Factors Predicting the Need for Surgery of the Opposite Side After Unilateral Evacuation of Bilateral Chronic Subdural Hematomas

Neurosurgery ◽  
2018 ◽  
Vol 85 (5) ◽  
pp. 648-655 ◽  
Author(s):  
Rouzbeh Motiei-Langroudi ◽  
Ajith J Thomas ◽  
Luis Ascanio ◽  
Abdulrahman Alturki ◽  
Efstathios Papavassiliou ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chronic Subdural Hematoma ◽  
Reoperation Rate ◽  
Contralateral Side ◽  
Significant Determinant ◽  
Midline Shift ◽  
Significant Difference ◽  
Hematoma Growth ◽  
Bilateral Chronic Subdural Hematoma ◽  
Symptomatic Side

Abstract BACKGROUND Patients with bilateral chronic subdural hematoma (bCSDH) undergo unilateral evacuation for the large or symptomatic side because the contralateral hematoma is either small or asymptomatic. However, the contralateral hematoma may subsequently grow and require evacuation. OBJECTIVE To characterize factors that predict contralateral hematoma growth and need for evacuation. METHODS A retrospective study on 128 surgically treated bCSDHs. RESULTS Fifty-one and 77 were bilaterally and unilaterally evacuated, respectively. Glasgow Coma Scale was lower and midline shift was higher in those evacuated unilaterally compared to those evacuated bilaterally. Hematoma size was a significant determinant of decision for unilateral vs bilateral evacuation. The contralateral side needed evacuation at a later stage in 7 cases (9.1%). There was no significant difference in terms of reoperation rate between those evacuated unilaterally and bilaterally. Greater contralateral hematoma thickness on the first postoperative day computed tomography (CT) and more postoperative midline shift reversal had higher rates of operation in the opposite side. There was no difference between the daily pace of hematoma decrease in the operated and nonoperated sides (0.7% decrease per day vs 0.9% for the operated and nonoperated sides, respectively). CONCLUSION Results of this study show that most bCSDHs evacuated unilaterally do not experience growth in the nonoperated side and unilateral evacuation results in hematoma resolution for both sides in most cases. Hematoma thickness on the opposite side on the first postoperative day CT and amount of midline shift reversal after surgery are the most important factors predicting the need for surgery on the opposite side.

scholarly journals Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

2020 ◽  
Vol 2 (1) ◽  
pp. 30-34
Author(s):  
Suresh Sapkota ◽  
Kiran Niraula ◽  
Subash Lohani ◽  
Shikher Shrestha ◽  
Bibhusan Shrestha ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Subdural Hematoma ◽  
Surgical Outcome ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Midline Shift ◽  
External Drainage ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Significant Difference

Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

scholarly journals Bilateral Chronic Subdural Hematoma in the Posterior Fossa Treated with a Burr Hole Irrigation: A Case Report and Review of the Literature

2019 ◽  
Vol 11 (1) ◽  
pp. 87-93
Author(s):  
Takuro Inoue ◽  
Hisao Hirai ◽  
Ayako Shima ◽  
Fumio Suzuki ◽  
Masayuki Matsuda
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Posterior Fossa ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Ventricular Drainage ◽  
Review Of The Literature ◽  
Bilateral Chronic Subdural Hematoma ◽  
Radiological Examinations

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare. The surgical strategy is still controversial. We report a case of bilateral CSH in the posterior fossa successfully treated with a single-burr hole surgery. A 74-year-old man under anticoagulation and antiplatelet therapy developed headache and nausea during observation for an asymptomatic supratentorial CSH. Radiological examinations revealed appearance of bilateral CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient’s consciousness, an urgent treatment was required. A burr hole was made near the transverse-sigmoid junction on the left side to access the hematoma. No ventricular drainage was placed as his consciousness improved during the decompression of the hematoma. Postoperative computed tomography showed that bilateral CSH and hydrocephalus had been successfully treated. In bilateral CSH in the posterior fossa, there may be a connection between each side. CSH in the posterior fossa, when urgent, can be treated under local anesthesia with a unilateral burr hole irrigation.

