Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Fu Mei Chen,Xiao Feng Yang,Kang Li Xu,Tian Xiang Zhan,Liang Gao,Fei Cheng,Li Wang,Ke Wang,Hao Wang,Zuo-Bing Chen

doi:10.1186/s12883-020-01669-5

Abstract

BackgroundTo investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage.MethodsA multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019.ResultsA total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH.ConclusionsThis study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Highlights

Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage; its pathogenic mechanism remains unclear
Several studies have revealed that predictors of chronic subdural hematoma (CSDH) recurrence following surgical evacuation include age, sex, antiplatelet or anticoagulation therapy, Glasgow Coma Scale (GCS), diabetes mellitus, hypertension, bilateral hematoma, preoperative hematoma size, midline shift, hematoma density, intraoperative irrigation, type of surgery and postoperative air collection, these results are inconsistent [7, 13,14,15,16,17,18,19]
Important to identify the clinical and perioperative risk factors associated with acute intracranial hemorrhage (AIH) and CSDH recurrence following burr hole drainage (BHD) surgery. In this multi-center retrospective study we evaluated the clinical factors associated with postoperative AIH and CSDH recurrence, to determine an optimal perioperative management strategy for BHD with or without irrigation in CSDH patients

Summary

Introduction

Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage; its pathogenic mechanism remains unclear. The treatment is often surgical evacuation, using techniques such as twist-drill craniotomy and burr hole drainage (BHD) or craniotomy. Several studies have revealed that predictors of CSDH recurrence following surgical evacuation include age, sex, antiplatelet or anticoagulation therapy, Glasgow Coma Scale (GCS), diabetes mellitus, hypertension, bilateral hematoma, preoperative hematoma size, midline shift, hematoma density, intraoperative irrigation, type of surgery and postoperative air collection, these results are inconsistent [7, 13,14,15,16,17,18,19]. To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage

Methods

Results

Discussion

Conclusion