Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

Abstract Background With chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. We therefore sought to determine whether statins reduce the rate of repeat surgery after CSDH drain. Methods We performed an analysis of all patients who underwent surgery for CSDH at our institution between 2012 and 2018. The patients were separated into those who received statins as part of their previous medication (statin group) and those who did not (control group). The medical records were reviewed for repeat surgeries and complications. Additionally, patients or their relatives were contacted via phone to obtain missing data and inquire about possible repeat surgeries at other institutions. Results We identified 407 patients who received CSDH evacuation via burr hole craniotomy. In total, 123 patients were treated with statins as part of their daily medication. Repeat surgery was performed in 26 patients in the statin group (21.1%) and 57 patients in the non-statin group (20.1%, p = 0.81). Upon multivariate logistic regression analysis, neither of the variables statins, age, antithrombotic medication, Charlson comorbidity index, or Markwalder grading score yielded a statistically significant effect upon the revision rate. Conclusions We found no evidence for the protective effect of statins in patients who underwent surgery for CSDH. We thus conclude that statin therapy is not warranted for CSDH perioperatively.

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Recurrence and Coniglobus Volumetric Resolution of Subacute and Chronic Subdural Hematoma Post-Middle Meningeal Artery Embolization

Diagnostics ◽

10.3390/diagnostics11020257 ◽

2021 ◽

Vol 11 (2) ◽

pp. 257

Author(s):

Ambooj Tiwari ◽

Adam A. Dmytriw ◽

Ryan Bo ◽

Nathan Farkas ◽

Phillip Ye ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Volumetric Analysis ◽

Primary Therapy ◽

Curative Therapy ◽

Complete Obliteration ◽

Embolization Treatment ◽

Long Term Follow Up ◽

Meningeal Artery

Objective: To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. Methods: Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. Results: Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. Conclusion: MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.

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Risk of recurrence of subdural hematoma after EMMA vs surgical drainage – Systematic review and meta-analysis

Interventional Neuroradiology ◽

10.1177/1591019921990962 ◽

2021 ◽

pp. 159101992199096

Author(s):

Joshua Dian ◽

Janice Linton ◽

Jai JS Shankar

Keyword(s):

Confidence Interval ◽

Subdural Hematoma ◽

Meta Analysis ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Control Group ◽

Complication Rates ◽

Recurrence Rates ◽

Invasive Approach ◽

Risk Of Recurrence

Objective Chronic subdural hematoma (CSDH) is a common and debilitating neurological condition whose treatments, including burr hole drainage and craniotomy, suffer from high rates of recurrence and complication. Embolization of the middle meningeal artery (EMMA) is a promising minimally invasive approach to manage CSDH in a broad set of patients. Methods To evaluate the efficacy and safety of EMMA, a database search was conducted including the terms “subdural hematoma; embolization; embolized; middle meningeal” was performed and yielded a total of 260 results. Following exclusion based on predefined criteria, a total of four studies were identified and outcomes including recurrence rates and complication rates were extracted for analysis. Results Four studies including intervention and control groups were included with a total of n = 888 patients. The relative risk of CSDH recurrence in the EMMA (3.5%) compared to control group (23.5%) was significantly reduced when EMMA was performed (risk ratio = 0.17; 95% confidence interval (CI) 0.05–0.67). In addition, rates of complication were not significantly different between patients with conventional therapy and those who received EMMA (OR = 0.77; 95 confidence interval (CI) 0.3–1.99). Conclusion Based on limited data, EMMA reduces the risk of recurrence by 20% compared to surgical treatment for CSDH.

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The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom

Journal of Neurosurgery ◽

10.3171/2016.8.jns16134 ◽

2017 ◽

Vol 127 (4) ◽

pp. 732-739 ◽

Cited By ~ 47

Author(s):

Paul M. Brennan ◽

Angelos G. Kolias ◽

Alexis J. Joannides ◽

Jonathan Shapey ◽

Hani J. Marcus ◽

...

Keyword(s):

United Kingdom ◽

Clinical Research ◽

Functional Outcome ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Bed Rest ◽

Repeat Surgery ◽

Symptomatic Recurrence ◽

The United Kingdom ◽

High Flow Oxygen

OBJECTIVESymptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH.METHODSData on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4–6) at NSU discharge < 30%.RESULTSData from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not.CONCLUSIONSThis is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-world setting the effectiveness of placing a subdural drain. This study identified a number of modifiable prognostic factors but questions the necessity of some common aspects of CSDH management, such as enforced postoperative bed rest. Future studies should seek to establish how practitioners can optimize perioperative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multicenter trainee-led research and audits. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.

