Chronic Subdural Hematoma Patients Research Articles

Incidence of Chronic Subdural Hematoma after Mild Head Trauma in Elderly Patients with or without Pre-traumatic Conditioning of Anti-thrombotic Drugs.

Anti-thrombotic drugs may increase the risk for chronic subdural hematoma (CSDH). However, whether to continue or discontinue/counteract these drugs has not been investigated in patients with mild head trauma. CSDH incidence after mild head trauma, as well as the risk for CSDH in patients with anti-thrombotic drugs, were investigated in this study. The study included 765 consecutive elderly (>65 y.o.) patients with mild head trauma and an initial Glasgow Coma Scale (GCS) score of 14 or 15. All patients received initial CT within 24 hours after trauma and were re-examined 30 days after trauma to detect CSDH formation, repeating for every 30 days to examine symptomatic CSDH progression. Patients were divided into two groups, with anti-thrombotic drugs (n = 195) or without them (n = 263), to investigate the influence of pre-traumatic conditioning with anti-thrombotic drugs on CSDH. The whole sample was 458 out of 765 cases. The incidence of CSDH formation was 91 out of 458 cases (19.9%) after mild head trauma, with no significant difference between with and without anti-thrombotic drugs. CSDH progressed as symptomatic in 21 out of 458 cases (4.6%), with no significant difference between with and without anti-thrombotic drugs. Pre-traumatic conditioning with anti-thrombotic drugs and its continuation after trauma did not affect the incidence of formation or symptomatic progression of CSDH. This finding suggests that discontinuing and/or counteracting anti-thrombotic drugs may be unnecessary in patients with mild head trauma.

Time and Influencing Factors to Chronic Subdural Hematoma Resolution After Middle Meningeal Artery Embolization

We sought to describe the resolution time of chronic subdural hematoma (CSDH) after middle meningeal artery embolization (MMAE) and potential variables that may affect hematoma resolution. A retrospective analysis was performed on CSDH patients between December 2018 and December 2021. Patient characteristics, radiologic manifestations, and data of hematoma resolution were recorded. Univariate and multivariate analyses were conducted to identify predictors of CSDH resolution time. A total of 53 patients were enrolled including 53 hematomas. Only 1 participant relapsed and did not require surgical evacuation. Hematoma resolution was observed in 27 (50.9%) at 4 months and 48 (90.6%) cases at the last radiologic follow-up. The median MMAE-to-resolution time was 19 weeks (interquartile range: 8-24). The burr-hole irrigation+ MMAE group showed faster hematoma resolution than MMAE alone during early follow-up periods, but no significant difference was found at 6 months. Increased thickness of residual hematoma, excessive postoperative midline shift, high-density hematoma, mixed-density hematoma, separated hematoma, and anticoagulant or antiplatelet agents used were predictive of nonresolution at 4 months as determined by univariate analysis, whereas anticoagulant or antiplatelet agents used and high-density hematoma were not significant on multivariate analysis. No significant association was noted between hematoma resolution and comorbidities or other hematoma radiologic features. MMAE is an effective and minimally invasive treatment for CSDH with a lower recurrence rate. The median resolution time of CSDH following MMAE was 19 weeks (interquartile range: 8-24). Burr-hole irrigation contributed to early hematoma resolution but had no significant effect at 6 months. In addition, residual hematoma thickness, postoperative midline shift, and specific type of hematoma were associated with delayed hematoma resolution at 4 months.

Cortical atrophy in chronic subdural hematoma from ultra-structures to physical properties

Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation.

Middle meningeal artery embolization for chronic subdural hematoma in a young patient with refractory thrombocytopenia secondary to leukemia: more evidence for a paradigm shift? Illustrative case.

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical presentations, with an increasing number now also presenting with concurrent thrombocytopenia. Although middle meningeal artery (MMA) embolization has been considered in elderly patients with high comorbidities, it may permit treatment of CSDH in patients who are at high risk for recurrence or deemed unsuitable for surgical management due to thrombocytopenia. A 35-year-old man who had severe thrombocytopenia due to blast cell crisis with chronic myeloid leukemia developed an atraumatic CSDH. The patient developed severe headaches in the hospital while being treated for febrile neutropenia. He remained neurologically intact. MMA embolization was undertaken due to the morbidity and mortality risks associated with surgery and the high risk of recurrence due to severe thrombocytopenia. At 2 months post-procedure the patient was asymptomatic and there was almost complete resolution of the hematoma. Thrombocytopenia in the presence of a CSDH is becoming increasingly common. This case highlights the particular role of MMA embolization in patients with severe thrombocytopenia where surgery carries high morbidity and increased mortality.

