Value of routine early post-operative computed tomography in determining short-term functional outcome after drainage of chronic subdural hematoma: An evaluation of residual volume

Abstract

Background:Computed tomography (CT) scans are widely used in managing chronic subdural hematoma (CSDH). Factors that determine early post-operative volume have not been examined. The value of routine early post-operative residual volume have not been evaluated. Our study aims to compare pre-operative and early post-operative CT findings to determine the factors affecting residual hematoma and evaluate if early post-operative CT scans are useful in the management of CSDH.Methods:Forty-three patients who underwent burr hole drainage of unilateral CSDH from August 2006 to January 2013 and had routine post-operative CT scans within 48 hours of surgery were selected. Data regarding age, sex, neurological deficit, Glasgow Coma Scale (GCS), pre-existing medical conditions, use of antiplatelets or anticoagulation, operative time, usage of drains, and number of burr holes were obtained. The pre-operative CSDH volume, CSDH density, and midline shift were measured. Residual volume was calculated from early post-operative CT scans. Clinical outcome was evaluated with Glasgow Outcome Scale (GOS) at the time of discharge. Statistical analysis was performed to look for correlation between the pre-operative factors and residual volume, and the residual volume and GOS.Results:Pre-operative volume was found to correlate significantly with post-operative residual volume. There was no significant correlation between all other pre-operative factors and residual volume. There was also no correlation between residual volume and GOS at discharge.Conclusion:Routine post-operative CT brain for burr hole drainage of CSDH may be unnecessary in view of the good predictive value of pre-operative volume, and also because it is not predictive of the clinical outcome.

Core Outcomes and Common Data Elements in Chronic Subdural Hematoma: A Systematic Review of the Literature Focusing on Reported Outcomes

“…Certainly, at our institution, routine post-operative scanning is not undertaken and is based on clinical need and there is recent data to suggest that it does not influence post-operative management. 26 …”

Chronic subdural hematoma: Predicting postoperative recurrence using a correlation of computerized tomographic volume with intraoperative volume

“…Computed tomography scan (CT scan) of the brain is the gold standard for diagnosing CSDH, defining it as hypo-dense subdural (extra-axial crescentic) collection, compared with the brain parenchyma. [ 1 5 6 7 ]…”

“…Operative and nonoperative options of treatment have been used for CSDH; however, surgical treatment usually results in rapid relief of neurologic symptoms with good prognosis. [ 6 7 8 ] CSDH recurrence is the most common complication following surgery, accounting for 10%–28.8% of postoperative complications. [ 5 9 , 10 ] Imaging methods and surgical strategies have not substantially improved postoperative recurrence rate; therefore, there is a need to identify patients at significant risk of recurrence for better patient care.…”