Presenting symptoms and functional outcome of chronic subdural hematoma patients

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.

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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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Functional recovery following surgery for chronic subdural hematoma

Surgical Neurology International ◽

10.25259/sni_689_2020 ◽

2020 ◽

Vol 11 ◽

pp. 450

Author(s):

Sarah A. Merrill ◽

Daniel Khan ◽

Alexandra E. Richards ◽

Maziyar A. Kalani ◽

Naresh P. Patel ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Physical Therapy ◽

Functional Recovery ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Neurological Deficits ◽

Presenting Symptoms

Background: Among the elderly, chronic subdural hematoma is a relatively common neurosurgical condition. Presenting symptoms range from headache and focal neurological deficits to seizure and coma depending on location and extent of brain compression. Functional recovery following surgery for chronic subdural hematoma is central to quality of life and ongoing health for elderly patients; however, there is a paucity of data regarding functional recovery in this population. Methods: In this study, the physical activity of patients who underwent surgical evacuation of chronic subdural hematoma was surveyed, as well as participation in physical therapy following surgery. In total, 38 patients completed the survey. Results: Of the 30 patients who exercised regularly before surgery, 28 (90.3%) returned to exercise within 1 year after surgery. Of 13 patients who reported playing hobby sports before surgery, 9 (69.2%) returned to those sports. 17/38 (44.7%) patients participated in physical therapy after surgery. 35/38 (92.1%) of patients reported that the surgery improved their quality of life. Conclusion: The majority of patients who underwent surgery for chronic subdural hematoma were able to return to exercise within 1 year. Participation in physical therapy was associated with return to exercise and sports. Further study is needed to determine which factors contribute to a return to baseline levels of physical activity following surgery for chronic subdural hematoma.

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Third Ventricle Volume Predicts Functional Outcome in Chronic Subdural Hematoma

Acta Neurologica Scandinavica ◽

10.1111/ane.13546 ◽

2021 ◽

Author(s):

Rafael Martinez‐Perez ◽

Michael W. Kortz ◽

Timothy H. Ung ◽

Natalia Rayo ◽

Alfonso Lagares ◽

...

Keyword(s):

Functional Outcome ◽

Subdural Hematoma ◽

Third Ventricle ◽

Chronic Subdural Hematoma ◽

Ventricle Volume

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A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation

Journal of Neurosurgery ◽

10.3171/2012.11.jns12689 ◽

2013 ◽

Vol 118 (3) ◽

pp. 694-700 ◽

Cited By ~ 15

Author(s):

Mina Safain ◽

Marie Roguski ◽

Alexander Antoniou ◽

Clemens M. Schirmer ◽

Adel M. Malek ◽

...

Keyword(s):

Subdural Hematoma ◽

Medical Center ◽

Chronic Subdural Hematoma ◽

Retrospective Chart Review ◽

Attractive Alternative ◽

Traditional Methods ◽

Presenting Symptoms ◽

Significant Difference ◽

Before And After ◽

Port System

Object The traditional methods for managing symptomatic chronic subdural hematoma (SDH) include evacuation via a bur hole or craniotomy, both with or without drain placement. Because chronic SDH frequently occurs in elderly patients with multiple comorbidities, the bedside approach afforded by the subdural evacuating port system (SEPS) is an attractive alternative method that is performed under local anesthesia and conscious sedation. The goal of this study was to evaluate the radiographic and clinical outcomes of SEPS as compared with traditional methods. Methods A prospectively maintained database of 23 chronic SDHs treated by bur hole or craniotomy and of 23 chronic SDHs treated by SEPS drainage at Tufts Medical Center was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcome was collected. The volume of SDH before and after treatment was semiautomatically measured using imaging software. Results There was no significant difference in initial SDH volume (94.5 cm3 vs 112.6 cm3, respectively; p = 0.25) or final SDH volume (31.9 cm3 vs 28.2 cm3, respectively; p = 0.65) between SEPS drainage and traditional methods. In addition, there was no difference in mortality (4.3% vs 9.1%, respectively; p = 0.61), length of stay (11 days vs 9.1 days, respectively; p = 0.48), or stability of subdural evacuation (94.1% vs 83.3%, respectively; p = 0.60) for the SEPS and traditional groups at an average follow-up of 12 and 15 weeks, respectively. Only 2 of 23 SDHs treated by SEPS required further treatment by bur hole or craniotomy due to inadequate evacuation of subdural blood. Conclusions The SEPS is a safe and effective alternative to traditional methods of evacuation of chronic SDHs and should be considered in patients presenting with a symptomatic chronic SDH.

