Analysis of the Computed Tomographic Findings Related with the Mean Duration of Brain Expansion after the Operation of Chronic Subdural Hematoma

Recurrences after evacuation of chronic subdural hematoma are seen in 2-33% of cases with various surgical approaches. Various demographical, clinical, radiological, surgical and postoperative management strategies have been explored as the possible predictors of recurrence. We performed a retrospective analysis in 160 patients with chronic subdural hematoma with an aim to analyze the post-operative recurrences and factors associated with it. Various socio demographic and clinico-radiological parameters were studied against the rate of recurrence after surgery using Chi square/Fischer Exact Test. Factors showing significant association on univarate analysis were then analysed using binary logistic regression. The rate of recurrence of CSDH in our study was 5% and the mean duration of recurrence was 33 days. Chronic alcohol use (p=0.007) and intraoperative brain expansion ((p=0.001) were the two factors associated with recurrence of CSDH. On binary logistic regression chronic alcohol use (wald-6.467, p=0.011) and intraoperative brain expansion (wald=6.674, p=0.010) were both associated significantly with recurrence of CSDGH with an odds of 7.804 and 0.058 respectively.

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Treatment of chronic subdural hematoma by twist-drill craniostomy with continuous catheter drainage

Journal of Neurosurgery ◽

10.3171/jns.1986.65.2.0183 ◽

1986 ◽

Vol 65 (2) ◽

pp. 183-187 ◽

Cited By ~ 85

Author(s):

Mark Camel ◽

Robert L. Grubb

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Total Mortality ◽

Clinical Syndrome ◽

Twist Drill ◽

Catheter Drainage ◽

Content Type ◽

Excellent Outcome ◽

Duration Of Hospitalization ◽

The Mean

✓ The case records of 114 patients were reviewed to ascertain the efficacy of bedside twist-drill craniostomy and continuous closed-system catheter drainage for the treatment of chronic subdural hematomas. Ninety-eight (86%) patients achieved an excellent outcome, and seven (6%) had no significant improvement. The total mortality from all causes was 8% in this group. Successful catheter drainage of the chronic subdural hematoma was accomplished by either one or two catheter placements in 102 (90%) patients. Twelve patients required additional operative procedures. The mean duration of hospitalization for the study group was 16 ays. No infections occurred in these patients. Remission of the clinical syndrome did not require the adiographic resolution of the chronic subdural hematoma.

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HYPEREMIA BENEATH EVACUATED ACUTE SUBDURAL HEMATOMA IS FREQUENT AND PROLONGED IN PATIENTS WITH AN UNFAVORABLE OUTCOME

Neurosurgery ◽

10.1227/01.neu.0000341872.17024.44 ◽

2009 ◽

Vol 64 (4) ◽

pp. 705-718 ◽

Cited By ~ 13

Author(s):

Arturo Chieregato ◽

Alberto Noto ◽

Alessandra Tanfani ◽

Giovanni Bini ◽

Costanza Martino ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Subdural Hematoma ◽

Time Course ◽

Unfavorable Outcome ◽

Acute Subdural Hematoma ◽

Control Group ◽

Computed Tomographic ◽

The Mean

Abstract OBJECTIVE To verify the values and the time course of regional cerebral blood flow (rCBF) in the cortex located beneath an evacuated acute subdural hematoma (SDH) and their relationship with neurological outcome. METHODS rCBF levels were measured in multiple regions of interest, by means of a Xe-computed tomographic technique, in the cortex underlying an evacuated SDH and contralaterally in 20 patients with moderate or severe traumatic brain injury and an evacuated acute SDH. Twenty-three patients with moderate or severe traumatic brain injury and an evacuated extradural hematoma or diffuse injury served as the control group. Outcome was evaluated by means of the Glasgow Outcome Scale at 12 months. RESULTS Values for the maximum (rCBFmax) and the mean of all rCBF levels in the cortex beneath the evacuated SDH were more frequently consistent with hyperemia. The side-to-side differences in the mean of all rCBF and rCBFmax levels between lesioned and nonlesioned hemispheres were greater in patients with evacuated SDH than in controls (P = 0.0013 and P = 0.0018, respectively). The side-to-side difference in the maximum rCBF value was higher in SDH patients with unfavorable outcomes than in controls at 24 to 96 hours and at 4 to 7 days and higher than in patients with favorable outcomes at 4 to 7 days. The widest side-to-side difference in rCBFmax value was more elevated in patients with an evacuated SDH with unfavorable outcome than in patients with a favorable outcome (P = 0.047), whereas no differences were found in controls. The SDH thickness and the associated midline shift were greater in patients with unfavorable outcomes than in those with favorable outcomes. CONCLUSION On average, hyperemic long-lasting rCBF values frequently occur in the cortex located beneath an evacuated SDH and seem to be associated with unfavorable outcome.

