعمارهم أكثر من 50 سنة، وكانت الفئة العمرية الثانية الاكثر شيوعا هي الأقل من 1 سنة. وكان الذكور أكثر شيوعا من الإناث وكانت في جهة واحدة أكثر من الثنائية، كما هو مبين من قبل الاشعة المقطعية التي كان الأسلوب الأكثر موثوقية للتشخيص والتقييم. الاستنتاجات: وكان العلاج الأنسب تثقيب الجمجمة في الفئة العمرية الأكبر سنا ولكن فتح الجمجمة مع استئصال الغشاء لا تزال تنفذ. في المرضى الذين تقل أعمارهم عن 1 سنة، وجدت تحويلة تحت الجافية بريتونية لتكون الطريقة المفضلة. وتبين هذه الدراسة أن المضاعفات الأكثر شيوعا هي التكرار والعدوى. النتيجة تعتمد أساسا على التشخيص المبكر والعلاج. التوصيات: تثقيب الجمجمة يجب ان تكون النهج الجراحي الرئيسي في العلاج للمرضى مع اعطاء علاج الستيرويد لتقليل إمكانية التكرار. مفتاح الكلمات: ورم دموي تحت الام الجافية المزمن، وإصابات الدماغ الصدامية، بزل ثقوب الجمجمة.

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Management of chronic subdural hematoma: Burr hole versus twist drill – A prospective study

Asian Journal of Neurosurgery ◽

10.4103/ajns.ajns_99_16 ◽

2018 ◽

Vol 13 (2) ◽

pp. 319 ◽

Cited By ~ 2

Author(s):

RamKumar Goyal ◽

Biswaranjan Nayak ◽

Rajiv Maharshi ◽

DebadulalDas Bidhar ◽

Sunil Panchal ◽

...

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Twist Drill ◽

A Prospective Study

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A clinicoradiological scoring for management of acute subdural hematoma: a prospective study

Romanian Neurosurgery ◽

10.2478/romneu-2018-0045 ◽

2018 ◽

Vol 32 (2) ◽

pp. 359-365

Author(s):

Sachidanand Gautam ◽

Anubhav Sharma ◽

S.C. Dulara

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Scoring System ◽

Head Injuries ◽

Postoperative Outcome ◽

Clinical History ◽

Acute Subdural Hematoma ◽

Subdural Hemorrhage ◽

Male Predominance ◽

A Prospective Study

Abstract Background: Acute subdural hematoma is the most common type of traumatic intra cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The aim of this study is to analyze the prognostic factors and to propose Neuro-clinical and radiological prognostic scoring system on the clinical spectrum and to evaluate the postoperative outcome and validate the same. Methods: This is a prospective Study which included 100 patients admitted in Government Medical College, Kota, Rajasthan from 01st Jan 2016 to 30 June 2017 with head injury and were diagnosed to have Traumatic Subdural Hemorrhage. A detailed clinical history, Physical examination, Computerized Tomography scan was performed in all patients and were divided into 2 groups; that is conservative or surgical interventional as per Neuro-clinical and radiological prognostic scoring system. Results: The maximum patients suffering from Subdural Hematoma were in the age group of 11-60 years with male predominance 72%. The most common mode of injury was RTA with 68 % of incidence. 36 out of 100 cases presented to hospital with GCS <8 while 44 patients showed improvement of GCS after resuscitation. Out of 100 cases, surgical approach was considered in 34 patients while remaining patients were managed conservatively. Pupillary reaction, Hypotension, CT scan findings that is, thickness of hematoma >10mm and midline shift of >5mm, delay in interval between the surgery had greatly affected on outcome of patients. Conclusions: According to the results, use of Neuro-clinical and radiological prognostic scoring system is very useful in determining early intervention and also avoids unnecessary surgical intervention.

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Twist Drill Craniostomy and Closed System Drainage of Chronic and Subacute Subdural Hematomas

Neurosurgery ◽

10.1227/00006123-198308000-00008 ◽

1983 ◽

Vol 13 (2) ◽

pp. 153-159 ◽

Cited By ~ 22

Author(s):

Candace K. Carlton ◽

Richard L. Saunders

Keyword(s):

Prospective Study ◽

Ct Scan ◽

Closed System ◽

Chronic Subdural Hematoma ◽

Twist Drill ◽

Computed Tomographic ◽

Subdural Hematomas ◽

Initial Procedure ◽

A Prospective Study ◽

Length Of Hospitalization

Abstract Based on reports in the literature on the success and low morbidity of twist drill craniostomy (TDC) and closed system drainage (CSD) for chronic subdural hematomas, a prospective study was initiated in 1981 and included all symptomatic patients presenting with a history and clinical and computed tomographic (CT) findings consistent with subacute or chronic subdural hematoma. A total of nine patients were treated with TDC and CSD as the initial procedure. An asymptomatic or progressively improving patient with greater than 50% reduction in subdural size by repeat CT scan was set as the end point of therapy. There were no complications, all patients improved with drainage, and seven were cured by this method alone. The results are compared retrospectively to surgically treated patients, and an overall decrease in morbidity and length of hospitalization are noted. The technique and CT scan correlations are described, and the rationale for use of this method is discussed in terms of our current understanding of the pathophysiology and complications of the disease.

