Predictors of re-operation in the setting of non-acute subdural hematomas: A 12-year single center retrospective study

Hulou, M. Maher; McLouth, Christopher J.; Hayden, Christopher; Sheldrake, Amy K.; Parekh, Mansi; Dillen, William L.; Wheeler, Greg R.; Fraser, Justin F.

doi:10.1016/j.jocn.2020.09.052

Cited by 10 publications

(6 citation statements)

References 28 publications

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“…Craniotomy was, however, reported to be a risk factor for a worse outcome and postoperative complications (15). Maher Hulou et al report a six-fold higher probability of recurrent NASH after craniotomy as compared to trepanation (12). Gender and age of patients in our cohort were not observed to be risk factors for recurrence rate.…”

Section: Discussioncontrasting

confidence: 49%

“…In particular, the separated type is most often described as a risk factor (3,14,19,23). The preoperative and postoperative fi ndings of hematoma hyperdensity are also considered to be a signifi cant risk factor for recurrence, as indicated by high recurrence rate of homogeneous hyperdense hematoma in our study (7,9,12,17,23,18,25).…”

Section: Discussionmentioning

confidence: 48%

“…The recurrence rate of NASH is reported to be in wide range of 2.3 to 33.0 % (3,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In our study, the overall rate of NASH recurrence requiring surgery reached 13.…”

Section: Discussionmentioning

confidence: 99%

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Non-acute subdural hematoma: estimation of recurrence using CT-volumetric measurements

Opšenák¹,

Hanko²,

Benčo³

et al. 2022

BLL

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OBJECTIVES: To identify risk factors for unilateral non-acute subdural hematomas NASH recurrence, as well as to perform volumetric quantitative analysis of hematoma, postoperative pneumocephalus and extent of hematoma evacuation. BACKGROUND: Recurrence of NASH increases morbidity and mortality and has negative socio-economic consequences. Its accurate prediction could improve patient specifi c care. METHODS: Records of 102 patients after unilateral NASH evacuation during the period from 2014 to 2020 with a 4-month follow-up were evaluated. Impacts of preoperative clinical signs and factors on the incidence of NASH recurrence were evaluated, namely those of age, gender, timing of surgery, hematoma side, surgical technique (number of burr holes, trepanation versus craniotomy), duration of drainage, antithrombotic agents, morphological type of hematoma, preoperative hematoma volume (PHV), post-evacuation hematoma cavity volume (PHCV), pneumocephalus volume (PCV) and extent of hematoma evacuation (EHE) on the incidence of NASH recurrence were evaluated. RESULTS: An overall recurrence rate of 13.7 % was observed. Preoperative hematoma volume, postoperative hematoma cavity volume and postoperative pneumocephalus volume had a signifi cant impact on incidence of recurrence. CONCLUSIONS: Pre-and postoperative volumetric evaluations, of patients with NASH, particularly the measurements of preoperative hematoma volume and postoperative volume of hematoma cavity and pneumocephalus have a potential to improve the prediction of clinically signifi cant recurrence (Tab. 6, Fig. 3, Ref. 51).

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 48%

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Non-acute subdural hematoma: estimation of recurrence using CT-volumetric measurements

Opšenák¹,

Hanko²,

Benčo³

et al. 2022

BLL

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“…Burr hole and twist drill craniostomy and craniotomy yield similar results in terms of their safety and efficacy [ 25 , 26 ]. In 10–30% of operated patients, a recurrence of CSDH occurs [ 27 , 28 ]. Additionally, with bilateral CSDH, the recurrence rate is even higher than that of unilateral CSDH [ 9 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