scholarly journals Evaluation of horizontal condylar angle in malocclusions with mandibular lateral displacement using cone-beam computed tomography

2021 ◽  
Author(s):  
Roberto L. Velásquez ◽  
Jorge C. Coro ◽  
José M. Bustillo ◽  
Sadao Sato
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Lateral Displacement ◽  
Class Ii ◽  
Contralateral Side ◽  
Class I ◽  
Cone Beam ◽  
Class Iii ◽  
Skeletal Class ◽  
Significant Difference

ABSTRACT Objectives To evaluate the horizontal condylar angle (HCA) in mandibular lateral displacement (MLD). Materials and Method s: HCA in MLD malocclusions were examined using cone-beam computed tomography data in subjects with MLD and control subjects. Results HCA in joints of control patients and contralateral side joints of MLD patients were not significantly different. The mean HCA on the shifted side was larger than on the contralateral side (P < .001) in the different HCA groups. HCA was significantly larger on the shifted side than on the contralateral side in skeletal Class I, Class II, and Class III groups (P < .001). Conclusions (1) There was no statistically significant difference between HCA in control patients and on the contralateral side in MLD patients. (2) HCA was significantly larger on the shifted side than on the contralateral side. (3) HCA on the shifted side and the contralateral side in MLD Class I, Class II, and Class III are significantly different.

scholarly journals Multiple contralateral recurrence of bilateral chronic subdural hematoma: case report and literature review

2019 ◽  
Vol 9 (6) ◽  
Author(s):  
Diawara Seylan ◽  
Alpha Boubacar Bah ◽  
Ibrahima Berete ◽  
Ibrahima Sory Souare ◽  
Vamala Guilavogui ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Relevant Literature ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Multiple Recurrence ◽  
Opposite Hemisphere ◽  
Bridging Veins ◽  
Bilateral Chronic Subdural Hematoma ◽  
Symptomatic Side

We report a case of bilateral chronic subdural hematoma (CSDH) operated with a single burr-hole on the more symptomatic side (left) followed by a symptomatic expansion of the contralateral (right) hematoma 7 days after the surgery treated again with a burr-hole on the other side. A week later the patient presented again a bilateral CSDH that was re-operated on both side with a good outcome at 6 months follow-up. Relevant literature was reviewed, and we believe that the multiple recurrence of these hematomas in the opposite hemisphere resulted from the rapid drainage of the hematoma, which caused the rupture of weak bridging veins during drainage. Slow decompression is recommended to avoid rapid intracranial changes during drainage of a subdural hematoma.

scholarly journals Correlation of Initial Computed Tomography Findings with Outcomes of Patients with Acute Subdural Hematoma: A Prospective Study

2020 ◽  
Author(s):  
Ajay Choudhary ◽  
Kaviraj Kaushik ◽  
Surya Narayanan Bhaskar ◽  
Laxmi Narayan Gupta ◽  
Rajesh Sharma ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Emergency Services ◽  
Skull Fracture ◽  
Contralateral Side ◽  
Acute Subdural Hematoma ◽  
Outcome Analysis ◽  
Midline Shift

