Surgical Treatment Options for Chronic Subdural Haematoma

Siddique, Attiya Nasir; Khan, Shahbaz Ali; Khan, Abdul Aziz; Aurangzeb, Ahsan

doi:10.55519/jamc-03-10225

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…It was noted that 75.7% of subjects were male and 24.3% were female, and the male-to-female ratio was almost 3:1. Siddique, M. et al found the male-to-female predominance was greater than 2.6:1, which closely resembled the study (12).…”

Section: Discussionsupporting

confidence: 70%

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

Sultana,

Hossain,

Sultana

et al. 2024

Bangladesh J. Nuclear Med.

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Objectives: Pelviureteric junction (PUJ) obstruction is the most common congenital abnormality of urinary tract and accounts for about 80% cases. 99mTc-DTPA renography with diuretic challenge helps to distinguish obstructive hydronephrosis from non-obstructive calyceal dilatation and also allows the surgeons to select cases for surgical intervention. This study aims to compare and evaluate the surgical outcomes of PUJ obstructive patients by 99mTc-DTPA renography. Patients and Methods: This prospective, longitudinal study was carried out at the Institute of Nuclear Medicine & Allied Sciences (INMAS), Dhaka, during July 2016 to June 2017 and 99mTc-DTPA renography was done in diagnosed cases of PUJ obstruction (diagnosed by ultrasonography and intravenous urography) before and 3 months after Anderson Hynes (A-H) pyeloplasty. Static renal imaging was also done after 1 and 2 hours after the dynamic acquisition to compare the pre and postoperative anatomical findings. The study included a total of 70 patients with PUJ obstruction before and after A-H pyeloplasty. Patients with GFR < 10 ml/min, serum creatinine level > 3 mg/dl and pregnancy were excluded. Result: In this study, 70 (100%) of the preoperative patients had obstructive uropathy. Following surgery, 31 patients (44.3%) had obstructive uropathy, 22 patients (31.4%) had partial obstruction, and 17 patients (24.3%) had functional obstruction. Before surgery, the individuals’ mean differential renal function (%) was 38.7 ± 8.2, and after surgery, it was 41 ± 9.8. In preoperative subjects, the mean glomerular filtration rate (ml/min) was 42.1 ± 9.1, while in postoperative ones, it was 46.2 ± 10.8. In preoperative subjects, the mean total glomerular filtration rate (ml/min) was 92.1 + 8.9, while in postoperative ones, it was 95.5 ± 10.4. The pre- and postoperative DTPA renography results differed in a statistically significant way (p < 0.05). Before surgery, the patients had a mean serum creatinine (mg/dl) of 1.3 ± 0.4, and after surgery, it was 1.2 ± 0.4. The pre- and postoperative differences were not statistically significant (p > 0.05). Static images of the DTPA renogram acquired one and two hours in post pyeloplasty patients revealed the characteristics of obstruction. Three months after the pyeloplasty, 23 (32.9%) of the participants had stable renal function, 36 (51.4%) had improved renal function, and the remaining 11 (15.7%) had worsened renal function in 99mTc-DTPA renogram. Conclusion: Most of the study subjects showed improved renal parenchymal function and glomerular filtration rate (GFR) in post pyeloplasty 99mTc-DTPA renograms at 3 months. Routine 99mTc-DTPA renogram of all the patients with PUJ obstruction before and after the pyeloplasty might be beneficial for further management as it is a simple, non-invasive, cost-effective technique with low radiation exposure. Bangladesh J. Nuclear Med. 27(1): 16-20 , 2024

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Section: Discussionsupporting

confidence: 70%

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

Sultana,

Hossain,

Sultana

et al. 2024

Bangladesh J. Nuclear Med.