Clinical characteristics, brain computerized tomography scan and surgical outcome in elderly patients with chronic subdural hematoma

Objective: To determine clinical characteristics, computer tomography brain imaging, and surgical outcome for elderly patients with chronic subdural hematoma (CSDH). Subject and method: A cross-sectional, descriptive, and retrospective study was conducted on 74 elderly patients diagnosed with CSDH and operated at 108 Military Central Hospital from June 2020 to June 2021. Result: Mean age was 75.2 years; male/female ratio was 3.93/1, the most common cause was traumatic brain injury (49%). The common presenting symptoms of CSDH were altered mental state (70.9%) and headache (68.9%), followed by cognitive impairment (54.1%), hemiparesis (21.6%), hematoma maximal thickness and midline shift were associated with a higher rate of hemiparesis in CSDH patients (p<0.05); The percentage of patients with GCS score ≥ 13 was 90.5%. The portion of unilateral on the brain CT was 78.4%. The most common densities of CSDH obtained from CT imaging was isodense (accounting for 54.0%); followed by hypodense (20.3%), high-density (17.6%), and mixed-density (8.1%); The most common complication of burr hole technique was pneumocephalus (accounting for 8.1%); recurrence of CSDH (5.4%). The Glasgow outcome scale (GOS) 4-5 was 89.7% within 3 months. Conclusion: Chronic subdural hematoma was one of the most common diseases in neurosurgery. The burr hole drainage technique was safe and effective.

Clinical Outcome and Recurrence Risk of Chronic Subdural Hematoma After Surgical Drainage.

Introduction Chronic subdural hematoma (CSDH) is one of the most encountered neurosurgical cases. CSDH is defined as the accumulation of liquified blood products in the space between the dura and the arachnoid. A reported incidence of 17.6/100,000/year has more than doubled in the past 25 years in parallel with an aging population. Surgical drainage remains the mainstay of treatment, yet it is challenged by variable recurrence risks. Less invasive embolization methods of the middle meningeal artery (EMMA) could reduce the recurrence risks. Before adopting a newer treatment (EMMA), it is prudent to establish the outcomes from surgical drainage. The purpose of this study is to assess the clinical outcome and recurrence risk in surgically treated CSDH patients in our center. Methods A retrospective search of our surgical database was done to identify CSDH patients undergoing surgical drainage in the year 2019-2020. Demographic and clinical details were collected, and quantitative statistical analysis was performed. Peri-procedural radiographic information and follow-ups were also included as per the standard of care. Results A total of 102 patients (mean age: 69 years; range: 21-100 years; male: 79) with CSDH underwent surgical drainage with repeat surgery in 13.7% of the patients (n=14). Peri-procedural mortality and morbidity were 11.8%(n=12) and 19.6% (n=20), respectively. Overall, among our patient population, recurrence was seen in 22.55% (n=23). The mean total hospital stay was 10.6 days. Conclusions Our retrospective cohort study showed an institutional CSDH recurrence risk of 22.55%, in keeping with what is reported in the literature. This baseline information is important for a Canadian setting and provides a basis for comparison for future Canadian trials.

Efficacy and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma.

This paper aims to analyze the clinical effect and prognosis of neuroendoscopy-assisted surgery for chronic subdural hematoma (CSDH). The clinical data of CSDH patients who underwent surgery between March 2018 and June 2020 in the Department of Neurosurgery of the First Affiliated Hospital of Xiamen University were retrospectively collected and analyzed. Eighty patients with CSDH who met the inclusive criteria were selected. A control group (32 cases treated with burr hole drainage) and an observation group (48 cases treated with neuroendoscopy-assisted surgery) were set according to different operation methods. The hematoma clearance rate, surgery-related indicators, related complications, hematoma recurrence rate and related prognostic indicators of the two groups were compared and analyzed. The postoperative hematoma clearance rate of the observation group was 92.59%, which was higher than that of the control group (77.78%) (P<0.05). The operation time of the observation group was longer than that of the control group (P<0.05). The postoperative hospitalization time of the observation group was shorter than that of the control group (P<0.05). The postoperative complication rate of the observation group was lower than that of the control group (P<0.05). The recurrence rate of hematoma in the observation group in the six-month postoperative follow-up was 1.85%, which was lower than that in the control group (P<0.05). The limb motor function and daily living ability score of the observation group were higher than those of the control group, and the Markwalder grading score was lower than that of the control group (P<0.05). Neuroendoscopy-assisted treatment which is safe and effective is superior to traditional burr-hole drainage surgery. It can reduce the recurrence rate; thus, it is worth advocating and applying.

Research Article Chronic Subdural Hematoma in Khost

In this study, chronic subdural hematoma patient investigated and information related to chronic subdural hematoma collected, the CSDH described briefly, this study was conducted in different hospital in khost province, information related to age, gender, causes, clinical manifestation, and hematomae location has been collected.