Angiogenetic Factors in Chronic Subdural Hematoma Development

et al. 2022

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The levels of angiogenic factors were analyzed in eight patients who underwent the embolization of chronic subdural hematoma (CSDH) with non-adhesive liquid embolic agents. Four of these patients had previously undergone surgical treatment for hematoma removal and had recurrences of a similar volume, and four had an increase in hematoma volume due to rebleeding. The levels of vascular endothelial growth factor (VEGF), matrix metallopeptidase 9 (MMP 9), angiopoietin-2 (Ang2), transforming growth factor beta 1 (TGF-β1) and platelet-derived growth factor BB (PDGF-BB) in the arterial and venous blood were analyzed. The most significant results were obtained from the peripheral venous blood samples. The levels of VEGF in the samples of all the patients were close to normal or slightly decreased. There was an increase in the MMP9 levels (the factor that contributes to the disintegration of the vessel wall components) in all the patients. The Ang2 and especially the PDGF TGF-β1 (the factor that plays an important role in the growth of the vessel wall from the already existing blood vessel tissue) levels were distinctly low in most of the cases and slightly elevated only in a number of patients who had previously been operated on. The results obtained show that there is an imbalance in the angiogenesis factors in patients with rebleeding CSDH. At the same time, the factors determining the formation of the vessel wall were reduced, and the levels of factors contributing to the degradation of extracellular matrix components were significantly increased. Such factors could help us to anticipate the increased risk of hemorrhages. Highlights: The levels of VEGF, MMP 9, Ang2, TGF-β1 and PDGF-BB in the arterial and venous blood were analyzed. The most significant results were obtained from the peripheral venous blood samples. The results obtained show that there is an imbalance in the angiogenesis factors in patients with rebleeding CSDH. Such a profile of factors could help us to anticipate the increased risk of hemorrhages.

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“…In 10–30% of the operated patients, recurrence of the CSDH will occur [ 10 ]. Craniotomy (instead of burr hole), postoperative blood in the operative field, and thrombocytopenia are associated with an increased likelihood of postoperative CSDH recurrence without embolization [ 11 ]. In bilateral CSDHs, the recurrence rate is even higher than in unilateral CSDH [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Chronic Subdural Hematomas through Embolization: A Pilot Study with a Non-Adhesive Liquid Embolic Agent of Minimal Viscosity (Squid)

Петров

Ivanov

Рожченко

et al. 2021

JCM

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Objective: Endovascular embolization using non-adhesive agents (e.g., ethylene vinyl alcohol copolymer with suspended micronized tantalum dissolved in dimethyl sulfoxide; Squid, Balt Extrusion) is an established treatment of brain arteriovenous malformations, dural arteriovenous fistulas, and hypervascular neoplasms. Middle meningeal artery (MMA) embolization is a relatively new concept for treating chronic subdural hematomas (CSDH). This study aimed to evaluate the safety and effectiveness of the use of Squid in the endovascular treatment of CSDH. Methods: Embolization was offered to patients with CSDH with minimal or moderate neurological deficits and patients who had previously undergone open surgery to evacuate their CSDH without a significant effect. Distal catheterization of the MMA was followed by embolization of the hematoma capsule with Squid 12 or Squid 18. Safety endpoints were ischemic or hemorrhagic stroke and any other adverse event of the endovascular procedure. Efficacy endpoints were the feasibility of the intended procedure and a ≥ 50% reduction of the maximum depth of the CSDH confirmed by follow-up computed tomography (CT) after >3 months. Results: Between November 2019 and July 2021, 10 patients (3 female and 7 male, age range 42–89 years) were enrolled. Five patients had bilateral hematomas, and five patients had previously been operated on with no significant effect and recurrent hematoma formation. The attempted embolization was technically possible in all patients. No technical or clinical complication was encountered. During a post-procedural follow-up (median 90 days), 10 patients improved clinically. A complete resolution of the CSDH was observed in 10 patients. The clinical condition of all enrolled patients during the so-far last contact was rated mRS 0 or 1. Conclusion: A distal catheterization of the MMA for the endovascular embolization of CSDH with Squid allowed for the devascularization of the MMA and the dependent vessels of the hematoma capsule. This procedure resulted in a partial or complete resolution of the CSDH. Procedural complications were not encountered.

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Predictors of re-operation in the setting of non-acute subdural hematomas: A 12-year single center retrospective study

Cited by 10 publications

References 28 publications

Non-acute subdural hematoma: estimation of recurrence using CT-volumetric measurements

Non-acute subdural hematoma: estimation of recurrence using CT-volumetric measurements

Angiogenetic Factors in Chronic Subdural Hematoma Development

Endovascular Treatment of Chronic Subdural Hematomas through Embolization: A Pilot Study with a Non-Adhesive Liquid Embolic Agent of Minimal Viscosity (Squid)

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