Chronic subdural hematoma: Surgical treatment and outcome in 104 patients

Ernestus, Ralf‐Ingo; Bełdziński, Piotr; Lanfermann, Heinrich; Klug, N.

doi:10.1016/s0090-3019(97)80031-6

Cited by 228 publications

(164 citation statements)

References 21 publications

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“…O hematoma subdural crônico (HSC) representa uma das formas mais frequentes de hemorragia intracraniana 1 e é considerado uma lesão benigna, ainda que cronicamente progressiva 1-3 . O maior acometimento de pacientes idosos leva a uma variedade de dificuldades diagnósticas e terapêuticas devido a inespecificidade dos sintomas bem como patologias associadas 1,4 . Na maioria dos casos a evolução sem a instituição do tratamento cirúrgico pode ser fatal tanto pela compressão cerebral exercida pelo hematoma quanto pelas doenças associadas 5 .…”

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“…O maior acometimento de pacientes idosos leva a uma variedade de dificuldades diagnósticas e terapêuticas devido a inespecificidade dos sintomas bem como patologias associadas 1,4 . Na maioria dos casos a evolução sem a instituição do tratamento cirúrgico pode ser fatal tanto pela compressão cerebral exercida pelo hematoma quanto pelas doenças associadas 5 .…”

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“…Na maioria dos casos a evolução sem a instituição do tratamento cirúrgico pode ser fatal tanto pela compressão cerebral exercida pelo hematoma quanto pelas doenças associadas 5 . Por outro lado o diagnóstico precoce e a drenagem cirúrgica permitem a recuperação completa na maioria dos casos 1 .…”

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Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Yasuda

Morita

Nishimori

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%), da cor branca (85,1%) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio) superiores a 1,25 e/ou trombocitopenia (p<0,001 e p=0,004, respectivamente) e mortalidade menor para os pacientes com antecedente de traumatismo cranioencefálico (76%) (p=0,044). Os resultados ressaltam a importância da avaliação pré-operatória com o coagulograma a fim de se corrigir possíveis alterações.PALAVRAS-CHAVE: hematoma subdural crônico, coagulação, mortalidade. Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalitiesABSTRACT-The chronic subdural hematoma represents one of the most frequent types of intracranial hemorrhage. One hundred sixty one patients operated in the Clinical Hospital of State University of Campinas -SP (UNICAMP) from April 1994 to May 2000, were analyzed retrospectively in order to characterize the population and to study the importance of the pre-operative coagulation analysis in the outcome. The majority of the population was male (86%), white (85.1%) and in the fifth decade (median age: 57 years). A high mortality index in the postoperative period was found in patients with INR (international normalized ratio) values greater than 1.25 and/or thrombocytopenia (p<0.001 and p=0.004 respectively). Patients with previous head injury history (76%) showed a lower mortality (p=0.044). The results stand out the importance of the pre-operative evaluation with coagulation studies in order to correct possible abnormalities.KEY WORDS: chronic subdural hematoma, coagulation, mortality. O hematoma subdural crônico (HSC) representa uma das formas mais frequentes de hemorragia intracraniana 1 e é considerado uma lesão benigna, ainda que cronicamente progressiva 1-3 . O maior acometimento de pacientes idosos leva a uma variedade de dificuldades diagnósticas e terapêuticas devido a inespecificidade dos sintomas bem como patologias associadas 1,4 . Na maioria dos casos a evolução sem a instituição do tratamento cirúrgico pode ser fatal tanto pela compressão cerebral exercida pelo hematoma quanto pelas doenças associadas 5 . Por outro lado o diagnóstico precoce e a drenagem cirúrgica permitem a recuperação completa na maioria dos casos 1 .O HSC é caracterizado por uma coleção encapsulada e bem delimitada entre a dura máter e a membrana aracnóide contendo uma mistura de sangue fluido e coagulado de vários estágios 5,6 . A fisiopatologia do hematoma subdural crônico tem sido alvo de estudos desde a publicação de Virchow em 1857, em que descrevia com detalhes a lesão como uma paquimeningite hemorrágica 2,7,8 . Apesar das diversas teorias desenvolvidas desde então, a su...

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Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Yasuda

Morita

Nishimori

et al. 2003

Arq. Neuro-Psiquiatr.

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“…However, according to newer studies, the incidence appears to be as high as 13.1 cases per 100,000 [14]. Patients older than 40 years account for 80 % of cases [15,16].…”

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SDH with Bleeding Diathesis—a Management Protocol

et al. 2015

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Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

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Additional treatment after primary conservative treatment in patients with chronic subdural hematoma—A retrospective study

Fakhry,

Dirven,

Moudrous

et al. 2024

Brain and Behavior

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ObjectiveChronic subdural hematoma (CSDH) is a common neurological condition and is typically treated with burr hole craniostomy. Nevertheless, conservative treatment may lead to spontaneous hematoma resolution in some patients. This study aims to describe the characteristics of patients who were treated conservatively without the eventual need for additional treatment.MethodsData were retrospectively collected from patients who were primarily treated conservatively in three hospitals in the Netherlands from 2008 to 2018. The Primary outcome was the nonnecessity of additional treatment within 3 months after the initial CSDH diagnosis. We used univariable and multivariable logistic regression analyses to identify factors associated with not receiving additional treatment.ResultsIn this study, 83 patients were included and 61 patients (73%) did not receive additional treatment within 3 months. Upon first presentation, the patients had a Markwalder Grading Scale score (MGS) of 0 (n = 5, 6%), 1 (n = 43, 52%), and 2 (n = 35, 42%). Additional treatment was less often received by patients with smaller hematoma volumes (adjusted odds ratio [aOR] 0.78 per 10 mL; 95% confidence interval [CI] 0.64–0.92). Patients using antithrombotic medication also received less additional treatment, but this association was not significant (aOR 2.02; 95% CI 0.61–6.69).ConclusionsThree quarters of the initially conservatively treated CSDH patients do not receive additional management. Typically, these patients have smaller hematoma volumes. Further, prospective research is needed to distinguish which patients require surgical intervention and in whom primary conservative treatment suffices.

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Chronic subdural hematoma: Surgical treatment and outcome in 104 patients

Cited by 228 publications

References 21 publications

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

SDH with Bleeding Diathesis—a Management Protocol

Additional treatment after primary conservative treatment in patients with chronic subdural hematoma—A retrospective study

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