Follow-up Computed Tomography after Evacuation of Chronic Subdural Hematoma

Schucht, Philippe; Fischer, Urs; Fung, Christian; Bernasconi, Corrado; Fichtner, Jens; Vulcu, Sonja; Schöni, Daniel; Nowacki, Andreas; Wanderer, Stefan; Eisenring, Christian; Krähenbühl, Anna Katharina; Mattle, Heinrich; Arnold, Marcel; Söll, Nicole; Tochtermann, Lucas; Z'Graggen, Werner Josef; Jünger, Stefanie T; Gralla, Jan; Mordasini, Pasquale; Dahlweid, Fried-Michael; Raabe, Andreas; Beck, Jürgen

doi:10.1056/nejmc1812507

Cited by 60 publications

(41 citation statements)

References 5 publications

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“…Typically, most patients were sent to their local hospital the day after surgery. We do not routinely perform a postoperative CT scan at our department prior to discharge, except in the absence of improvement after surgery [11]. This policy was similar in both time periods.…”

Section: Postoperative Managementmentioning

confidence: 99%

The influence of irrigation fluid temperature on recurrence in the evacuation of chronic subdural hematoma

2019

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Background Chronic subdural hematomas (cSDH) are one of the most common conditions requiring neurosurgical treatment. The reported recurrence after surgery is 3-21.5% with closed system drainage. In clinical practice, irrigation fluids at body temperature (37°C) and at room temperature (22°C) are routinely used in the evacuation of cSDH. Our hypothesis was that irrigation at body temperature might have more beneficial effects on coagulation and solubility of the chronic subdural hematoma than irrigation at room temperature. The aim of this study was to compare the effects of different intraoperative irrigation fluid temperatures on recurrence rates. Methods This was a retrospective study where we included all consecutive patients from a defined geographical area of western Sweden between September 2013 and November 2014. In the course of 6 months, we performed intraoperative irrigation at body temperature (37°C, BT-group) during burr hole evacuation of chronic subdural hematoma. This was then compared with the previous 6-month period, when irrigation fluid at room temperature (22°C, RT-group) was used. The primary endpoint was same-sided recurrence in need of reoperation within 6 months. Results Recurrence occurred in 11 of 84 (13.1%) patients in the RT-group compared with 4 of 88 (4.5%) in the BT-group (p = 0.013). There were no significant between-group differences regarding age, sex, duration of surgery, frequency of bilateral hematomas, hematoma density, and use of anticoagulant/antithrombotic therapy. Conclusion Our study demonstrates that intraoperative irrigation fluid at body temperature is associated with lower recurrence rates compared with irrigation fluid at room temperature. To investigate this further, a prospective randomized controlled trial has been initiated (clinicaltrials.gov, NCT0275235). Trial registration ClinicalTrials.gov Identifier: NCT0275235

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Section: Postoperative Managementmentioning

confidence: 99%

The influence of irrigation fluid temperature on recurrence in the evacuation of chronic subdural hematoma

2019

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“…Consequently, there is a growing healthcare burden related to CSDH. Only a few studies have described the financial impact of CSDH [12,13,35].…”

