Outcomes and recurrence rates in chronic subdural haematoma

Amirjamshidi, Abbass; Abouzari, Mehdi; Eftekhar, Behzad; Rashidi, Armin; Rezaii, Jalal; Esfandiari, Khalil; Shirani, AM; Asadollahi, Marjan; Aleali, Hamideh

doi:10.1080/02688690701272232

Cited by 97 publications

(86 citation statements)

References 27 publications

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“…Among the recurrent group, the one with a width greater than 2 cm was significantly higher than that of below 2 cm (p < 0.05). However, in agreement with a previous reports 2,19) , hematoma thickness on the preoperative imaging studies were found not to affect postoperative recurrence rate significantly in this study.…”

Section: Related Factors For Recurrencesupporting

confidence: 82%

“…However, the results reported have sometimes been inconsistent 1,2,13,19,24) . Some authors have regarded older age is one of the risk factors of CSDH recurrence, while other do not agree 7) .…”

Section: Related Factors For Recurrencementioning

confidence: 99%

“…Amirjamshidi et al 2) reported that the persistence of the postoperative subdural cavity is a risk factor for reaccumulation of the hematoma and the presence of postoperative residual air prevents reduction of the cavity. Oishi et al 15) demonstrated irrigation should be avoided to prevent complications caused by a sudden decrease in intracranial pressure and intraoperative invasion.…”

Section: One Vs Two Burr Holesmentioning

confidence: 99%

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One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma

Han

Park

Kim

et al. 2009

J Korean Neurosurg Soc

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Objective : Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH. Methods : From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre-and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge. Results : Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p > 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates. Conclusion :In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.

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Section: Related Factors For Recurrencesupporting

confidence: 82%

Section: Related Factors For Recurrencementioning

confidence: 99%

Section: One Vs Two Burr Holesmentioning

confidence: 99%

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One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma

Han

Park

Kim

et al. 2009

J Korean Neurosurg Soc

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“…Under 3% of all the referred patients in this cohort were in coma (GCS ≤ 8), which is similar to a Scandinavian population-based cohort [17]. Other studies based in Iran [16] and India [7] reported a much higher proportion of comatose patients (10 and 14% respectively), presumably reflecting variations in referral practices. We found that comatose patients had worse functional outcome at discharge and higher mortality risk compared to non-comatose patients.…”

Section: Discussionsupporting

confidence: 54%

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Christopher

Poon²,

Glancz

et al. 2018

Neurosurg Rev

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Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and noncomatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.

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“…It is a common disease in the elderly (1,2). Its incidence increases gradually from 1 to 8.2 per 100.000 cases, each year in the sixth and seventh decades of life (3)(4)(5)(6)(7). The disease will be more frequent in coming years with increase of life expectancy (8,9).…”

Section: Background and Importancementioning

confidence: 99%

Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases

Bakhti

Tighilt

Djennas

2016

IrJNS

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Background & Importance: Chronic subdural hematoma (CSH) is one of the most frequent intracranial hemorrhages in adults. However, gold standard treatment of CSH is not yet defined. Since the 80's, closed drainage is a standard among techniques using drains because the open type has been incriminated in high rates of postoperative infections. However, closed drainage requires materiel which is sometimes not available or expensive in some countries. Open drainage was reintroduced in our department in the middle of the 90's because of economic crisis at this time. We have then conducted a prospective study to assess safety and efficacy of open drainage in treatment of CSH.Case Presentation: A prospective study of adult patients with CSH was conducted from January 2008 to December 2011. All patients have the same surgical procedure which included one burr-hole craniostomy, spontaneous evacuation and open drainage. The study focused on infectious complications, postoperative seizures, and recurrences. Results are compared with those of literature. In our study, 189 patients were operated with mean age of 69.2 years old. Of all, 163 patients were cured. Overall rate of complications was 15.34% with an infection rate of 1.58%, a postoperative seizure rate of 1.05% and a recurrence rate of 14.2%. Mortality rate was 5.8%. Results were in concordance with those of large series of literature. Conclusion:Data of the current study suggested that open drainage is a safe and efficient method in treatment of CSH. It is also a costefficient treatment that could be very interesting for middle-and low-income countries. Keywords AbstractBackground and Importance

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Outcomes and recurrence rates in chronic subdural haematoma

Cited by 97 publications

References 27 publications

One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma

One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases

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