Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence

Baé, Marcos Escosa; Wessling, H.; Salca, Horia Calin; Echeverría, Pedro de las Heras

doi:10.1007/s00701-010-0903-3

Cited by 40 publications

(16 citation statements)

References 35 publications

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“…We found that the preoperative haematoma volume was a predictor of postoperative recurrence. Additionally, we found that the prognosis of no-recurrence was very high (94.4 %) in our cohort if the preoperative haematoma volume was under 115 ml, consistent with a general consideration that patients with large CSDH are at increased risk for the recurrence [10, 16, 24, 29]. Increased size of haematoma is attributed to brain atrophy associated with ageing, which may provide the CSDH with a potential space in which to grow [30].…”

Section: Discussionsupporting

confidence: 86%

“…Numerous CT scan characteristics traditionally related to recurrence of CSDH have been reported and extensively discussed in the literature. These included bilateral site of CSDH [2–9], preoperative and postoperative haematoma width determined at the level of its maximum in-plane thickness [7, 8, 10–14], preoperative and postoperative maximum midline displacement [2, 7, 8, 10–12], haematoma densities [2, 4, 8, 13, 15–21], brain atrophy [19, 22–24], intracranial extension [17], enhancement and thickness of inner membrane of CSDH [25, 26], postoperative presence of residual air accumulation in the CSDH cavity [4, 7–9, 19, 27] and postoperative persistence of residual CSDH space [4, 9, 12, 27]. However, the findings are not consistent between the studies.…”

Section: Introductionmentioning

confidence: 99%

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Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients

et al. 2012

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BackgroundChronic subdural haematoma (CSDH) is a common entity in neurosurgery with a considerable postoperative recurrence rate. Computerised tomography (CT) scanning remains the most important diagnostic test for this disorder. The aim of this study was to characterise the relationship between the recurrence of CSDH after treatment with burr-hole irrigation and closed-system drainage technique and CT scan features of these lesions to assess whether CT findings can be used to predict recurrence.MethodsWe investigated preoperative and postoperative CT scan features and recurrence rate of 107 consecutive adult surgical cases of CSDH and assessed any relationship with univariate and multivariate regression analyses.ResultsSeventeen patients (15.9 %) experienced recurrence of CSDH. The preoperative haematoma volume, the isodense, hyperdense, laminar and separated CT densities and the residual total haematoma cavity volume on the 1st postoperative day after removal of the drainage were identified as radiological predictors of recurrence. If the preoperative haematoma volume was under 115 ml and the residual total haematoma cavity volume postoperatively was under 80 ml, the probability of no recurrence was very high (94.4 % and 97.4 % respectively).ConclusionsThese findings from CT imaging may help to identify patients at risk for postoperative recurrence.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients

et al. 2012

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“…[ 98 ] The results of TDC in terms of recurrence rates, morbidity, and mortality, are the same as compared to burr-hole craniostomy. [ 99 100 ]…”

Section: Twist Drill Craniostomymentioning

confidence: 99%

Chronic subdural hematoma

et al. 2016

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Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule. Contrast-enhanced CT or MRI could detect associated primary or metastatic dural diseases. Although definite history of trauma could be obtained in a majority of cases, some cases may be secondary to coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., Recurrent bleeding, increased exudates from outer membrane, and cerebrospinal fluid entrapment have been implicated in the enlargement of CSDH. Burr-hole evacuation is the treatment of choice for an uncomplicated CSDH. Most of the recent trials favor the use of drain to reduce recurrence rate. Craniotomy and twist drill craniostomy also play a role in the management. Dural biopsy should be taken, especially in recurrence and thick outer membrane. Nonsurgical management is reserved for asymptomatic or high operative risk patients. The steroids and angiotensin converting enzyme inhibitors may also play a role in the management. Single management strategy is not appropriate for all the cases of CSDH. Better understanding of the nature of the pathology, rational selection of an ideal treatment strategy for an individual patient, and identification of the merits and limitations of different surgical techniques could help in improving the prognosis.

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“…These included bilateral site of CSDH, preoperative and postoperative haematoma thickness or volume, preoperative and postoperative midline shift, haematoma densities, postoperative presence of air in the CSDH cavity, and postoperative persistence of residual CSDH space. [18,27,28] However, the influence of these CT features on outcome was not consistent between studies.…”

Section: Relationship Between Csdh's Rrr and Ct Characteristicsmentioning

confidence: 95%

Recurrence of Chronic Subdural Hematomas Requiring Reoperation: Could Small Trephination Be a Valid Alternative to Conventional Approaches?

Adam¹,

Iftimie²,

Moisescu³

2018

Romanian Neurosurgery

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Background: Chronic subdural hematomas (CSDHs) are one of the most common intracranial lesions treated in a neurosurgical department. They associate significant morbidity and mortality that increase in the case of recurrences requiring reoperation. Despite extensive published literature, there is still significant debate regarding optimal management of CSDHs and their potential recurrence. Objective: Identify factors for recurrence requiring reoperation of CSDHs in order to adjust our management strategies. Methods: A retrospective review of 64 cases harbouring 71 CSDHs that were surgically treated in the Neurosurgery Department of “Saint Pantelimon” Clinical Emergency Hospital over a period of two years (January 2016 - December 2017). Two main surgical techniques were used: small trephine and large bone flap craniotomy, according to the operating surgeon’s preference. CT scans were performed at admission and 24 hours postoperatively. Postoperative management was similar in all cases. Results: Recurrence requiring reoperation (RrR) was encountered in 16 (25%) of the reviewed cases. Reoperation was found to be significantly more often encountered in particular preoperative CT characteristics: laminar type (RrR=38,10%, p=0.027) and maximal thickness above 22 mm (43,75%, p = 0,013). Surgical technique had a substantial impact on recurrence: in trephinated cases, reoperation was required in only 8 of 51 patients (RrR=15,69%, p = 0.007), while large bone flap craniotomy associated a RrR of 61,54% (p = 0.008), which increased when associated with inner membranectomy (RrR=87,5%, p = 0,007) or subdural drain placement (88,89%, p = 0.007). Reoperations not only doubled the neurosurgical hospital length of stay, but also associated higher perioperative mortality rates (18.75% versus 14,58%). Conclusions: In our series, surgical technique had a decisive impact on the rate of recurrence. CSDH surgery is another example of “in medio stat virtus”, where finding the right balance between the least and most aggressive technique has the potential of providing the best outcomes, and thus small trephination could be taken into consideration.

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Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence

Cited by 40 publications

References 35 publications

Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients

Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients

Chronic subdural hematoma

Recurrence of Chronic Subdural Hematomas Requiring Reoperation: Could Small Trephination Be a Valid Alternative to Conventional Approaches?

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