Analysis of the efficacy and influencing factors of different surgical treatment of bilateral chronic subdural hematomas

Abstract

Objective To investigate the efficacy and influencing factors of different surgical treatment of bilateral chronic subdural hematomas. Methods A retrospective analysis was performed on 134 patients with bilateral chronic subdural hematomas treated with drilling and drainage from January 2011 to December 2016 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. There were 30 patients undergoing unilateral surgery and 104 patients undergoing bilateral surgery. The differences in brain tissue restoration between 2 surgical strategies were compared. Resetting the bilateral brain tissues within 1 week postoperatively to a distance of less than 10 mm from the inner table of skull was defined as good recovery. The relevant factors that affected brain tissue resetting were analyzed. Results Of the 134 patients, 52.2% (70) had a good brain tissue resetting within 7 days postoperatively, including 57.7% (60/104) in the bilateral surgery group and 33.3% (10/30) in the unilateral surgery group (P=0.023). Within 24 hours after surgery, the incidence of hematoma enlargement on one side was 63.3% (19/30) in the unilateral surgery group and 16.3% (17/104) in the bilateral surgery group (P<0.001). Within 7 days after operation, the cumulative incidence of hematoma enlargement on one side in the unilateral surgery group was 60.0% (18/30) and 6.7% (7/104) in the bilateral surgery group. The difference was statistically significant (P< 0.001). Multivariate logistic regression analysis showed that the surgical method (OR=0.251, 95% CI: 0.087-0.722, P=0.010) was an independent factor affecting brain tissue remodeling. Conclusion Compared with unilateral surgery, bilateral drilling drainage in the treatment of chronic subdural hematomas could improve the efficacy of restoration of bilateral brain tissues and help reduce the likelihood of hematoma enlargement after surgery. Key words: Hematoma, subdural, chronic; Bilateral; Drilling and drainage; Root cause analysis