Management of Recurrent Subdural Hematomas

Desai, Virendra R.; Scranton, Robert A.; Britz, Gavin W.

doi:10.1016/j.nec.2016.11.010

Cited by 31 publications

(21 citation statements)

References 55 publications

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“…Patient age, cognitive status, overall medical condition, radiological evolution (including the occurrence of multiple membranous subdural structures) and consideration of adjuvant medical therapy such as corticosteroids27 or atorvastatin,28 are other parameters generally considered before opting for a second surgery. Consequently, the indications for surgical removal of a recurrent, previously surgically evacuated CSDH remain subjective and may depend on individual or institutional practices 29 30…”

Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Derraz

Boetto

et al. 2019

J NeuroIntervent Surg

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BackgroundChronic subdural hematoma (CSDH) is a common condition requiring surgical treatment; however, recurrence occurs in 15% of cases at 1 year. Middle meningeal artery (MMA) embolization has recently emerged as a promising treatment to prevent CSDH recurrence.ObjectiveTo investigate the effect of MMA embolization on hematoma volume resorption (HVR) after surgery in symptomatic patients.MethodsFrom April 2018 to October 2018, participants with CSDH requiring surgery were prospectively randomized in a pilot study, and received either surgical treatment alone (ST group) or surgery and adjuvant MMA embolization (ST+MMAE group). The primary outcome was HVR measured on the 3 month CT scan compared with the immediate pre-embolization CT scan. Secondary outcomes were clinical recurrence of CSDH and safety measures.Results46 patients were randomized and 41 of these achieved a 3 month follow-up . Twenty-one patients received MMA embolization. At 3 months, the HVR from postsurgical level was higher in the ST+MMAE group (mean difference 17.5 mL, 95% CI 3.87 to 31.16 mL; p=0.015). Two participants presented a CSDH recurrence (one in each group). One patient died (ST group). No MMA embolization-related adverse events were reported.ConclusionThe addition of MMA embolization to surgery led to an increase in CSDH resorption at 3 months. One recurrence of CSDH was reported in each group, and there were no treatment-related complications.

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Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Derraz

Boetto

et al. 2019

J NeuroIntervent Surg

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“…The overall reoccurrence rate was 19% (22% and 13 18% in females and males respectively), with the median age of patients with the reoccurrence of 76 years, similar to previously published studies. [20][21][22] There was no statistically significant difference in the hematoma reoccurrence based on the patients' general characteristics. We noted hematoma reoccurrence in 5 patients operated in supine, and only one patient operated in sitting position.…”

Section: Discussionmentioning

confidence: 78%

“…Most common patient-related risk factors for the worse outcome of this procedure are chronic alcoholism, seizure disorders, and history of a ventriculoperitoneal shunt. [20,23] The impact of diabetes mellitus remains controversial. [23,24] Most studies suggest age, sex, hypertension, cardiac disease, and use of anticoagulants or antiplatelets do not affect the reoccurrence rate [23,25], but do influence the overall outcome.…”

Section: Risk Factors For Reoccurrencementioning

confidence: 99%

“…The impact of intraoperative irrigation and postoperative patient position (flat vs. upright) is controversial, although, some studies revealed no significant influence of postoperative patient posture on the hematoma reoccurrence. [20,22,28,29] Our surgical technique was uniform in both groups of patients and included burr-hole craniostomy, closed system drainage and irrigation with saline solution to achieve the best possible outcome in both groups of patients. [27]…”

Section: Risk Factors For Reoccurrencementioning

confidence: 99%

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Sitting position awake craniostomy with drainage for chronic subdural hematoma: A viable alternative?

