The Danish Chronic Subdural Hematoma Study—Risk Factors for Second Recurrence

Jensen, T. S.; Andersen-Ranberg, Nina Christine; Poulsen, Frantz Rom; Bergholt, Bo; Hundsholt, Torben; Fugleholm, Kåre

doi:10.1016/j.wneu.2022.09.072

Cited by 8 publications

(4 citation statements)

References 27 publications

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“…The identification of a risk profile for recurrent CSDH holds substantial clinical potential, as it may lead to personalized treatment of the sub-cohort of CSDH patients in increased recurrence risk, while avoiding overtreatment of the entire CSDH population. Several studies on risk factors have been published, but the focus has largely been on patient characteristics [ 41 , 42 ]. CSDH recurrence may be driven by a higher level of angiogenetic, fibrinolytic, and/or inflammatory involvement.…”

Section: Discussionmentioning

confidence: 99%

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Urokinase Plasminogen Activator Receptor: An Important Focal Player in Chronic Subdural Hematoma?

Jensen,

Olsen,

Lelkaitis

et al. 2024

Inflammation

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Chronic subdural hematoma (CSDH) development involves inflammatory, angiogenetic, and fibrinolytic mechanisms, several components of which are now unraveled through intensive research. The urokinase plasminogen activator receptor (uPAR) is part of the plasminogen activator system and possesses inflammatory, angiogenetic, and fibrinolytic capabilities. As a first, this study aims to identify uPAR in the hematoma fluid, hematoma membrane, dura mater, and systemic blood from patients with CSDH and, if present, to investigate if the uPAR level at the time of surgery may be a predictor for later developing recurrent CSDH. uPAR expression in the hematoma membrane and dura mater was analyzed using immunohistochemistry and presented as the H-score of the positive immunostaining. The uPAR levels in the hematoma fluid and systemic blood were determined using a multiplex antibody bead kit (Luminex). Samples were collected at the time of the first CSDH surgery, and in the case of recurrent CSDH within 90 days, the samples were again collected at reoperation. A comparison of uPAR expression between the hematoma membrane and dura mater, as well as uPAR levels in systemic blood and hematoma fluid, was performed using the Wilcoxon rank sum test. We included 112 patients, 26 of whom had recurrent CSDH. The median hematoma uPAR level was 22,125 (14,845–33,237) and significantly higher than the median systemic blood level of 789 pg/L (465–2,088) (p < 0.001). Similarly, the uPAR level of the hematoma membrane was 14.3 (7.54–44.8) and significantly higher than the dural uPAR level of 0.81 (0.3–1.98) (p < 0.001). For the first time, we identified uPAR in the subdural fluid, hematoma membrane, dura mater, and systemic blood from patients with CSDH. The high expression of uPAR in the subdural fluid and hematoma membrane indicates that the mechanisms of CSDH are predominantly in the subdural fluid collection and surrounding hematoma membrane.

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Section: Discussionmentioning

confidence: 99%

“…This study has several limitations. First, multiple factors may cause an inflammatory response, including hypertension, chronic alcohol abuse, hepatic diseases, renal insufficiency, diabetes mellitus, and several others [ 41 , 42 , 46 – 50 ]. These factors may theoretically elevate uPAR levels.…”

Section: Discussionmentioning

confidence: 99%

Urokinase Plasminogen Activator Receptor: An Important Focal Player in Chronic Subdural Hematoma?

Jensen,

Olsen,

Lelkaitis

et al. 2024

Inflammation

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“…The selection between a single burr hole vs multiple burr holes during hematoma evacuation often rests on surgeon preference, institutional protocols, and perceived clinical outcomes. The "Danish protocol," 6 as practiced in our center, stipulates the use of a single burr hole for CSDH evacuation. This approach aims to achieve optimal hematoma clearance while minimizing potential complications associated with multiple cranial perforations.…”

Section: Discussionmentioning

confidence: 99%

“…Local anesthesia, often with light intravenous sedation, was preferred, but general anesthesia could be used in cases of poor patient cooperation or at the discretion of the neurosurgeon or neuroanesthesiologist. According to the Danish CSDH treatment guidelines, 6 patients with passive open drainage are allowed to mobilize immediately after surgery.…”

Section: Methods Study Designmentioning

confidence: 99%

Intraoperative Irrigation and Risk of Chronic Subdural Hematoma Recurrence

Schack,

Rønn Jensen,

Jensen

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: In most neurosurgical centers, irrigation is an essential part of the surgical procedure for chronic subdural hematoma (CSDH). However, it is unknown whether the volume of irrigation fluid affects the risk of CSDH recurrence. This study aimed to investigate a potential association between the volume of irrigation fluid used during burr hole evacuation of CSDH and the risk of CSDH recurrence. METHODS: This study is a subanalysis of 2 randomized trials (Drain Time & Drain Time 2) designed to investigate the effect of drainage duration on the recurrence of CSDH. Intraoperative irrigation volume was measured, and patients were followed for 90 days for recurrent CSDH. RESULTS: A total of 525 patients with CSDH were included. There was no significant difference in the volume of irrigation fluid used between patients with recurrence (mean = 938 mL, SD = ±552) and without recurrence (mean = 852 mL, SD = ±454) (P-value = .15). Patients with recurrent CSDH had larger primary CSDH volumes (mean = 134 cm3, SD = ±69) than patients without recurrence (mean = 119 cm3, SD = ±58) (P = .04). Multiple logistic regression analysis revealed no association between irrigation volume and recurrence, also when stratified for hematoma size. CONCLUSION: There was no significant association between irrigation volume and recurrent CSDH within 90 days in patients undergoing burr hole surgery for CSDH.

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