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Influence of Antithrombotic Medication on the Risk of Chronic Subdural Hematoma Recurrence after Burr-Hole Surgery

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2019.0194 ◽

2020 ◽

Vol 63 (4) ◽

pp. 513-518

Author(s):

Jongwook Choi ◽

Jinsu Pyen ◽

Sungmin Cho ◽

Jongyeon Kim ◽

Younmoo Koo ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Antithrombotic Medication

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Embolization of the Middle Meningeal Artery Effectively Treats Refractory Chronic Subdural Hematoma: A Systematic Review

Romanian Neurosurgery ◽

10.2478/romneu-2014-0034 ◽

2014 ◽

Vol 21 (3) ◽

pp. 251-258

Author(s):

Alfotih Gobran ◽

Fang-Cheng Li ◽

Xin-Ke Xu ◽

Shang-Yi Zhang

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Endovascular Embolization ◽

Common Disease ◽

Old People ◽

Repeat Surgery ◽

Repeated Surgery ◽

Surgical Treatments ◽

Meningeal Artery

AbstractChronic subdural hematoma (CSDH) formation mechanism is very complex, and has not entirely understood. It represents a frequent type of intracranial hemorrhage, and is very common disease in Neurosurgery practice, especially in older patients. Various surgical treatments have been proposed for the treatment of CSDH. The rate of recurrence in CSDH after surgery ranges from 5% to 30%, repeated surgery must be considered. But in some cases subdural collections are still persistent. Endovascular embolization of the middle meningeal artery (MMA) is an option for treatment of refractory CSDH. We review all cases that were treated with embolization to assess the effect of this intervention. Our review revealed 6 papers with a total enrollment of 14 patients were treated with MMA embolization for refractory chronic subdural hematoma without any postoperative complication or recurrence. In this study we suggest MMA embolization as an alternative for treatment of non-curable CSDH, especially for old people with systematic diseases, who cannot tolerate repeat surgery.

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Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01508-9 ◽

2020 ◽

Author(s):

Sae-Yeon Won ◽

Daniel Dubinski ◽

Thomas Freiman ◽

Volker Seifert ◽

Florian Gessler ◽

...

Keyword(s):

Status Epilepticus ◽

Mortality Rate ◽

Subdural Hematoma ◽

Functional Outcomes ◽

Chronic Subdural Hematoma ◽

Control Group ◽

Acute Bleeding ◽

Symptomatic Seizures ◽

Acute Symptomatic Seizures

Abstract Purpose Acute-on-chronic subdural hematoma (acSDH) describes acute bleeding into a chronic subdural hematoma (SDH), after surgery or second trauma. Because seizures are a well-known complication of SDH, associated with substantial morbidity and mortality, we aimed to analyze the incidence of acute symptomatic seizures (ASz), including status epilepticus, and determine the functional outcomes in this specific cohort of patients. Methods A retrospective analysis was performed, including patients with acSDH who were admitted to our department between 2010 and 2019. The incidence and timely onset of ASz and status epilepticus were evaluated. Functional outcomes at discharge and at 3–6 month follow-up were analyzed based on the modified Rankin scale. Results Of 506 patients with chronic SDH, 29 patients (5.7%) were diagnosed with acSDH. The overall incidence of ASz and status epilepticus were 72.4% and 10.3%, respectively. Favorable outcomes were identified in 11 patients (52.4%) in the ASz group compared with 6 patients (75%) in the non-ASz group. The mortality rate was higher in the ASz group compared with that in the control group (29% vs 0%). At follow-up, favorable outcomes were similar to those observed at discharge (52.4% in the ASz group and 71.4% in the control group). The mortality rate was still higher in the ASz group, at 32% compared with 14% for the control group. Conclusion AcSDH has a high risk for ASz, including status epilepticus, and is associated with unfavorable outcomes and high mortality. Thus, prophylactic treatment with antiepileptic drugs should be considered among this specific cohort of patients.

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Effect of atorvastatin on resolution of chronic subdural hematoma: a prospective observational study [RETRACTED]

Journal of Neurosurgery ◽

10.3171/2015.12.jns151991 ◽

2016 ◽

pp. 1-10 ◽

Cited By ~ 12

Author(s):

Hua Liu ◽

Zhongkun Liu ◽

Yong Liu ◽

Shifeng Kan ◽

Jian Yang ◽

...

