Factors predicting contralateral hematoma growth after unilateral drainage of bilateral chronic subdural hematoma

Abstract

OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a recurrence rate of 9.2%-26.5% after bur hole surgery. Occasionally patients with bilateral CSDH undergo unilateral surgery because the contralateral hematoma is deemed to be asymptomatic, and in some of these patients the contralateral hematoma may subsequently enlarge, requiring additional surgery. The authors investigated the factors related to the growth of these hematomas. METHODS Ninety-three patients with bilateral CSDH who underwent unilateral bur hole surgery at Aizu Chuo Hospital were included in a retrospective analysis. Findings on preoperative MRI, preoperative thickness of the drained hematoma, and the influence of antiplatelet or anticoagulant drugs were considered and evaluated in univariate and multivariate analyses. RESULTS The overall growth rate was 19% (18 of 93 hematomas), and a significantly greater percentage of the hematomas that were iso- or hypointense on preoperative T1-weighted imaging showed growth compared with other hematomas (35.4% vs 2.3%, p < 0.001). Multivariate logistic regression analysis showed that findings on preoperative T1-weighted MRI were the sole significant predictor of hematoma growth, and other factors such as antiplatelet or anticoagulant drug use, patient age, patient sex, thickness of the treated hematoma, and T2-weighted MRI findings were not significantly related to hematoma growth. The adjusted odds ratio for hematoma growth in the T1 isointense/hypointense group relative to the T1 hyperintense group was 25.12 (95% CI 3.89-51.58, p < 0.01). CONCLUSIONS The findings of preoperative MRI, namely T1-weighted sequences, may be useful in predicting the growth of hematomas that did not undergo bur hole surgery in patients with bilateral CSDH.

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

“…Some studies have reported that male sex is an independent risk factor of CSDH recurrence, and that males likely have more trauma and more frequent complications than females. However, other studies have suggested that gender is not associated with CSDH recurrence [13,36]. In our study, 295 patients had a history of trauma, including 233 males and 62 females.…”

“…Many studies suggest that preoperative hematoma density is associated with CSDH recurrence, and hyperdense hematoma is an independent risk factor for CSDH recurrence [13,38]. In present study, although nearly 1/3 of the patients had hyperdense imaging findings, according to our clinical experience and our definition of CSDH, neurosurgeons evaluated patients with subdural hematoma no matter what the density of subdural hematoma on imaging, once they were able to be treated with BHD, these patients could be managed as patients with CSDH.…”

“…BHD is the most widely used technique, and has a satisfactory outcome, but has a CSDH recurrence rate of 4-38% [6][7][8][9][10][11][12]. Several studies have revealed that predictors of CSDH recurrence following surgical evacuation include age, sex, antiplatelet or anticoagulation therapy, Glasgow Coma Scale (GCS), diabetes mellitus, hypertension, bilateral hematoma, preoperative hematoma size, midline shift, hematoma density, intraoperative irrigation, type of surgery and postoperative air collection, however, these results are inconsistent [7,[13][14][15][16][17][18][19]. The more controversial risk factors include surgery type and intraoperative irrigation [9,10,[20][21][22].…”

Effects of atorvastatin on chronic subdural hematoma

“…What is more, Wang et al [13] performed a prospective study showing that the hematomas of 5 CSDH patients with antiplatelet treatment disappeared, and several recent studies found that antiplatelet or anticoagulant medications were not related to hematoma growth or hematoma recurrence. [32–34] …”

“…[3–5] Previous studies have reported that corticosteroids, angiotensin converting enzyme inhibitors, tranexamic acid may be adjunctive to surgery, or even as a monotherapy for CSDH treatment. [2,6,7] Nonetheless, there are various surgical intervention and drug options for patients with CSDH, achieving a clinically efficient permanent cure is still far out of reach, and no explicit mechanism can explain this situation so far, we have known that high- and mixed-density of hematoma, leukemia, chronic renal failure, liver diseases are the risk factors for CSDH recurrence. [8] …”