Chronic subdural hematoma: Differences between unilateral and bilateral occurrence

Hsieh, Cheng-Ta; Su, I‐Chang; Hsu, Szu-Kai; Huang, Chih-Ta; Lian, Foot-Juh; Chang, Chih‐Ju

doi:10.1016/j.jocn.2016.09.015

Cited by 41 publications

(36 citation statements)

References 28 publications

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“…7,17 Furthermore, midline shift is not as common and distinct in cases of bcSDH. 6,7,17 In our study the mean hematoma volumes in patients in whom bilateral surgical evacuation was performed were 120.8 cm 3 (right) and 123.3 cm 3 (left). Unilateral evacuation was performed in patients with mean hematoma volumes of 136.6 cm 3 (right) and 136.3 cm 3 (left) ( Table 1).…”

Section: Discussionmentioning

confidence: 52%

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

Scheichel¹,

Popadic²,

Ungersboeck³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEUnilateral evacuation of bilateral chronic subdural hematomas (bcSDHs) is associated with higher retreatment rates than an initial bilateral intervention. One reason for that is a possible progression in the size of the contralateral side after unilateral treatment. Thus, the authors focused their study on finding predictors of the need for contralateral retreatment.METHODSAll patients who had undergone unilateral or bilateral evacuation of bcSDHs in the Department of Neurosurgery at the University Hospital of St. Poelten during a 5-year period (7/2012 to 6/2017) were retrospectively identified. The preoperative hematoma volume was calculated using the XYZ/2 method.RESULTSOf a total of 103 patients with bcSDHs, 61 patients underwent bilateral evacuation and 42 patients underwent unilateral evacuation. The retreatment rate after bilateral evacuation was significantly lower than that after unilateral evacuation (14.8% vs 31%, respectively; p = 0.049). Contralateral retreatment after unilateral evacuation was necessary in 9 patients (21.4%). The preoperative contralateral hematoma volume was significantly higher in those patients who needed contralateral retreatment after initial unilateral evacuation (68.4 cm3 vs 27.4 cm3, respectively; p < 0.001). Furthermore, the so-called volume relation ratio created by dividing the smaller by the larger hematoma volume was significantly higher when contralateral retreatment became necessary (0.56 vs 0.21, respectively; p < 0.001).CONCLUSIONSPatients needing evacuation of bcSDHs should be considered for primary bilateral evacuation if the hematoma volume on the smaller side is greater than 40 cm3 and the subsequent volume relation ratio is greater than 0.4.

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Section: Discussionmentioning

confidence: 52%

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

Scheichel¹,

Popadic²,

Ungersboeck³

et al. 2019

Journal of Neurosurgery

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“…Comparing our results with previous studies, our definition of CSDH, postoperative recurrence of CSDH and postoperative AIH are in accordance with medical norms and logic. CSDHs are usually unilateral, but do present as bilateral in~9.2-34.9% of cases [5,[28][29][30]. However, not all patients with bilateral CSDH warrant evacuation of both sides at initial presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage; however, its pathogenic mechanism remains unclear. The incidence of CSDH is~3.4-5/100000 per year in the general population and 60-80/100000 per year in those aged ≥65 [1][2][3][4][5]. The treatment is often surgical evacuation, using techniques such as twist-drill craniotomy and burr hole drainage (BHD) or craniotomy.…”

Section: Introductionmentioning

confidence: 99%

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

Chen

Wang

et al. 2020

BMC Neurol

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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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“…The incidence of CSDH is ~3.4-5/100 000 per year in the general population and 60-80/100 000 per year in those aged ≥65. [1][2][3][4][5] The treatment is often surgical evacuation, using techniques such as twist-drill craniotomy and burr hole drainage (BHD) or craniotomy. BHD is the most widely used technique, and has a satisfactory outcome, but has initially underwent BHD with or without irrigation at one of the two institutions.…”

Section: Introductionmentioning

confidence: 99%

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

Chen

Wang

et al. 2020

Preprint

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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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Chronic subdural hematoma: Differences between unilateral and bilateral occurrence

Cited by 41 publications

References 28 publications

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

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

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

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