Clinical characteristics and outcomes of supratentorial subdural hematoma following microvas-cular decompression

Abstract

Objective To summarize the clinical features of supratentorial subdural hematoma (SDH) following microvascular decompression (MVD). Methods A retrospective review of 4 937 consecutive patients who underwent MVD at Department of Neurosurgery, China-Japan Friendship Hospital between January 2015 and September 2017 revealed 29 patients with postoperative supratentorial SDH accounting for 5.9‰ of all MVD cases. Among the 29 patients with supratentorial SDH, 21 cases(5.7‰) occurred out of 3 656 patients following MVD for HFS (hemifacial spasm), 8(6.7‰) out of 1 197 patients for TN (trigeminal neuralgia). In addition, there were 84 cases of GN (glossopharyngeal neuralgia) and none of them developed SDH.A retrospective review of clinical features and outcomes of 29 patients with supratentorial SDH. Results The 29 patients included 11 males and 18 females. Their age ranged from 19 to 79 years old, with an average of 53.0±15.3 years old. The duration of illness was 0.5-20.0 years, with the median of 5.0 years. In 29 patients, supratentorial SDH occurred ipsilaterally in 16(55.2%) cases, contralaterally in 10(34.5%)cases, and bilaterally in 3(10.3%)cases. Hemorrhagic amount by CT analysis ranged from 2 ml to 15 ml, with the average of 6.5±3.6 ml. Among 28 patients with conservative treatment, 26 displayed complete or obvious absorption of hematomas at discharge and 2 showed hematoma absorption during follow-up. One patient turned into chronic supratentorial SDH and achieved good outcome following single-bore drainage. There was no SDH-related symptoms developed during the 6-month follow-up. Treatment of original illness remained effective in 27 (93.1%) cases. Conclusions The incidence of supratentorial SDH after MVD is much lower than other complications of MVD. Furthermore, most patients with conservative treatment seem to have good outcome. Even though, postoperative CT scan is recommended for all MVD patients. Key words: Microvascular decompression; Subdural hematoma; Disease attributes; upratentorial