Bilateral evacuation of bilateral non-acute subdural hematomas – evaluation of postoperative outcomes and complications

Abstract

INTRODUCTION: Bilateral fi nding of non-acute subdural hematomas (NASH) is less common compared to unilateral occurrence. The aim of this study was to evaluate results of surgical treatment of bilaterally treated bilateral NASH. METHODS: Retrospective analysis of patients, who underwent bilateral surgical evacuation of NASH (2014)(2015)(2016)(2017)(2018)(2019)(2020). This study was conducted to determine the association between the incidence of postoperative complications and outcome, hematoma recurrence and selected risk factors (including volumetric parameters). Correlations between variables were assessed by using Spearmanˊs correlation. Chi-squared test, Studentˊs t-test (unpaired and paired) and one-way ANOVA were used for univariate analysis. RESULTS: Our study included 29 patients with bilateral NASH who underwent bilateral surgical hematoma evacuation. The laminar hematoma type was associated with higher hematoma recurrence rate (p = 0.032) and worse clinical outcome (p = 0.043). Larger PHV was signifi cantly associated with larger PV after surgery and worse neurological outcome. Larger PHV, PHCV and PV were signifi cantly associated with higher incidence of NASH recurrence (p = 0.0008, p = 0.0007 and p = 0.00006). CONCLUSION: The laminar hematoma type and larger PHV were signifi cant risk factors for the recurrence of bilateral NASH and worse neurological outcome. Larger PHCV and PV were signifi cantly associated with hematoma recurrence (Tab. 7, Fig. 3, Ref. 24).

Non-acute subdural hematoma: estimation of recurrence using CT-volumetric measurements

“…PHV greater than 80 ml occurs more frequently in the recurrence group (18). Uda et al report a signifi cant effect of the preoperative hematoma volume on the recurrence rate (32), an observation similar to that of Stanišič (4) and us, even in our previous work describing bilateral non-acute subdural hematomas (24). In the study of Shen et al, the ratio of the postoperative pneumocephalus volume to the postoperative hematoma cavity volume was identifi ed as an independent risk factor for predicting NASH recurrence (28).…”

“…Similarly, there was no difference in the incidence of recurrence between homogeneous and heterogeneous hematomas. Most studies state that the heterogeneous type of hematoma represents a risk factor for NASH recurrence (4,5,11,14,16,19,23,24). In particular, the separated type is most often described as a risk factor (3,14,19,23).…”

Surgical Treatment of Bilateral Chronic Subdural Hematoma

“…e endoscopic monitoring system can guide the operation and avoid blind operation [30,31]. Endoscopy can not only clearly see the shape, structure, adhesion, and separation of the capsule but also separate and open the separation of the organized adhesion in the hematoma cavity under direct vision, which greatly improves the thoroughness of hematoma removal [32][33][34]. Neuroendoscopy can directly stop other obvious small active bleeding in the cavity with endoscopic bipolar electrocoagulation, which reduces the incidence of postoperative rebleeding.…”