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“…Another study proposed that extended preoperative administration of corticosteroids was linked to a decreased recurrence rate in the surgical management of chronic subdural hematoma (CSH) using burr-hole craniotomy [ 25 ]. According to another study, the administration of postoperative corticosteroids has been shown to be efficacious in mitigating disease recurrence among patients [ 26 - 28 ]. The administration of dexamethasone resulted in a reduction of subdural dimensions during the postoperative period, specifically in the second week, as observed in our study.…”

Section: Discussionmentioning

confidence: 99%

The Use of Adjuvant Dexamethasone in Chronic Subdural Hematoma After Surgery

Cine

2023

Cureus

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Objective: The use of oral anticoagulants in elderly patients is a predisposing factor in developing a subdural hematoma (SDH). The surgical option is often the standard approach but can be accompanied by complications. In this study, we hypothesized that dexamethasone administration after surgery would positively affect subdural change and subdural size in the second week. Materials and methods: Within the scope of this prospective research, 66 individuals who underwent surgical intervention for chronic subdural hematoma (CSH) at the neurosurgery department either as an outpatient or under emergency circumstances have been enrolled in the study. During the examination, the patients were questioned about the traumatic incident, the localization of injury, and the utilization of anticoagulant and antiplatelet medications. The Glasgow Coma Scale (GCS) was administered to all patients to assess neurological deficits. Computed tomography (CT) was utilized to determine the characteristics of the hematoma. Results: A total of 66 patients, 22 (33.3%) using and 44 (66.6%) not using dexamethasone, were included in the study. Analysis of variance (ANOVA) indicated that a statistical difference was achieved in the second week after the operation (p<0.043). During the examination of subdural dimensions after the operation and in the second postoperative week, a difference was detected between the radiological membrane and subdural dimensions. A statistically significant correlation was found between anticoagulation and the type of hematoma (p<0.025). Conclusion: Regarding the outcomes of this research, we can conclude that dexamethasone was not associated with any adverse events. Additionally, dexamethasone could leverage reoperation prevention for the elderly with various comorbidities.

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“…(6) The aforementioned outcomes are specific to the initial treatment of CSDH and may not be applicable for recurrent CSDH. Currently, craniotomy is recommended for recurrent CSDH (47,58,59). However, further studies are still needed.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different surgical techniques for chronic subdural hematoma: a network meta-analysis

et al. 2023

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BackgroundChronic subdural hematoma (CSDH) is a neurosurgical condition with high prevalence. Many surgical approaches are recommended for treating CSDH, but there needs to be a consensus on the optimal technique. This network meta-analysis (NMA) compared the efficacy and safety of different surgical treatments for CSDH.MethodsElectronic databases, including PubMed, Embase, and the Cochrane Library, were searched for relevant studies up to February 2023. An NMA was performed to compare the outcomes of patients with CSDH treated by single-hole or double-hole craniotomy (SBHC and DBHC, respectively), twist-drill craniotomy (TDC), mini-craniotomy, and craniotomy. The NMA protocol was registered at INPLASY (registration no. 202320114).ResultsThe NMA included 38 studies with 7,337 patients. For efficacy outcomes, DBHC showed the highest surface under the cumulative ranking area (SUCRA) values for recurrence (96.3%) and reoperation (87.4%) rates. DBHC differed significantly from mini-craniotomy in recurrence rate (odds ratio [OR] = 0.58, 95% confidence interval [CI]: 0.35, 0.97) and from SBHC (OR = 0.48, 95% CI: 0.25, 0.91) and TDC (OR = 0.40, 95% CI: 0.20, 0.82) in reoperation rate. For operative time, TDC was superior to SBHC (mean difference [MD] = −2.32, 95% CI: −3.78 to −0.86), DBHC (MD = −3.61, 95% CI: −5.55, −1.67), and mini-craniotomy (MD = −3.39, 95% CI: −5.70, −1.08). Patients treated by TDC had a shorter hospital stay than those treated by SBHC (MD = −0.82, 95% CI: −1.51, −0.12). For safety outcomes, there were no significant differences between groups in mortality and complication rates; however, mini-craniotomy (79.8%) and TDC (78.1%) had the highest SUCRAs.ConclusionDBHC may be the most effective surgical treatment for CSDH based on the low recurrence and reoperation rates, although all examined techniques were relatively safe.Systematic review registrationhttps://inplasy.com/inplasy-2023-2-0114/

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Surgical Treatment Options for Chronic Subdural Haematoma

Cited by 4 publications

References 26 publications

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

The Use of Adjuvant Dexamethasone in Chronic Subdural Hematoma After Surgery

Comparison of different surgical techniques for chronic subdural hematoma: a network meta-analysis

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