Keyword(s):

Regression Analysis ◽

Observational Study ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Control Group ◽

Hematoma Volume ◽

Atorvastatin Treatment ◽

Atorvastatin Group ◽

Significant Difference

OBJECTIVE Chronic subdural hematoma (CSDH) is prevalent in the aged population and is commonly treated with bur hole drainage. This treatment, however, can lead to various surgical complications. Atorvastatin may cure CSDH via its antiinflammatory and proangiogenesis effects, but not all patients treated with this medication can avoid surgery. The authors' aim was to investigate the effect of atorvastatin and identify characteristics of patients with CSDH sensitive to atorvastatin therapy. METHODS A prospective, placebo-controlled observational study was conducted in 80 patients with evidence of CSDH. The patients were enrolled between February 2012 and August 2014 and were randomly assigned to either atorvastatin treatment (atorvastatin group) or placebo (control group). Patients were followed up for 12 months after initiation of treatment. Clinically relevant data were collected and compared between the 2 groups. The atorvastatin group was subdivided into patients who required surgery and those who did not, and characteristics of these subgroups were also compared. The relationship between atorvastatin treatment and need for surgery was investigated by means of multiple regression analysis using the following variables as predictors: age, sex, admission Markwalder grade, level of dependency in activities of daily living (ADL) as assessed with the modified Barthel Index, presence of hemiparesis, and hematoma volume. RESULTS The proportion of patients who required surgical intervention during the follow-up period was significantly lower in the atorvastatin group than in the control group (p = 0.001), and the mean time to surgery was longer in the atorvastatin group (p = 0.018). Within the atorvastatin group, there was a significant difference with respect to Markwalder grades, degree of dependency in ADL, percentage of patients with hemiparesis, and mean hematoma volume between the patients who required surgery during the follow-up period and those who did not (p = 0.002, p = 0.001, p = 0.001, and p = 0.012, respectively). The results of the logistic regression analysis showed that atorvastatin significantly reduced the probability of surgery and that female sex and favorable admission Markwalder grades and favorable dependency status with respect to ADL (independent, slightly dependent, or moderately dependent) were independent predictors of not requiring surgery. CONCLUSIONS Atorvastatin administration can promote the resolution of CSDH, especially for women with favorable Markwalder grades and favorable ADL dependency status at admission.

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Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness

Journal of Neurosurgery ◽

10.3171/2016.3.jns152957 ◽

2017 ◽

Vol 126 (4) ◽

pp. 1042-1046 ◽

Cited By ~ 8

Author(s):

Yasuaki Abe ◽

Keisuke Maruyama ◽

Shigeomi Yokoya ◽

Akio Noguchi ◽

Eishi Sato ◽

...

Keyword(s):

Patient Outcomes ◽

Subdural Hematoma ◽

Repeated Measures ◽

Postoperative Morbidity ◽

Multivariate Logistic Regression Analysis ◽

Chronic Subdural Hematoma ◽

Patient Age ◽

Disturbance Of Consciousness ◽

Patient Âgé ◽

The Mean

OBJECTIVE Chronic subdural hematoma (CSDH) is widely treated by drainage through a bur hole opening. However, whether and how preexisting comorbidities causing disturbance of consciousness affect patient outcomes remains unclear. METHODS The authors analyzed 188 consecutive patients with CSDH who were surgically treated at the Neurosurgery Institute of the Kyorin University School of Medicine between 2010 and 2012 and followed them for more than 90 days. The mean patient age was 77.0 years (range 33–101 years) and 56 were women. Patient outcomes including modified Rankin Scale (mRS) score, postoperative morbidity and mortality, and recurrence 90 days after initial surgery were analyzed according to preexisting comorbidities causing disturbance of consciousness. The comorbidities observed in 46 patients (24%) included dementia (30 patients), history of ischemic stroke (10 patients), psychiatric disorders (3 patients), and others (3 patients). RESULTS Background characteristics of patients with comorbidities showed older patient age (p < 0.001), lower preoperative Glasgow Coma Scale score (p < 0.001), and higher preoperative mRS score (p < 0.001). The mean mRS score 90 days after the neurosurgical procedure was 1.2 in all 188 patients, which was significantly higher in those with comorbidities (p < 0.001). By 1-way ANOVA with repeated measures, interaction existed between the presence of comorbidities and mRS score, and improvement of mRS score was observed in smaller proportions of patients with comorbidities (p = 0.002). By multivariate logistic regression analysis, the presence of comorbidities, patient age, reoperation for recurrence, and preoperative mRS score were significantly related to poor outcomes, defined as mRS score of 3 or more at 90 days after surgery. Postoperative morbidity (p < 0.01) and mortality (p < 0.01) were significantly higher in those with comorbidities, whereas the rate of recurrence of CSDH was not significantly different. CONCLUSIONS The preexistence of comorbidities causing disturbance of consciousness affected severity and outcomes 90 days after surgical treatment of CSDH, and comorbidities were also correlated with aging.