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Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

10.21203/rs.2.19037/v2 ◽

2020 ◽

Author(s):

FuMei Chen ◽

Ke Wang ◽

KangLi Xu ◽

Li Wang ◽

TianXiang Zhan ◽

...

Keyword(s):

Logistic Regression ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Time Interval ◽

Multiple Logistic Regression ◽

Regression Analyses ◽

Anticoagulant Drug ◽

The Mean ◽

Mean Time

Abstract Objective To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8±28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7±2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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Bedside Percutaneous Twist Drill Craniostomy of Chronic Subdural Hematoma—A Single-Center Study

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1698485 ◽

2019 ◽

Vol 11 (01) ◽

pp. 084-088 ◽

Cited By ~ 1

Author(s):

Geo Senil Kidangan ◽

Binoy Damodar Thavara ◽

Bijukrishnan Rajagopalawarrier

Keyword(s):

Statistical Analysis ◽

Ct Scan ◽

Clinical Improvement ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Mass Effect ◽

Common Symptom ◽

Twist Drill ◽

Duration Of Symptoms ◽

The Mean

Abstract Background Chronic subdural hematoma (CSDH) is predominantly a disease of the elderly. Objectives This article studies the clinical and radiological outcomes in patients with CSDH who had undergone bedside percutaneous twist drill craniostomy (TDC). Patients and Methods A retrospective study was conducted in 80 patients who had undergone percutaneous TDC for CSDH between January 2017 and December 2018. Patients between 18 and 90 years of age were selected. CSDH showing computed tomography (CT) scan findings of homogeneous hypodensity, homogeneous isodensity, mixed density, and CSDH with hyperdense gravity-dependent fluid level were selected. CT evidence of multiple septations, recurrent CSDH, bilateral CSDH, and acute on CSDH were excluded. The presence of midline shift (MLS) was measured as any deviation of the septum pellucidum from the midline. The mass effect was determined by the effacement of the sulci, Sylvian fissure obscuration, or compression of lateral ventricles. Postoperative decrease in the signs and symptoms were considered as the postoperative clinical improvement. Improvement in the postoperative CT scan was determined by the decrease in the thickness of CSDH and absence of MLS with decrease in the mass effect. The presence of the CSDH with mass effect and MLS was considered as the significant residue in the postoperative CT scan. Statistical Analysis Statistical analysis is done using Epi Info software. Results The mean age range was 67.78 years ± 12.03 standard deviation (SD). There were 49 (61.25%) males and 31 (38.75%) females. Thirty-eight (47.5%) CSDHs were on the right side and 42 (52.5%) on the left side. The locations were in the frontotemporoparietal region in 91.25% patients and in the frontoparietal region in 8.75% patients. The mean duration of symptoms was 4.62 days ± 5.20 SD. History of trauma was present in 58.75% patients. The mean duration of trauma was 45.78 days ± 28.32 SD. The most common symptoms were weakness of the limbs (68.75%), altered sensorium or decreased memory (52.5%), and headache (32.5%). The preoperative Glasgow Coma Scale (GCS) score ranged from 4 to 15 (mean 12.86 ± 2.98 SD). Limb motor weakness was noted in 75% patients. The maximum thickness of the CSDH (in millimeter) in axial CT scan was 8 to 32 (mean 23.22 ± 4.87 SD). All of the 80 patients had MLS. Postoperative GCS ranged from 3 to 15 (mean 14.1 ± 2.78 SD). Postoperative power was improved in 95% of affected limbs. Postoperative power was deteriorated (including patients of complications and death) in 5% patients. Clinical improvement was noted in 93.75% patients. Postoperative CT scan improvement was noted in 95% patients. Two patients (2.5%) had significant residue which required reoperation. Two patients (2.5%) developed extradural hematoma which was operated. Five (6.25%) patients developed complications, among which 4 (5%) patients died. The mean duration of stay in the hospital was 6.82 days ± 4.16 SD. Conclusions CSDH is a disease of elderly population. CSDH is more common in male population. The most common symptom is weakness of the limbs. High clinical and radiological improvement can be achieved with TDC. TDC should be considered as a safe and effective alternative to burr hole craniostomy.

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Neurosurgical Aspects of the Parietal Boss in Patients with Chronic Subdural Hematomas

Neurosurgery ◽

10.1227/00006123-198111000-00007 ◽

1981 ◽

Vol 9 (5) ◽

pp. 531-534 ◽

Cited By ~ 4

Author(s):

Takashi Iwabuchi ◽

Tetsuji Sekiya ◽

Tetsuji Sekiya

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Ct Scanning ◽

Burr Hole ◽

Computed Tomographic ◽

Subdural Hematomas ◽

Ct Analysis

Abstract There are many modes of trephination for the treatment of chronic subdural hematoma. Angiographic and computed tomographic (CT) analysis of 60 consecutive patients with chronic subdural hematoma indicated that the parietal boss, which is likely to be overlooked by routine CT scanning, is one of the most suitable places for opening a burr hole. Our patients responded satisfactorily to irrigation therapy via a single burr hole in the parietal boss.

