Management of Chronic Subdural Hematoma: A Systematic Review and Component Network Meta-analysis of 455 Studies With 103 645 Cases

Henry, Jack; Amoo, Michael; Kissner, Malia; Deane, Thomas; Zilani, Gulam; Crockett, Matthew Thomas; Javadpour, Mohsen

doi:10.1227/neu.0000000000002144

Cited by 17 publications

(19 citation statements)

References 75 publications

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“…Initial management includes reversing anticoagulant/antiplatelet therapies and anti‐epileptic drugs 7 . Surgical intervention is advised in symptomatic cases with evidence of compression on imaging in SDH 7,11 . Also, placing a postoperative drain can decrease the risk of recurrence of chronic SDH 11 .…”

Section: Discussionmentioning

confidence: 99%

“… 7 Surgical intervention is advised in symptomatic cases with evidence of compression on imaging in SDH. 7 , 11 Also, placing a postoperative drain can decrease the risk of recurrence of chronic SDH. 11 Hence, as required in our case, we did a surgical evacuation of chronic SDH after EDH evacuation and placed a postoperative drain to reduce the recurrence of SDH.…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 11 Also, placing a postoperative drain can decrease the risk of recurrence of chronic SDH. 11 Hence, as required in our case, we did a surgical evacuation of chronic SDH after EDH evacuation and placed a postoperative drain to reduce the recurrence of SDH. The early surgical intervention in our patient led to rapid symptomatic improvement, and no symptoms were reported on monthly follow‐ups.…”

Section: Discussionmentioning

confidence: 99%

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Coexistence of ipsilateral acute‐on‐chronic subdural hematoma and acute extradural hematoma: A case report

Basit

Javed

Shahzad

et al. 2023

Clinical Case Reports

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Extradural hematomas (EDH) and subdural hematomas (SDH) are extra-axial hemorrhages. Acute EDH is often observed in young people after traumatic brain injury. 1 In contrast, chronic SDH is more commonly observed in elderly patients following minor or unperceived traumas. 1 Chronic SDH can be attributed to various factors, such as anticoagulants, antiplatelet drugs, chronic alcoholism, and intracranial hypotension. 2 Acute-on-chronic SDH may occur; however, the coexistence of ipsilateral EDH is rare. 3 Herein, we present the case of ipsilateral traumatic EDH and ipsilateral acute-on-chronic SDH in an elderly male. | CASE REPORTA 65-year-old male presented to the emergency with loss of consciousness following a road traffic accident. The patient was in the driving seat, not wearing a safety belt. The collision details and the exact timing of the injury could not be established. Personal history revealed arterial hypertension, for which the patient was taking amlodipine and valsartan, and ischemic heart disease, for which the patient was taking aspirin and clopidogrel. His personal history, family history, and psychosocial history were unremarkable.The Glasgow Coma Scale (GCS) score was 7 at the presentation, and a dilated left-sided pupil was observed. His vitals were a pulse rate of 58 per minute, blood pressure of 140/90 mm of Hg, and respiratory rate of 35 cycles per minute. A detailed neurological examination was not possible in the emergency setting.Immediate orotracheal intubation was done, two widebore intravenous lines were opened, and resuscitation was done with 0.9% normal saline. His blood investigations did not show any abnormalities. Coagulation profile tests were not done as the patient needed emergency surgery. Following this, we did an urgent computed tomography (CT) scan of the head, which revealed subdural hematoma,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Coexistence of ipsilateral acute‐on‐chronic subdural hematoma and acute extradural hematoma: A case report

Basit

Javed

Shahzad

et al. 2023

Clinical Case Reports

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“…However, neurosurgeons have disagreed on the best method for the surgical management of CSDH, varying a single burr hole with or without postoperative draining devices to multiple burr holes or extensive craniotomies [ 11 , 12 ]. Despite the type of surgical procedure, recurrences requiring re-operation have remained relatively high [ 13 – 15 ]. In the procedure described in the present report, the MMA is coagulated under direct inspection and divided before the dura mater is opened: it should follow that the risk of postoperative hemorrhagic complications should be less than that for routine burr hole evacuation.…”

Section: Discussionmentioning

confidence: 99%

Single Pterional Burr Hole Coupled with Coagulation of the Middle Meningeal Artery for Management of a Chronic Subdural Hematoma in a 98-Year-Old Patient: Illustrative Case