AbstractIn modern emergency service systems, patients are often treated with sedation, intubation, and ventilation at the accident site. But neurosurgical assessment before all these emergency services is important. Thus, this study was designed to investigate the relationships between various parameters of initial CT scan findings and the outcomes of the patients. Methodology A total of 56 adult patients of traumatic acute subdural hematoma (SDH) whose computed tomography (CT) scan was performed within 8 hours of injury were recruited. The patients with prolonged hypotension, open head injury or depressed skull fracture, bilateral side acute SDH, or contusions/hematoma/extradural hematoma on the contralateral side were excluded. Six separate CT findings were analyzed and recorded, including hematoma, midline shift, subarachnoid hemorrhage (SAH), presence of basal cistern obliteration (BCO), intraparenchymal hematoma/contusion in the same hemisphere, and presence of effacement of the sulcal spaces, and were followed up for three months for outcome analysis. Results The overall mortality and functional recovery rate were 27 and 50%, respectively. The patients with obliterated basal cisterns and the presence of underlying SAH in patients with acute SDH had statistically significant poorer outcomes as compared with others. However, the extent of midline shift, SDH thickness, and the presence of underlying contusions and sulcal effacement on initial CT scan showed no statistically significant correlation with patients’ outcomes. Conclusions BCO and presence of subarchnoid hemorrhage underlying acute SDH on the earliest scan in head injury patients signify the severity of brain parenchymal injury. Along with the initial Glasgow Coma Scale score after resuscitation, these two factors should be considered as the most significant ones for predicting the outcomes in traumatic acute SDH patients.

Factors predicting contralateral hematoma growth after unilateral drainage of bilateral chronic subdural hematoma

2017 ◽  
Vol 126 (3) ◽  
pp. 755-759 ◽  
Author(s):  
Shigeta Fujitani ◽  
Osamu Ishikawa ◽  
Keisuke Miura ◽  
Yasuhiro Takeda ◽  
Haruo Goto ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Multivariate Logistic Regression Analysis ◽  
Chronic Subdural Hematoma ◽  
Mri Findings ◽  
Additional Surgery ◽  
Anticoagulant Drugs ◽  
Anticoagulant Drug ◽  
Hematoma Growth ◽  
Weighted Sequences ◽  
Bilateral Chronic Subdural Hematoma

OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a recurrence rate of 9.2%–26.5% after bur hole surgery. Occasionally patients with bilateral CSDH undergo unilateral surgery because the contralateral hematoma is deemed to be asymptomatic, and in some of these patients the contralateral hematoma may subsequently enlarge, requiring additional surgery. The authors investigated the factors related to the growth of these hematomas. METHODS Ninety-three patients with bilateral CSDH who underwent unilateral bur hole surgery at Aizu Chuo Hospital were included in a retrospective analysis. Findings on preoperative MRI, preoperative thickness of the drained hematoma, and the influence of antiplatelet or anticoagulant drugs were considered and evaluated in univariate and multivariate analyses. RESULTS The overall growth rate was 19% (18 of 93 hematomas), and a significantly greater percentage of the hematomas that were iso- or hypointense on preoperative T1-weighted imaging showed growth compared with other hematomas (35.4% vs 2.3%, p < 0.001). Multivariate logistic regression analysis showed that findings on preoperative T1-weighted MRI were the sole significant predictor of hematoma growth, and other factors such as antiplatelet or anticoagulant drug use, patient age, patient sex, thickness of the treated hematoma, and T2-weighted MRI findings were not significantly related to hematoma growth. The adjusted odds ratio for hematoma growth in the T1 isointense/hypointense group relative to the T1 hyperintense group was 25.12 (95% CI 3.89–51.58, p < 0.01). CONCLUSIONS The findings of preoperative MRI, namely T1-weighted sequences, may be useful in predicting the growth of hematomas that did not undergo bur hole surgery in patients with bilateral CSDH.

scholarly journals Volume and Midline Shift as Preoperative Computed Tomography Imaging Predictors of Postoperative Chronic Subdural Hematoma Recurrence: Retrospective Review of 345 Patients With 412 Operative Subdural Sides

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Laila Malani Mohammad ◽  
William H McKay ◽  
Christine Meadows ◽  
Jacqueline O’Neill ◽  
Howard Yonas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subdural Hematoma ◽  
Retrospective Review ◽  
Surgical Intervention ◽  
Third Ventricle ◽  
Chronic Subdural Hematoma ◽  
Midline Shift ◽  
Computed Tomography Imaging ◽  
Patient Side ◽  
Anticoagulant Medication