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Chronic subdural hematoma: surgical management in 133 patients

Journal of Neurosurgery ◽

10.3171/jns.1984.61.2.0263 ◽

1984 ◽

Vol 61 (2) ◽

pp. 263-268 ◽

Cited By ~ 126

Author(s):

Richard G. Robinson

Keyword(s):

Subdural Hematoma ◽

Intracranial Hypotension ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Postoperative Management ◽

Content Type ◽

Brain Expansion ◽

Burr Holes ◽

Bilateral Lesions ◽

Active Policy

✓ One hundred and thirty-three patients with chronic subdural hematoma were treated surgically between 1943 and 1980. The patients, aged 5 to 84 years, were graded retrospectively according to the Bender scale; 28% were in Grades 3 and 4. There were 107 unilateral and 26 bilateral hematomas. The clots were removed mostly via burr-holes without drainage. The treatment of 121 patients included an active policy of brain expansion at operation and the postoperative management of intracranial hypotension by lumbar injection. Two patients died, for a mortality rate of 1.5%. The patients who died were 54 and 59 years old, both from among the 26 cases with bilateral lesions; 107 unilateral lesions were treated, with no deaths. None of 51 patients who were aged 61 years and over died. The mean postoperative stay was 17.2 days, and at 3 weeks 77% had been discharged home. Fifteen percent of survivors had permanent disabilities. The common residual deficits were personality and memory disorders, and there was hemiparesis in Grade 4 cases. The high-riskm groups of chronic subdural hematoma were those in Grades 3 and 4, bilateral hematomas, and the elderly. These seemed to be benefited by brain inflation and lumbar injections for intracranial hypotension.

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Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

10.21203/rs.2.19037/v3 ◽

2020 ◽

Author(s):

FuMei Chen ◽

Ke Wang ◽

KangLi Xu ◽

Li Wang ◽

TianXiang Zhan ◽

...

Keyword(s):

Logistic Regression ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Time Interval ◽

Multiple Logistic Regression ◽

Regression Analyses ◽

Anticoagulant Drug ◽

The Mean ◽

Mean Time

Abstract Background To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8±28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7±2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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National randomized clinical trial on subdural drainage time after chronic subdural hematoma evacuation

Journal of Neurosurgery ◽

10.3171/2021.10.jns211608 ◽

2021 ◽

pp. 1-8

Keyword(s):

Hospital Stay ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Length Of Hospital Stay ◽

Burr Hole ◽

Drainage Time ◽

Postoperative Length ◽

The Mean ◽

Burr Hole Evacuation

OBJECTIVE Placement of a subdural drain reduces recurrence and death after evacuation of chronic subdural hematoma (CSDH), but little is known about optimal drainage duration. In the present national trial, the authors investigated the effect of drainage duration on recurrence and death. METHODS In a randomized controlled trial involving all neurosurgical departments in Denmark, patients treated with single burr hole evacuation of CSDH were randomly assigned to 24 hours or 48 hours of postoperative passive subdural drainage. Follow-up duration was 90 days, and the primary study outcome was recurrent hematoma requiring reoperation. Secondary outcome was death. In addition, complications and length of hospital stay were recorded and analyzed. RESULTS Of the 420 included patients, 212 were assigned 24-hour drainage and 208 were assigned 48-hour drainage. The recurrence rate was 14% in the 24-hour group and 13% in the 48-hour group. Four patients died in the 24-hour group, and 8 patients died in the 48-hour group; this difference was not statistically significant. The ORs (95% CIs) for recurrence and mortality (48 hours vs 24 hours) were 0.94 (0.53–1.66) and 2.07 (0.64–7.85), respectively, in the intention-to-treat analysis. The ORs (95% CIs) for recurrence and mortality per 1-hour increase in drainage time were 1.0005 (0.9770–1.0244) and 1.0046 (0.9564–1.0554), respectively, in the as-treated sensitivity analysis that used the observed drainage times instead of the preassigned treatment groups. The rates of surgical and drain-related complications, postoperative infections, and thromboembolic events were not different between groups. The mean ± SD postoperative length of hospital stay was 7.4 ± 4.3 days for patients who received 24-hour drainage versus 8.4 ± 4.9 days for those who received 48-hour drainage (p = 0.14). The mean ± SD postoperative length of stay in the neurosurgical department was significantly shorter for the 24-hour group (2 ± 0.9 days vs 2.8 ± 1.6 days, p < 0.001). CONCLUSIONS No significant differences in the rates of recurrent hematoma or death during 90-day follow-up were identified between the two groups that randomly received either 24- or 48-hour passive subdural drainage after burr hole evacuation of CSDH.

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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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