Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

  • Ko, Byung-Soo (Department of Neurosurgery Chonnam National University Hospital & Medical School) ;
  • Lee, Jung-Kil (Department of Neurosurgery Chonnam National University Hospital & Medical School) ;
  • Seo, Bo-Ra (Department of Neurosurgery Chonnam National University Hospital & Medical School) ;
  • Moon, Sung-Jun (Department of Neurosurgery Chonnam National University Hospital & Medical School) ;
  • Kim, Jae-Hyoo (Department of Neurosurgery Chonnam National University Hospital & Medical School) ;
  • Kim, Soo-Han (Department of Neurosurgery Chonnam National University Hospital & Medical School)
  • Published : 2008.01.28
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Abstract

Objective : Burr hole drainage has been widely used to treat chronic subdural hematoma (CSDH). However, the incidence of recurrent CSDH varies from 3.7 to 30% after surgery. The authors attempted to elucidate the risk factors associated with the recurrence of CSDH in one burr hole drainage technique. Methods : A total of 255 consecutive cases who underwent one burr hole drainage for CSDH were included in this study. Twenty-four patients (9.4%) underwent a repeated operation because of the recurrence of CSDH. We analyzed retrospectively the demographic, clinical and radiologic factors associated with the recurrence of CSDH. Results : In this study, two risk factors were found to be independently associated with the recurrence of CSDH. The incidence of CSDH recurrence in the high- and mixed-density groups was significantly higher than those in the low- and iso-density groups (p<0.001). Bleeding tendency such as in leukemia, liver disease and chronic renal failure was also significantly associated with recurrence of CSDH (p=0.037). Conclusion : These results suggest that high- and mixed- density shown on computed tomographic scan was closely relates with a high incidence of recurrence. Therefore, the operation could be delayed in those cases unless severe symptoms or signs are present. Reoperation using the previous burr hole site is a preferred modality to treat the recurrent CSDH.

Keywords

References

  1. El-Kadi H, Miele VJ, Kaufman HH : Prognosis of chronic subdural hematomas. Neurosurg Clin N Am 11 : 553-567, 2000
  2. Frati A, Salvati M, Mainiero F, Ippoliti F, Rocchi G, Raco A, et al : Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma : a prospective study. J Neurosurg 100 : 24-32, 2004 https://doi.org/10.3171/jns.2004.100.1.0024
  3. Gazzeri R, Galarza M, Neroni M, Canova A, Refice GM, Esposito S : Continuous subgaleal suction drainage for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 149 : 487-493, 2007 https://doi.org/10.1007/s00701-007-1139-8
  4. Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez- Rumbo R : Chronic subdural haematoma : surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 107 : 223-229, 2005 https://doi.org/10.1016/j.clineuro.2004.09.015
  5. Gonugunta V, Buxton N : Warfarin and chronic subdural haematomas. Br J Neurosurg 15 : 514-517, 2001 https://doi.org/10.1080/02688690120097822
  6. Jeong CA, Kim TW, Park KH, Chi MP, Kim JO, Kim JC : Retrospective analysis of re-operated patients after chronic subdural hematoma surgery. J Korean Neurosurg Soc 38 : 116-120, 2005
  7. Kang HL, Shin HS, Kim TH, Hwang YS, Park SK : Clinical analysis of recurrent chronic subdural hematoma. J Korean Neurosurg Soc 40 : 262-266, 2006
  8. Kang MS, Koh HS, Kwon HJ, Choi SW, Kim SH, Youm JY : Factors Influencing recurrent chronic subdural hematoma after surgery. J Korean Neurosurg Soc 41 : 11-15, 2007
  9. Kim HY, Kwon SC, Kim TH, Shin HS, Hwang YS, Park SK : Analysis of management according to CT findings in chronic subdural Hematoma. J Korean Neurosurg Soc 37 : 96-100, 2005
  10. Kostanian V, Choi JC, Liker MA, Go JL, Zee CS : Computed tomographic characteristics of chronic subdural hematomas. Neurosurg Clin N Am 11 : 479-489, 2000
  11. Kuroki T, Katsume M, Harada N, Yamazaki T, Aoki K, Takasu N : Strict closed-system drainage for treating chronic subdural haematoma. Acta Neurochir (Wien) 143 : 1041-1044, 2001 https://doi.org/10.1007/s007010170010
  12. Murakami H, Hirose Y, Sagoh M, Shimizu K, Kojima M, Gotoh K, et al : Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 96 : 877-884, 2002 https://doi.org/10.3171/jns.2002.96.5.0877
  13. Nakaguchi H, Tanishima T, Yoshimasu N : Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 95 : 256-262, 2001 https://doi.org/10.3171/jns.2001.95.2.0256
  14. Nakaguchi H, Tanishima T, Yoshimasu N : Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage. J Neurosurg 93 : 791-795, 2000 https://doi.org/10.3171/jns.2000.93.5.0791
  15. Nomura S, Kashiwagi S, Fujisawa H, Ito H, Nakamura K : Characterization of local hyperfibrinolysis in chronic subdural hematomas by SDS-PAGE and immunoblot. J Neurosurg 81 : 910-913, 1994 https://doi.org/10.3171/jns.1994.81.6.0910
  16. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M : Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo) 41 : 382-386, 2001 https://doi.org/10.2176/nmc.41.382
  17. Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H : A comparative study of the treatment of chronic subdural hematomaburr hole drainage versus burr hole irrigation. Surg Neurol 57 : 405-409; discussion 410, 2002 https://doi.org/10.1016/S0090-3019(02)00720-6
  18. Tsutsumi K, Maeda K, Iijima A, Usui M, Okada Y, Kirino T : The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma. J Neurosurg 87 : 870-875, 1997 https://doi.org/10.3171/jns.1997.87.6.0870
  19. Voelker JL : Nonoperative treatment of chronic subdural hematoma. Neurosurg Clin N Am 11 : 507-513, 2000
  20. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S : Independent predictors of recurrence of chronic subdural hematoma : results of multivariate analysis performed using a logistic regression model. J Neurosurg 98 : 1217-1221, 2003 https://doi.org/10.3171/jns.2003.98.6.1217
  21. Yamashima T, Yamamoto S : Clinicopathological classification of chronic subdural hematoma. Zentralbl Neurochir 46 : 304-314, 1985