Section: Introductionmentioning

confidence: 99%

Chronic subdural hematoma—incidence, complications, and financial impact

et al. 2020

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Objective To examine the population-based incidence, complications, and total, direct hospital costs of chronic subdural hematoma (CSDH) treatment in a neurosurgical clinic during a 26-year period. The aim was also to estimate the necessity of planned postoperative follow-up computed tomography (CT). Methods A retrospective cohort (1990-2015) of adult patients living in Pirkanmaa, Finland, with a CSDH was identified using ICD codes and verified by medical records (n = 1148, median age = 76 years, men = 65%). Data collection was performed from medical records. To estimate the total, direct hospital costs, all costs from hospital admission until the last neurosurgical followup visit were calculated. All patients were followed until death or the end of 2017. The annual number of inhabitants in the Pirkanmaa Region was obtained from the Statistics Finland (Helsinki, Finland). Results The incidence of CSDH among the population 80 years or older has increased among both operatively (from 36.6 to 91/ 100,000/year) and non-operatively (from 4.7 to 36.9/100,000/year) treated cases. Eighty-five percent (n = 978) underwent surgery. Routine 4-6 weeks' postoperative follow-up CT increased the number of re-operations by 18% (n = 49). Most of the re-operations (92%) took place within 2 months from the primary operation. Patients undergoing re-operations suffered more often from seizures (10%, n = 28 vs 3.9%, n = 27; p < 0.001), empyema (4.3%, n = 12 vs 1.1%, n = 8; p = 0.002), and pneumonia (4.7%, n = 13 vs 1.4%, n = 12; p = 0.008) compared with patients with no recurrence. The treatment cost for recurrent CSDHs was 132% higher than the treatment cost of non-recurrent CSDHs, most likely because of longer hospital stay for re-admissions and more frequent outpatient follow-up with CT. The oldest group of patients, 80 years or older, was not more expensive than the others, nor did this group have more frequent complications, besides pneumonia. Conclusions Based on our population-based study, the number of CSDH patients has increased markedly during the study period (1990-2015). Reducing recurrences is crucial for reducing both complications and costs. Greater age was not associated with greater hospital costs related to CSDH. A 2-month follow-up period after CSDH seems sufficient for most, and CT controls are advocated only for symptomatic patients.

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“…There were also no follow-up statistics and analyses of other information such as long-term follow-up CT after surgery and mortality. 27…”

Section: Discussionmentioning

confidence: 99%

“…2 Compression of the brain parenchyma and intracranial hypertension can be caused by incremental hematoma, which may result in clinical symptoms such as motor disturbance, gait abnormality, headache, cognitive disturbance, and aphasia. 4 In general, CSDH is classified into four groups according to computed tomography (CT) density: low density (<25 HU), isodensity (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), hyperdensity (>35 HU), and mixed density. 5 If patients undergo head trauma more than once or if septa exist in the subdural cavity, the CT density may become mixed.…”

Section: Introductionmentioning

confidence: 99%

Neuroendoscopy-Assisted Evacuation of Chronic Subdural Hematoma with Mixed CT Density Through A Novel Small Bone Flap

Huang

Liu

Zhou³

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objective Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence and favorable prognosis. Surgery is the standard treatment for CSDH, and bur hole evacuation is the most widely employed technique. However, if mixed computed tomography (CT) density is found, burr hole hematoma evacuation is prone to recurrence. Endoscopic examination of the hematoma cavity provides a novel strategy. Here, we present a modification of burr hole evacuation by using neuroendoscopy through a novel small trapezoid bone flap and assess the advantages and risks of the procedure. Methods Twenty-five patients diagnosed with CSDH of mixed CT density were included in this study. Radiographic, epidemiologic, and clinical data were collected and analyzed. In all procedures the burr hole was replaced by a small trapezoidal cross-sectional bone flap, ∼2 cm in diameter. Neuroendoscopy was employed after the subdural cavity was cleaned and drained. The CSDH cavity was inspected thoroughly. If a blood clot, septa, stretching of cortical vessels, or intraluminal trabecular structures with active bleeding were found, the surgeon aspirated the region with a syringe pipe and/or used bipolar electrocoagulation. Results All 25 patients who received 26 neuroendoscopy-assisted operations achieved favorable clinical outcomes. The recurrence rate was 4%. The average operation time was slightly increased compared with the traditional burr hole evacuation due to the use of the neuroendoscope and eventual subsequent treatment. Conclusion Neuroendoscopy provides excellent illumination and vision when a small bone flap is employed. The main advantages of this technique include the precise treatment of structures which are related with progression and recurrence of CSDH, and the minimally invasive nature of the procedure.

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Follow-up Computed Tomography after Evacuation of Chronic Subdural Hematoma

Cited by 60 publications

References 5 publications

The influence of irrigation fluid temperature on recurrence in the evacuation of chronic subdural hematoma

The influence of irrigation fluid temperature on recurrence in the evacuation of chronic subdural hematoma

Chronic subdural hematoma—incidence, complications, and financial impact

Neuroendoscopy-Assisted Evacuation of Chronic Subdural Hematoma with Mixed CT Density Through A Novel Small Bone Flap

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