Subdural Air Increases Postoperative Recurrence of Chronic Subdural Hematoma After Initial Burr-hole Surgery Only in the Very Elderly: A Pilot Study

Ito, Sayaka; Higuchi, Kazushi

doi:10.1016/j.wneu.2021.07.143

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…In the long-term follow-up, 5 children with ATSEH developed brain atrophy, and no patient experienced recurrence and intracranial infection. In a previously reported recurrence rate of 13% in adult patients, no associated complications were found after burr-hole craniotomy with continuous drainage [31]. Percutaneous subdural puncture for treatment of subdural effusion in children has a high recurrence rate (42-100%) [32,33].…”

Section: Discussionmentioning

confidence: 85%

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

Yang

Wang

2023

Preprint

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Purpose Acute traumatic subdural effusion with hemorrhage (ATSEH) is a common type of head trauma in children. However, there is considerable variation in the previous literature regarding the clinical presentation, pathogenesis, and treatment strategies of ATSEH in children. The purpose of this study was to summarize the clinical features of ATSEH in children as well as to explore their treatment strategies. Methods There were 79 cases of ATSEH studied retrospectively at a pediatric teaching hospital over an 7-year period. The children ranged in age from 1 month to 3 years, with an average age of 8.51(4.33,11.00) months. We analyzed the relationship between the outcome of ATSEH treatment and factors such as age, sex, symptoms, signs, coagulation function, internal environmental homeostasis, and imaging materials. The mean follow-up time was 57.56(34,82) months. The mRS score was used for patient prognosis. Results 27 out of 79 (34.2%) children showed subtle findings. Impaired consciousness was observed in 26.4% of patients. 52 out of 79 (65.8%) children presented with overt neurological symptoms and signs, with vomiting was t the most common symptom. 51 of 79 children (64.6%) presented with increased fontanelle tone. 32 out of 79 (40.51%) patients required operative management. 73 of the 79 patients (92.4%) had a good prognosis. The patients in the surgical group showed reduced fibrinogen (<1.5g/L) in 53.1%, low hemoglobin (88.56±17.21) and hyponatremia (133.50±3.76). Conclusions Patients with an age of 9.07(4.31,8.30) presenting with increased impairment of consciousness and increased anterior fontanelle tone are the basis for surgical treatment. Through the treatment of patients with ATSEH, we have found that the essence of ATSEH is an impairment of cerebrospinal fluid circulation triggered by subdural hemorrhage, which leads to acute hydrocephalus. In patients with ATSEH with malignant cranial hypertension, the timely subdural drainage is the key to treating and reducing serious complications. Prevention and correction of hypofibrinogen and hyponatremia are important aspects of the treatment of ATSEH in children that cannot be ignored.

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Section: Discussionmentioning

confidence: 85%

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

Yang

Wang

2023

Preprint

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“…[23,27] Inconsistent with our conclusion, Tang et al [22] analyzed 245 patients with CSDH and suggested that atorvastatin perioperative administration may reduce the risk of CSDH recurrence. There are many factors attributed to a high risk of recurrence, for example, senior age (>75 years), [28] preoperative hematoma thickness, [29] hematoma density, [17] hematoma volume , [30] postoperative subdural air , [31] and duration of subdural drainage postsurgery. [32] Elderly patients often have more comorbidities, increasing the risk of recurrence , [33] and a considerable proportion of them take anticoagulation or antiplatelet drugs in general, which may increase rebleeding .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of atorvastatin administration after surgery in patients with chronic subdural hematoma

Xu,

Tang,

Liu

et al. 2023

Medicine

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To explore the clinical efficacy of atorvastatin administration after surgery in patients with chronic subdural hematoma. We conducted a retrospective study to analyze the clinical data of patients with chronic subdural hematoma. Patients receiving atorvastatin treatment after surgery were divided into the study group while others were divided into the control group. As the primary outcome, we compared the hematoma recurrence rate. The secondary outcomes were the remaining volume of hematoma and the activities of daily living (Barthel index) score at 3 months after discharge. A total of 53 patients were included in the study: 30 patients in the study group (n = 30) and 23 patients in the control group (n = 23). The baseline clinical data were similar in the 2 groups (P > .05). Four patients had recurrence of hematoma in the study group, while 5 patients had recurrence of hematoma in the control group [4/30 (13.3%) versus 5/23 (21.7%), P = .661] at 3 months after discharge. The mean remaining volume of hematoma was 12.10 ± 8.80 mL in the study group and 17.30 ± 9.50 mL in the control group at 3 months after discharge, respectively. The remaining volume of hematoma in the study group was less than that in the control group (P = .045).The activities of daily living score in the study group were higher than those in the control group (97.83 ± 4.48 vs 94.78 ± 5.73, P = .034) at 3 months after discharge. Atorvastatin administration after surgery barely reduce the recurrence rate of chronic subdural hematoma, however, reduced the remaining volume of hematoma and improved neurological function.

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“…Kanazawa et al also report that postoperative hematoma volume and postoperative signifi cant residual air were identifi ed as independent risk factors for potential NASH recurrence (9). Many studies have confi rmed the signifi cant effect of postoperative pneumocephalus on the incidence of recurrence (9,14,25,28,31,33,34). However, no correlation between cerebral atrophy and PCV has been demonstrated (31).…”

Section: Discussionmentioning

confidence: 99%

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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Subdural Air Increases Postoperative Recurrence of Chronic Subdural Hematoma After Initial Burr-hole Surgery Only in the Very Elderly: A Pilot Study

Cited by 11 publications

References 14 publications

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

Efficacy of atorvastatin administration after surgery in patients with chronic subdural hematoma

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

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