Critical Depressed Brain Volume Influences the Recurrence of Chronic Subdural Hematoma after Surgical Evacuation

Jang, Kyoung Min; Choi, Hye Sook; Mun, Hah Yong; Nam, Taek Kyun; Park, Yong Sook; Kwon, Jeong Taik

doi:10.1038/s41598-020-58250-w

Cited by 33 publications

(48 citation statements)

References 28 publications

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“…In our cohort, 47.5% of patients experienced hematoma resolution by 6 months after burr hole evacuation, of which the median surgery-to-resolution time was 161 days (IQR: 85–367); these metrics are similar to those reported in other recent studies ( 19 , 20 ). These results suggest that a large proportion of CSDH survivors continue to live with residual hematomas for several months or even years.…”

Section: Discussionsupporting

confidence: 88%

Predicting Chronic Subdural Hematoma Resolution and Time to Resolution Following Surgical Evacuation

et al. 2020

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Background: Growing evidence suggests that chronic subdural hematoma (CSDH) may have long-term adverse effects even after surgical evacuation. Hematoma recurrence is commonly reported as a short-term, postoperative outcome measure for CSDH, but other measures such as hematoma resolution may provide better insight regarding mechanisms behind longer-term sequelae. This study aims to characterize postoperative resolution times and identify predictors for this relatively unexplored metric. Methods: Consecutive cases ( N = 122) of burr hole evacuation for CSDH by a single neurosurgeon at Columbia University Irving Medical Center from 2000 to 2019 were retrospectively identified. Patient characteristics, presenting factors, and date of hematoma resolution were abstracted from the electronic health record. Outcome measures included CSDH resolution at 6 months, surgery-to-resolution time, and inpatient mortality. Univariate and multivariate analyses were performed to determine predictors of outcome measures. Results: Hematoma resolution at 6 months was observed in 58 patients (47.5%), and median surgery-to-resolution time was 161 days (IQR: 85–367). Heavy drinking was predictive of non-resolution at 6 months and longer surgery-to-resolution time, while increased age was predictive of non-resolution at 6 months. Antiplatelet agent resumption was associated with non-resolution at 6 months and longer surgery-to-resolution time on univariate analysis but was not significant on multivariate analysis. Conclusion: Postoperative resolution times for most CSDHs are on the order of several months to a year, and delayed resolution is linked to heavy drinking and advanced age. Subsequent prospective studies are needed to directly assess the utility of hematoma resolution as a potential metric for long-term functional and cognitive outcomes of CSDH.

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Section: Discussionsupporting

confidence: 88%

Predicting Chronic Subdural Hematoma Resolution and Time to Resolution Following Surgical Evacuation

et al. 2020

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“…This population would benefit most from optimization of therapy. Many preoperative radiological parameters have been reported as prognostic factors for CSDH recurrence, but results are conflicting [21][22][23][24][25][26][27][28][29][30][31][32][33][34]51]. [30] T a i w a n 2 0 0 5 -2006 Retro.…”

Section: Discussionmentioning

confidence: 99%

“…Many radiological parameters of CSDH have been reported to be associated with the recurrence risk, including uni-or bilateral hematoma, preoperative hematoma thickness and midline shift, hematoma density and internal architecture, cerebral atrophy, and hematoma volume [21][22][23][24][25][26][27][28][29][30][31][32][33][34]. However, studies have shown conflicting results and large discrepancies in recurrence rates due to heterogeneity in treatment, radiological measurement techniques, and variation in hematoma classifications for hematoma density or architecture.…”

Section: Introductionmentioning

confidence: 99%

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

et al. 2020

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Purpose Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. Methods Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. Results Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). Limitations Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. Conclusions Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.

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“…Preexisting cerebral atrophy is associated with alteration of brain elasticity and causes cerebral under-expansion after burr hole surgery for CSDH ( 21 , 22 ). Moreover, this may lead to a persistent cavity in the subdural space and subsequently cause CSDH recurrence ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…The recurrence rate of CSDH has been reported to range from 2.3 to 33% (1). Previous studies have reported many risk factors for CSDH recurrence, including brain atrophy, underexpansion, coagulopathy or anticoagulant use, male sex, hypertension, diabetes, bilateral CSDH, large preoperative hematoma volume, septations, mixed density of hematoma on brain computed tomography (CT) scans, iso-or hypointensity on T1-weighted magnetic resonance images, preoperative midline shift, persistence of a mass effect after burr hole trephination, large postoperative residual hematoma, and postoperative pneumocephalus (2,3).…”

Section: Introductionmentioning

confidence: 99%

Effects of Possible Osteoporotic Conditions on the Recurrence of Chronic Subdural Hematoma

Bae

Kim

et al. 2020

Front. Neurol.

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The recurrence rate of chronic subdural hematoma (CSDH) has been reported to range from 2.3 to 33%. As bridging veins are composed of abundant collagen bundles and bone matrix, we aimed to investigate the possible associations between skull Hounsfield unit (HU) values and the recurrence of CSDH. We retrospectively enrolled patients with CSDH who underwent burr hole surgery. The HU values of the frontal skull were measured on brain CT scans. The cumulative hazard for recurrence was estimated according to predictive factors. To identify the independent predictors associated with the recurrence of CSDH, hazard ratios (HRs) were estimated using multivariate Cox regression analysis. A total of 208 consecutive patients who underwent burr hole trephination for CSDH over a 7-years period at a single institution were enrolled in this study. We found that age, greater midline shift (≥10.5 mm), lower skull HU (<769.5), and diabetes were independent predictors for the recurrence of CSDH (HR 1.06, 95% confidence interval [CI] 1.00-1.12, p = 0.042; HR 5.37, 95% CI 1.48-19.46, p = 0.010; HR 6.71, 95% CI 1.84-24.45, p = 0.004; and HR 3.30, 95% CI 1.05-10.43, p = 0.042, respectively). A relationship between possible low bone mineral density (BMD) and CSDH recurrence was observed. In addition, age, greater preoperative midline shift, and diabetes were also identified as predictive factors for recurrence. We expect that our findings may facilitate our understanding of the possible association between CSDH and BMD.

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Critical Depressed Brain Volume Influences the Recurrence of Chronic Subdural Hematoma after Surgical Evacuation

Cited by 33 publications

References 28 publications

Predicting Chronic Subdural Hematoma Resolution and Time to Resolution Following Surgical Evacuation

Predicting Chronic Subdural Hematoma Resolution and Time to Resolution Following Surgical Evacuation

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

Effects of Possible Osteoporotic Conditions on the Recurrence of Chronic Subdural Hematoma

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