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Value of routine early post-operative computed tomography in determining short-term functional outcome after drainage of chronic subdural hematoma: An evaluation of residual volume

Surgical Neurology International ◽

10.4103/2152-7806.141299 ◽

2014 ◽

Vol 5 (1) ◽

pp. 136 ◽

Cited By ~ 5

Author(s):

NicolasK.K. King ◽

HuiYu Ng ◽

WaiHoe Ng

Keyword(s):

Computed Tomography ◽

Functional Outcome ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Residual Volume ◽

Short Term

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Efficacy of the direct aspiration-irrigation maneuver for the treatment of chronic subdural hematoma: A single hospital's experience

10.21203/rs.3.rs-273418/v1 ◽

2021 ◽

Author(s):

Zhenjiang Pan ◽

Jing Bao ◽

Shepeng Wei

Keyword(s):

Subdural Hematoma ◽

Chart Review ◽

Chronic Subdural Hematoma ◽

Retrospective Chart Review ◽

Burr Hole ◽

Attractive Alternative ◽

Presenting Symptoms ◽

Significant Difference ◽

Duration Of Surgery ◽

Space Volume

Abstract OBJECTIVE The traditional methods for managing symptomatic chronic subdural hematoma (CSDH) at our hospital include evacuation via single burr-hole irrigation with continuous closed subdural drainage (SBID). The single burr-hole aspiration and irrigation technique with continuous closed subdural drainage (SBAID) is an attractive alternative method. The goal of this study was to evaluate the radiographic and clinical outcomes of SBAID compared with traditional SBID methods. METHODS A database of 51 CSDH patients treated with the SBAID method and 35 CSDH patients treated with the SBID method was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcomes was collected. Predictors of recurrence requiring reoperation and other outcomes were analyzed. RESULTS Compared to the patients in the SBID group, the patients in the SBAID group had a shorter mean duration of surgery (56.6 ± 5.6 minutes vs 59.5 ± 4.8 minutes, respectively, P = 0.02); a shorter mean interval from procedure to discharge (6.2 ± 1.2 days vs 6.8 ± 1.3 days, respectively, P = 0.046); no significant difference in preoperative hematoma volume (106.4 ± 21.7 cm3 vs 101.3 ± 16.3 cm3, respectively, P = 0.25); and a smaller subdural space volume 48 hours after the operation (43.6 ± 7.4 cm3 vs 47.4 ± 9.1 cm3, respectively, P = 0.03).

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Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital

Neurosurgical FOCUS ◽

10.3171/2018.7.focus18253 ◽

2018 ◽

Vol 45 (4) ◽

pp. E7 ◽

Cited By ~ 3

Author(s):

David Kitya ◽

Maria Punchak ◽

Jihad Abdelgadir ◽

Oscar Obiga ◽

Derek Harborne ◽

...

Keyword(s):

Wound Infection ◽

Low Income ◽

Subdural Hematoma ◽

Clinical Presentation ◽

Chronic Subdural Hematoma ◽

Referral Hospital ◽

Regional Referral Hospital ◽

Icu Admission ◽

Presenting Symptoms ◽

Gcs Score

OBJECTIVECauses, clinical presentation, management, and outcomes of chronic subdural hematoma (CSDH) in low- and middle-income countries are not well characterized in the literature. Knowledge regarding these factors would be beneficial in the development and implementation of effective preventive and management measures for affected patients. The authors conducted a study to gain a better understanding of these factors in a low-income setting.METHODSThis prospective study was performed at Mbarara Regional Referral Hospital (MRRH) in Uganda between January 2014 and June 2017. Patients of any age who presented and were diagnosed with CSDH during the aforementioned time period were included in the study. Variables were collected from patients’ files at discharge and follow-up clinic visits. The primary outcome of interest was death. Secondary outcomes of interest included discharge Glasgow Coma Scale (GCS) score, ICU admission, wound infection, and CSDH recurrence.RESULTSTwo hundred five patients, the majority of whom were male (147 [72.8%]), were enrolled in the study. The mean patient age was 60.2 years (SD 17.7). Most CSDHs occurred as a result of motor vehicle collisions (MVCs) and falls, 35.6% (73/205) and 24.9% (51/205), respectively. The sex ratio and mean age varied depending on the mechanism of injury. Headache was the most common presenting symptom (89.6%, 173/193), whereas seizures were uncommon (11.5%, 23/200). Presenting symptoms differed by age. A total of 202 patients underwent surgical intervention with burr holes and drainage, and 22.8% (46) were admitted to the ICU. Two patients suffered a recurrence, 5 developed a postoperative wound infection, and 18 died. Admission GCS score was a significant predictor of the discharge GCS score (p = 0.004), ICU admission (p < 0.001), and death (p < 0.001).CONCLUSIONSTrauma from an MVC is the commonest cause of CSDH among the young. For the elderly, falling is common, but the majority have CSDH with no known cause. Although the clinical presentation is broad, there are several pronounced differences based on age. Burr hole surgery plus drainage is a safe and reliable intervention. A low preoperative GCS score is a risk factor for ICU admission and death.

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Analysis of 150 Cases with Chronic Subdural Hematoma in Adult on the Factors Related to Functional Outcome

Recent Advances in Neurotraumatology ◽

10.1007/978-4-431-68231-8_32 ◽

1993 ◽

pp. 145-148

Author(s):

Yoshitaka Okimura ◽

Junichi Ono ◽

Hirohide Karasudani ◽

Katsumi Isobe ◽

Akira Yamaura

Keyword(s):

Functional Outcome ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma

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