Cardoso

2023

Am J Case Rep

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Patient: Male, 98-year-old Final Diagnosis: Chronic subdural hematoma Symptoms: Headache and vomiting Clinical Procedure: Burr hole drainage Specialty: Neurosurgery Objective: Management of emergency care Background: Chronic subdural hematoma (CSDH) is more common in older people, for which burr-hole drainage is a standard procedure. Middle meningeal artery (MMA) embolization was first proposed as an adjuvant therapy to prevent recurrence after surgical evacuation of CSDH and subsequently as the primary treatment modality. Disadvantages of MMA embolization include expensive procedural price, increased radiation exposure, and additional labor. MMA embolization also has the disadvantages of slow clinical response and prolonged time for radiographic clearance. Case Report: A 98-year-old man presented with a symptomatic CSDH. A single pterional burr hole was placed over the origin of the calvarial portion of the MMA, thus allowing for the drainage of the CSDH and coagulation of the MMA. The procedure resulted in immediate cessation of symptoms, decrease of the hematoma size, disappearance of the hematoma at 4 weeks, and no recurrence. Conclusions: The location where the calvarial portion of the MMA leaves the outer sphenoid wing and enters the cranial vault can be reliably identified by means of external landmarks and confirmed by intraoperative fluoroscopy. Drainage of the CSDH and coagulation of the calvarial branch of the MMA can be achieved with a single procedure performed under local/conscious sedation. This report has shown that in cases of CSDH in the elderly, imaging is important to determine the optimum approach to hematoma drainage, which, in this case, required a pterional burr hole combined with MMA coagulation. This case report demonstrates feasibility of a novel procedure; further studies are needed to ascertain its usefulness.

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“…Surgical evacuation is not without disadvantages as it exposes these, often elderly and frail, patients to concomitant risk of complications such as post-operative intracranial haemorrhage, pneumocephaly, seizures, delirium and pneumonia (up to 15%) (6)(7)(8). Hematoma recurrence is another well-known complication that arises in the weeks following surgery in approximately 13% of patients (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Success of conservative therapy for chronic subdural hematoma patients: a systematic review

Foppen,

Bandral,

Slot

et al. 2023

Front. Neurol.

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BackgroundConservative therapy for chronic subdural hematoma (cSDH) is an option for patients who express no, or only mild symptoms, thereby preventing surgery in some. Because it is not clear for whom conservative therapy is successful, we aimed to estimate the success rate of conservative therapy and to identify which factors might influence success.MethodsWe systematically searched MEDLINE and EMBASE databases to identify all available publications reporting outcome of conservative therapy for cSDH patients. Studies containing >10 patients were included. The primary outcome was the success rate of conservative therapy, defined as “no crossover to surgery” during follow-up. In addition, factors possibly associated with success of conservative therapy were explored. Bias assessment was performed with the Newcastle Ottowa Scale and the Cochrane risk-of-bias tool. We calculated pooled incidence and mean estimates, along with their 95% confidence intervals (CIs), using OpenMeta[Analyst] software.ResultsThe search yielded 1,570 articles, of which 11 were included in this study, describing 1,019 conservatively treated patients. The pooled success rate of conservative therapy was 66% (95% CI: 50–82%). One study (n = 98) reported smaller hematoma volume to be associated with success, whilst another study (n = 53) reported low hematoma density and absence of paresis at diagnosis to be associated with success.ConclusionConservative therapy is reported to be successful in the majority of cSDH patients who have either no, or only mild symptoms. Hematoma volume, low hematoma density and absence of paresis could be factors associated with success. However, further research is warranted in order to establish factors consistently associated with a successful conservative therapy.OtherNo funding was acquired for this study. The study was not registered nor was a study protocol prepared.

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Management of Chronic Subdural Hematoma: A Systematic Review and Component Network Meta-analysis of 455 Studies With 103 645 Cases

Cited by 17 publications

References 75 publications

Coexistence of ipsilateral acute‐on‐chronic subdural hematoma and acute extradural hematoma: A case report

Coexistence of ipsilateral acute‐on‐chronic subdural hematoma and acute extradural hematoma: A case report

Single Pterional Burr Hole Coupled with Coagulation of the Middle Meningeal Artery for Management of a Chronic Subdural Hematoma in a 98-Year-Old Patient: Illustrative Case

Success of conservative therapy for chronic subdural hematoma patients: a systematic review

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