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  18. Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients vol.155, pp.2, 2008, https://doi.org/10.1007/s00701-012-1565-0
  19. Multiple Densities of the Chronic Subdural Hematoma in CT Scans vol.54, pp.1, 2013, https://doi.org/10.3340/jkns.2013.54.1.38
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  27. A Case of Gait Disturbance due to Chronic Bilateral Subdural Hematoma Mimicking Cervical Spondylotic Myelopathy vol.49, pp.4, 2008, https://doi.org/10.4055/jkoa.2014.49.4.316
  28. Comparison of the Indications and Treatment Results of Burr-Hole Drainage at the Maximal Thickness Area versus Twist-Drill Craniostomy at the Pre-Coronal Point for the Evacuation of Symptomatic Chroni vol.56, pp.3, 2008, https://doi.org/10.3340/jkns.2014.56.3.243
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  32. Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach vol.6, pp.1, 2008, https://doi.org/10.4103/2152-7806.161788
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  35. Risk Factors of Chronic Subdural Hematoma Progression after Conservative Management of Cases with Initially Acute Subdural Hematoma vol.11, pp.2, 2015, https://doi.org/10.13004/kjnt.2015.11.2.52
  36. Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma vol.158, pp.1, 2016, https://doi.org/10.1007/s00701-015-2625-z
  37. Endoscopic surgery to chronic subdural hematoma with neovessel septation: technical notes and literature review vol.38, pp.5, 2008, https://doi.org/10.1080/01616412.2016.1139772
  38. Effects of atorvastatin on chronic subdural hematoma : A systematic review vol.96, pp.26, 2008, https://doi.org/10.1097/md.0000000000007290
  39. Organized Chronic Subdural Hematomas Treated by Large Craniotomy with Extended Membranectomy as the Initial Treatment vol.12, pp.4, 2008, https://doi.org/10.4103/ajns.ajns_8_15
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  51. Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis vol.161, pp.6, 2008, https://doi.org/10.1007/s00701-019-03881-w
  52. Traitement chirurgical des hématomes sous-duraux chroniques en Guinée : étude de 22 cas à l’hôpital Kipe de Conakry vol.65, pp.2, 2019, https://doi.org/10.1016/j.neuchi.2019.03.005
  53. High-degree centrum semiovale-perivascular spaces are associated with development of subdural fluid in mild traumatic brain injury vol.14, pp.9, 2008, https://doi.org/10.1371/journal.pone.0221788
  54. Chronic Subdural Hematoma: Pitfalls to Avoid for Better Outcome vol.9, pp.4, 2008, https://doi.org/10.4236/ojmn.2019.94039
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