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Endoscopic Management of Chronic Subdural Hematoma

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1698388 ◽

2020 ◽

Vol 81 (04) ◽

pp. 330-341

Author(s):

Yad Ram Yadav ◽

Shailendra Ratre ◽

Vijay Parihar ◽

Jitin Bajaj ◽

Mallika Sinha ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Skin Incision ◽

Burr Hole ◽

Endoscopic Technique ◽

Endoscopic Management ◽

Number Of Patients ◽

Surgical Methods ◽

Duration Of Surgery ◽

A Prospective Study

Abstract Background Twist drill evacuation, burr hole aspiration, mini-craniotomy, and craniotomy are some of the surgical methods to remove chronic subdural hematoma (CSDH). Endoscopic treatment was also recently found to be useful. Methods We conducted a prospective study of 72 hematomas in 68 patients. Computed tomography was performed in all cases. Endoscopic surgery was performed in all CSDH patients. Surgical procedure A 4-cm skin incision was performed at the most curved part of skull with the CSDH. A mini-craniotomy or enlarged burr hole was made. The inner and outer table of the burr hole margin was drilled to provide a straight trajectory to the hematoma cavity. An endoscope supported by a telescope holder was used. A modified silicone brain retractor was used in five patients. A subgaleal drain was left in all patients for 3 to 5 days. Results There were 42 male and 26 female patients. The age ranged from 45 to 79 years (average: 69 years). All patients had a history of head trauma. Preoperative average Glasgow Coma Scale Score was 14. The procedure was effective in hematoma evacuation and a good visualization of the whole cavity in all patients. The endoscopic technique helped in complete hematoma removal in organized/solid clot, septations, and bridging vessels in 17, 2, and 2 cases, respectively. Duration of surgery ranged from 35 to 80 minutes. One death occurred. There was no recurrence, infection, fresh bleed, or injury to the brain or membrane. Conclusion The endoscopic technique is an effective alternative technique for treating CSDH. Although the study has limitations because of the small number of patients with a short follow-up, the study indicated that thick and vascular membranes, septations, and organized and solid clots can be removed effectively using this technique.

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Predictors of Brain Natriuretic Peptide Serum Level Elevation in Patients with Symptomatic Chronic Subdural Hematoma: A Prospective Study

Journal of Clinical Medicine ◽

10.3390/jcm10081791 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1791

Author(s):

Mehdi Chihi ◽

Ramazan Jabbarli ◽

Ahmet Parlak ◽

Marvin Darkwah-Oppong ◽

Oliver Gembruch ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Subdural Hematoma ◽

Early Stage ◽

Linear Regression Analysis ◽

Chronic Subdural Hematoma ◽

Serum Levels ◽

Neurological Deficits ◽

Level Elevation ◽

A Prospective Study

Background: Brain natriuretic peptide serum levels (BNP) on admission are frequently elevated in patients with symptomatic chronic subdural hematoma (cSDH) and predict unfavorable long-term functional outcomes. However, the reasons for these elevated levels remain unclear. Therefore, we aimed to identify the predictors of BNP elevation. Methods: Patients with unilateral symptomatic cSDH who were surgically treated in our department between November 2016 and May 2020 were enrolled. Patients’ symptoms and neurological deficits were prospectively assessed using a study questionnaire. On initial computer tomography, hematoma volumes and midline shift (MLS) values were measured to analyze the degree of brain compression. Results: In total, 100 patients were analyzed. Linear regression analysis showed that higher BNP levels were significantly associated with smaller hematoma volumes (p = 0.003) and littler MLS values (p = 0.022). Multivariate analysis revealed that presence of a neurological deficit (p = 0.041), a hematoma volume < 140 mL (p = 0.047), advanced age (p = 0.023), and head trauma within 24 h of admission (p = 0.001) were independent predictors of BNP elevation. Conclusion: In symptomatic cSDH, BNP elevation is related, among others, to the presence of neurological deficits and smaller hematoma volumes. Whether BNP elevation may coincide with the early stage of hematoma growth, i.e., immaturity of cSDH neomembrane, requires further investigations.

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