et al. 2021

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Background / Aim. Chronic subdural hematoma (CSDH) is one of the most frequent neurosurgical conditions with an overall incidence ranging from 1.72 to 20.6 per 100,000persons per year. The surgical procedure for chronic subdural hematoma is relatively simple and usually performed in the supine position. Reported reoccurrence rates range from 11.7% to 28%. Postperative pneumocephalus was previously identified as a sole predictor of reoccurrence. This study evaluates the procedure in the sitting position and the possible impact on the reoccurrence rate. Methods. The study included 31 patients who underwent awake craniostomy with closed system drainage for chronic subdural hematoma (16 in supine and 15 in sitting position) in our department in the period from December 2016 to March 2018. Results. Twenty-two males and nine females were included in the study. The overall reoccurrence rate was 19% (22% and 18% in females and males respectively). The reoccurrence was noted in 5 patients who underwent surgery in the supine position, and in one case operated in sitting position. Our results revealed a lower reoccurrence rate in patients undergoing surgery in the sitting position, although not reaching statistical significance (OR: 0.18, CI: 0.01-1.42, p=0.172). Conclusion. Craniostomy in the sitting position under local anesthesia is a safe, simple, and reliable procedure for chronic subdural hematoma treatment. Apart from being very comfortable for the patient, according to our initial results, it might also lead to a lower reoccurrence rate, probably due to the better management of the air inflow, and consequential pneumocephalus. Apstrakt Uvod / Cilj. Hronični subduralni hematom je jedan od najčešćih neurohiruršklih entiteta sa ukupnom incidencom javljanja od 1,72 do 20,6 na 100 000 osoba godišnje. Hirurška procedura za lečenje CSDH je relativno jednostavna i obično se izvodi u ležećem položaju. Stopa recidiva iznosi od 11,7% do 28%. Postoperativni pneumocefalus se smatra 4 nezavisnim pojedinačnim prediktorom recidiva. Ova studija evaluira izvođenje procedure u sedećem položaju so eventualnim uticajem na stopu recidiva. Metode. Studija je obuhvatila 31 pacijenta kome je urađena kraniostomija sa zatvorenim sistemom za drenažu hroničnog subduralnog hematoma pod lokalnom anestezijom (16 u ležećem položaju na ledjima i 15 u sedećem), u periodu od decembra 2016., do maja 2018.godine. Rezultati. U studiju su bila uključena 22 muškarca i 9 žena. Ukupna stopa recidiva je iznosila 19% (22% kod žena i 18% kod muškaraca). Recidiv se javio kod 5 pacijenata operisanih u ležećem položaju i kod samo jedne pacijentkinje operisane u sedećem položaju. Naši rezultati su pokazali trend ređe pojave recidiva kod pacijenata operisanih u sedećem položaju, iako razlika u našoj grupi pacijenata nije statistički značajna (OR:0,18, CI:0,01-1,42, p=0,172). Zakljuĉak: Kraniostomija u sedećem položaju pod lokalnom anestezijom je sigurna, jednostavna i pouzdana procedura za lečenje hroničnog subduralnog hematoma. Pored toga što je veoma komforna za p...

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“…We initially considered that inadequate surgical technique and procedures related to hemostasis after the initial emergency surgery caused the hematoma. [ 11 18 ] However, postoperative hematoma appeared again as AEDH after cranioplasty. Hemorrhagic complications can recur despite sufficient hemostatic procedures during surgery.…”

Section: Discussionmentioning

confidence: 99%

Mild hemophilia a presaged by recurrent postoperative hemorrhagic complications in an elderly patient

Ono¹,

Sase²,

Takasuna³

et al. 2017

Surg Neurol Int

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Background:Mild hemophilia without spontaneous bleeding can remain undiagnosed for a lifetime. However, intracranial hemorrhage is one of the most serious complications for patients with hemophilia. In addition, hemorrhagic complications after emergency surgery tend to arise from coagulopathy.Case Description:An 80-year-old man was admitted with left hemiparesis and disturbed consciousness. He had no history of trauma, fever, or drug and alcohol intake. Computed tomography imaging upon admission disclosed a hemispheric subdural hematoma with a midline shift. No vascular abnormalities were identified as a source of the hemorrhage. The hematoma was removed on an emergency basis with external decompression. However, a large subcutaneous hematoma was again evident on the following day. Insufficient hemostatic maneuvers during surgery were considered the cause of this hemorrhagic complication. A second operation was performed to achieve hemostasis of the subcutaneous and muscle tissue. Thereafter, he was rehabilitated without treatment for hemophilia as he had no bleeding episodes. Cranioplasty proceeded using artificial bone at 40 days after the first operation. However, epidural hematoma developed again on postoperative day 1. His neurological status did not worsen so a repeat procedure was unnecessary. Close scrutiny uncovered a diagnosis of mild hemophilia A.Conclusions:Accurate diagnosis is important for the management of postoperative hemorrhagic complications caused by pathologies of the coagulation system. Sufficient hemostasis of hemorrhage from subcutaneous and muscle tissue is essential even during emergency surgery to avoid postoperative complications. A diagnosis of hemophilia should be considered in the face of prolonged activated partial thromboplastin time (APTT).

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Management of Recurrent Subdural Hematomas

Cited by 31 publications

References 55 publications

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Sitting position awake craniostomy with drainage for chronic subdural hematoma: A viable alternative?

Mild hemophilia a presaged by recurrent postoperative hemorrhagic complications in an elderly patient

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