Surgical Treatment of Chronic Subdural Hematoma: Predicting Recurrence and Cure

Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially among elderly patients. Here we have analyzed our institutional experience with surgical management of CSDH. We aimed at identifying predictors of hematoma recurrence and cure, and the respective time course. Pertinent...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2019-08, Vol.128, p.e1010-e1023
Main Authors: Ridwan, Sami, Bohrer, Anna-Margarete, Grote, Alexander, Simon, Matthias
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Chronic subdural hematoma
Cure
Female
Hematoma, Subdural, Chronic - complications
Hematoma, Subdural, Chronic - diagnostic imaging
Hematoma, Subdural, Chronic - surgery
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Nervous System Diseases - etiology
Neuroimaging
Neurosurgical Procedures - methods
Predictive Value of Tests
Predictors
Recurrence
Survival Analysis
Treatment Outcome
Trephining
Volumetric analysis
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially among elderly patients. Here we have analyzed our institutional experience with surgical management of CSDH. We aimed at identifying predictors of hematoma recurrence and cure, and the respective time course. Pertinent data were collected from all 208 patients (136 males; median age, 78 years) treated for unilateral CSDH in our department from 2014 to 2016 after exclusion of cases with CSDH following previous head surgery or missing postoperative imaging. Pre- and postoperative neuroimaging studies were subjected to computer-assisted volumetric analyses. CSDH composition and anatomy were assessed using a modified Nakaguchi classification. A total of 67.8% of the patients presented with neurologic deficits, and 51.4% were at least on 1 anticoagulant agent. Burr hole trephinations were performed in 94.7%. The median residual hematoma volume was 35.0 mL (44.1 mL including air). Surgical recurrences were seen in 17.8%. The median time to repeat surgery was 17 days, and 91.9% of recurrences occurred within 60 days. Recurrence rates varied between 36.4% (separated or trabecular subtypes and postoperative CSDH volume ≥35.0 mL) and 3.7% (all other subtypes and postoperative CSDH volume
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2019.05.063