Abstract INTRODUCTION The treatment and management of chronic subdural hematoma (cSDH) is highly variable, with recurrent surgery resulting in increased elderly morbidity, and economic burden to patients and the healthcare system. By conducting a retrospective review of patients with cSDH who underwent evacuation, we will provide a better understanding of predictive factors of recurrence, thereby optimizing a surgeon's management and treatment. METHODS We conducted a retrospective review of 345 patients with a total of 412 sides of cSDH, who received either burr-hole craniostomy or a craniotomy with closed system drainage. We reviewed the immediate preoperative and postoperative computed tomography (CT) scan, and defined recurrence as repeat surgical intervention on the side of initial evacuation. We performed a per-patient and per-side analysis of the collected data. RESULTS A total of 49 (11.9%) patients and 51 sides (12.4%) experienced a recurrent cSDH requiring re-evacuation. In the per-patient analysis, the preoperative hematoma volume [CI 1.082 (1.013-1.155)] and midline shift at the third ventricle [CI 1.118 (1.1028-1.215)] were predictors of recurrence. This was also observed in the per-side analysis at CI 1.088 (1.021-1.159) and CI 1.130 (1.045-1.222), respectively. On the per-patient side, comorbidities (diabetes, liver disease, alcohol abuse, antiplatelet/anticoagulant medication) and other demographic factors (gender, age) were not linked to recurrence. If a patient had a bilateral hematoma and both sides were operated on, it was found to be protective of recurrence with a CI of 0.111 (0.025-0.486). CONCLUSION Larger preoperative volumes and a greater midline shift significantly increased the risk of re-evacuation for cSDH, while other demographic and CT characteristics did not. Therefore, this may represent that a high-risk subgroup can be used as a target for preventative therapy.

Calcium-Suppressed Technique in Dual-Layer Detector Computed Tomography to Evaluate Knee Articular Cartilage

2020 ◽  
Vol 16 ◽  
Author(s):  
Qinglin Meng ◽  
Mengqi Liu ◽  
Weiwei Deng ◽  
Ke Chen ◽  
Botao Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Articular Cartilage ◽  
Bone Marrow Edema ◽  
Knee Joints ◽  
Infrapatellar Fat Pad ◽  
Proton Density ◽  
Knee Cartilage ◽  
Significant Difference ◽  
Marrow Edema

Background: Calcium-suppressed (CaSupp) technique involving spectral-based images has been used to observe bone marrow edema by removing calcium components from the image. Objective: This study aimed to evaluate the knee articular cartilage using the CaSupp technique in dual-layer detector computed tomography (DLCT). Methods: Twenty-eight healthy participants and two patients with osteoarthritis were enrolled, who underwent DLCT and magnetic resonance imaging (MRI) examination. CaSupp images were reconstructed from spectral-based images using a calcium suppression algorithm and were overlaid conventional CT images for visual evaluation. The morphology of the knee cartilage was evaluated, and the thickness of the articular cartilage was measured on sagittal proton density– weighted and CaSupp images in the patellofemoral compartment. Results: No abnormal signal or density, cartilage defect, and subjacent bone ulceration were observed in the lateral and medial femorotibial compartments and the patellofemoral compartment on MRI images and CaSupp images for the 48 normal knee joints. CaSupp images could clearly identify cartilage thinning, defect, subjacent bone marrow edema, and edema of the infrapatellar fat pad in the same way as MRI images in the three knee joints with osteoarthritis. A significant difference was found in the mean thickness of the patellar cartilage between MRI images and CaSupp images, while the femoral cartilage presented no significant difference in thickness between MRI images and CaSupp images over all 48 knee joints. Conclusion: The present study demonstrated that CaSupp images could effectively be used to perform the visual and quantitative assessment of knee cartilage.

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