Radiolological predictors of recurrence of chronic subdural hematoma.

Imran Altaf Hussain,Anjum Habib Vohra,Shahzad Shams

doi:10.12669/pjms.341.13735

Abstract

Objective:Chronic subdural hematoma is one of the most common clinical entities encountered in daily neurosurgical practice. Considerable recurrence rates have been reported for chronic subdural hematoma following surgical evacuation. Many studies have suggested various radiological factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. This study focuses on determining the radiological factors predictive of chronic subdural hematoma recurrence.Methods:A retrospective analysis of 113 patients diagnosed with chronic subdural hematoma who were surgically treated between August 2013 and December 2014 was performed. The radiological features were analyzed to clarify the correlation between these radiological factors and postoperative recurrence of chronic subdural hematoma.Results:Twenty patients (17.7%) experienced recurrence. Chronic subdural hematoma recurrence was found to be significantly associated (p<0.05) with preoperative hematoma thickness ≥ 20 mm. Midline shift, hematoma density and bilaterality were not significantly associated with recurrence. Post operative drainage also significantly (p<0.05) reduced chronic subdural hematoma recurrence.Conclusion:Preoperative hematoma thickness ≥ 20 mm is an independent predictor of recurrence of chronic subdural hematoma. Postoperative drainage also significantly reduces chronic subdural hematoma recurrence.

Highlights

Chronic subdural hematoma (CSDH) is one of the most common clinical entities encountered in daily neurosurgical practice.[1,2,3,4,5]
Recurrence of CSDH was defined as re-accumulation of blood within the postoperative hematoma cavity on follow up CT scan within the first three months after surgery and re-appearance of neurological symptoms
Jung Min Lee et al.[6] and Dae Hyo Song et al.[15] found preoperative midline displacement to be an independent predictor of CSDH recurrence, whereas Ecosa Bae M et al.[10] and Yoon-Gyo Jung et al.[17] concluded that preoperative midline displacement was not significantly associated with recurrence

Summary

Introduction

Chronic subdural hematoma (CSDH) is one of the most common clinical entities encountered in daily neurosurgical practice.[1,2,3,4,5] The incidence of CSDH has been reported to be as high as 13.1 cases per 100000 inhabitants.[6]. The condition is treated by various surgical procedures including burr-hole trephination, twist-drill trephination and craniotomy.[7,8,9,10] Of these procedures, burrhole evacuation is the most popular technique worldwide.[1,6,7] considerable recurrence rates have been reported ranging from 3 to 30% following surgical management.[7,9,11,12]

Methods

Results

Conclusion