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Imaging Features of Artificial Intelligence Algorithm in the Analysis of Cerebral Protective Effect of Craniotomy Hematoma Removal under Propofol Anesthesia in Patients with Chronic Subdural Hematoma

Scientific Programming ◽

10.1155/2021/6435476 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Manyun Bai ◽

Yufang Li ◽

Qian Zhao ◽

Renzhong Guo

Keyword(s):

Artificial Intelligence ◽

Protective Effect ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Ct Images ◽

Control Group ◽

Brain Ct ◽

Intelligence Algorithm ◽

Artificial Intelligence Algorithm ◽

Experimental Group

Objective. The aim of this work was to study the cerebral protective effect of craniotomy hematoma removal under propofol anesthesia based on the artificial intelligence algorithm analysis of the changes in imaging characteristics of chronic subdural hematoma (CSDH) patients. Methods. A total of 60 CSDH patients who were treated in hospital were recruited and were randomly rolled into an experimental group and a control group, with 30 people in each group. Patients in the experimental group were treated with propofol anesthesia + craniotomy hematoma removal, while those in the control group were treated with conventional anesthesia + craniotomy hematoma removal. Head CT examinations were performed on the next day, one week, one month, three months, and six months after the operation. A two-dimensional empirical mode decomposition (BEMD) algorithm was used for edge detection and denoising of brain CT images of CSDH patients. Then, the amount of hematoma was calculated, and the Markwalder grading was performed to evaluate the neurological function. The number of recurrence and reoperation cases within six months of follow-up was collected. Results. 1. The quality of CT images was remarkably improved after processing with artificial intelligence algorithms. 2. The amount of hematoma in the experimental group was remarkably lower than that in the control group at January, March, and June after surgery (12.89 ± 2.12 VS 20.32 ± 16.41; 7.55 ± 4.13 VS 15.88 ± 14.22; 3.39 ± 3.79 VS 6.55 ± 3.69, P < 0.05 ). 3. The experimental group was remarkably better than the control group in Markwalder grading three months and six months after the operation ( P < 0.05 ). Conclusion. Artificial intelligence algorithm had good effect on the brain CT image processing of CSDH patients, and craniotomy hematoma removal under propofol anesthesia had an ideal brain protection effect.

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THE ROLE OF POSTOPERATIVE PATIENT POSTURE IN THE RECURRENCE OF TRAUMATIC CHRONIC SUBDURAL HEMATOMA AFTER BURR-HOLE SURGERY

Neurosurgery ◽

10.1227/01.neu.0000298908.94129.67 ◽

2007 ◽

Vol 61 (4) ◽

pp. 794-797 ◽

Cited By ~ 102

Author(s):

Mehdi Abouzari ◽

Armin Rashidi ◽

Jalal Rezaii ◽

Khalil Esfandiari ◽

Marjan Asadollahi ◽

...

Keyword(s):

Recurrence Rate ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Burr Hole ◽

Upright Posture ◽

Postoperative Patient ◽

Repeat Surgery ◽

Group A

Abstract OBJECTIVE Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, especially in the elderly, with a significant recurrence rate ranging from 9.2 to 26.5%. The role of postoperative patient posture in the recurrence of CSDH has not been studied sufficiently. METHODS A total of 84 consecutive patients with unilateral traumatic CSDH without known risk factors of CSDH recurrence were prospectively enrolled in this study. All patients underwent burr-hole surgery with closed system drainage and were then allocated randomly to either of two groups: Group A (n = 42) patients were kept in a supine position for 3 days after the operation, whereas Group B (n = 42) patients assumed a sitting position in bed, with the head of the bed elevated to 30 to 40 degrees, for the same duration as Group A. After 3 days, there was no restriction in patients' activities in both groups. All patients were followed-up for at least 3 months after surgery. RESULTS The groups were not significantly different in age, sex, presence of brain atrophy or hydrocephalus, preoperative hematoma width, and postsurgery subdural space width. The recurrence rate in Groups A and B were 2.3 and 19.0% (necessitating repeat surgery in one patient), respectively (P = 0.02). Other complications in Groups A and B, respectively, were atelectasis (10 versus seven; P = 0.41), pneumonia (five versus four; P = 0.72), decubitus ulcer (three versus two; P = 0.64), and deep vein thrombosis (zero versus one; P = 0.31). CONCLUSION Assuming an upright posture soon after burr-hole surgery was associated with a significantly increased incidence of CSDH recurrence but not with a significant change in other position-related postsurgical complications. According to this result, it is not recommended that elderly patients assume an upright posture soon after burr-hole surgery to prevent postoperative atelectasis and dementia, as these might significantly increase the risk of CSDH recurrence.

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