The cognitive status of chronic subdural hematoma patients after treatment: an exploratory study

ObjectiveChronic subdural hematoma (CSDH) is a common neurological condition, often affecting the elderly. Cognitive impairment is frequently observed at presentation. However, the course and longer term aspects of the cognitive status of CSDH patients are unknown. In this study, we aim to explore the cognitive status of CSDH patients after treatment.MethodsAn exploratory study in which CSDH patients were assessed 3 months after treatment and compared to healthy controls. A total of 56 CSDH patients (age 72.1 SD ± 10.8 years with 43 [77%] males) and 60 healthy controls were included (age 67.5 ± SD 4.8 with 34 [57%] males). Cognitive testing was performed using the Telephonic Interview of Cognitive Status-modified (TICS-m), a 12-item questionnaire in which a total of 50 points can be obtained on several cognitive domains.ResultsMedian time between treatment and cognitive testing was 93 days (range 76–139). TICS-m scores of CSDH patients were significantly lower than healthy controls, after adjusting for age and sex: mean score 34.6 (95% CI: 33.6–35.9) vs. 39.6 (95% CI: 38.5–40.7), p value < 0.001. More than half (54%) of CSDH patients have cognitive scores at follow-up that correspond with cognitive impairment.ConclusionA large number of CSDH patients show significantly worse cognitive status 3 months after treatment compared to healthy controls. This finding underlines the importance of increased awareness for impaired cognition after CSDH. Further research on this topic is warranted.

Predicting neurosurgical referral outcomes in patients with chronic subdural hematomas using machine learning algorithms - A multi-center feasibility study.

Chronic subdural hematoma (CSDH) incidence and referral rates to neurosurgery are increasing. Accurate and automated evidence-based referral decision-support tools that can triage referrals are required. Our objective was to explore the feasibility of machine learning (ML) algorithms in predicting the outcome of a CSDH referral made to neurosurgery and to examine their reliability on external validation. Multicenter retrospective case series conducted from 2015 to 2020, analyzing all CSDH patient referrals at two neurosurgical centers in the United Kingdom. 10 independent predictor variables were analyzed to predict the binary outcome of either accepting (for surgical treatment) or rejecting the CSDH referral with the aim of conservative management. 5 ML algorithms were developed and externally tested to determine the most reliable model for deployment. 1500 referrals in the internal cohort were analyzed, with 70% being rejected referrals. On a holdout set of 450 patients, the artificial neural network demonstrated an accuracy of 96.222% (94.444-97.778), an area under the receiver operating curve (AUC) of 0.951 (0.927-0.973) and a brier score loss of 0.037 (0.022-0.056). On a 1713 external validation patient cohort, the model demonstrated an AUC of 0.896 (0.878-0.912) and an accuracy of 92.294% (90.952-93.520). This model is publicly deployed: https://medmlanalytics.com/neural-analysis-model/. ML models can accurately predict referral outcomes and can potentially be used in clinical practice as CSDH referral decision making support tools. The growing demand in healthcare, combined with increasing digitization of health records raises the opportunity for ML algorithms to be used for decision making in complex clinical scenarios.

Is drug discontinuation necessary before burr hole trephination surgery in chronic subdural hematoma patients taking antithrombotic agents?: a multicenter retrospective cohort study

Is drug discontinuation necessary before burr hole trephination surgery in chronic subdural hematoma patients taking antithrombotic agents?: a multicenter retrospective cohort study

The Value of Suction Drainage for a Chronic Subdural Hematoma in Elderly Patients: A Retrospective Cohort study

Background: The use of suction in the subgaleal drainage system after the burr-hole evacuation of chronic subdural hematoma (CSDH) is still debatable. This study aimed to investigate the value of adding suction to the drainage system of CSDH in elderly patients. Methods: This cohort study retrospectively reviewed the data of the CSDH patients operated on at our university hospital in the last eight years. The inclusion criteria were elderly patients who underwent evacuation of a unilateral CSDH through two burr holes followed by placing a subgaleal drainage tube. Two hundred seventy-three consecutive patients met the inclusion criteria. Seventy-six patients (27.8%) received suction drainage. The comparison between groups with qualitative data was done using the chi-square test. The comparison between groups with quantitative data was done using the t-test. The statistical analyses were conducted using SPSS software version 21 (IBM Corp., Armonk, New York, USA). Results: There were no statistically significant differences between the suction and the non-suction drainage groups regarding the hospitalization period, the postoperative seizures, or the recurrence rate. However, the postoperative pneumocephalus volume in the suction drainage group was significantly lower than in the non-suction drainage group. None of the patients developed acute subdural or intracerebral hemorrhage. Conclusions: Suction drainage did not add statistically significant value to the closed drainage system regarding the hospitalization period, postoperative seizures, or recurrence rate of the CSDH. A prospective controlled study is needed to increase the evidence for this finding.

Surgical treatment and outcome of chronic subdural hematoma: a comparative study between Ethiopia and Norway.

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Here, we studied differences in demographics, treatment, and outcome for CSDH patients in low-income (Ethiopia) and high-income (Norway) countries and assessed potential outcome determinants. We included patients from Addis Ababa University Hospitals (AAUH) and Haukeland University Hospital (HUH) who had surgery for CSDH (2013-2017). Patients were included prospectively in Ethiopia and retrospectively in Norway. We enrolled 314 patients from AAUH and 284 patients from HUH, with a median age of 60 and 75years, respectively. Trauma history was more common in AAUH (72%) than in HUH patients (64.1%). More patients at HUH (45.1%) used anticoagulants/antiplatelets than at AAUH (3.2%). Comorbidities were more frequent in HUH (77.5%) than in AAUH patients (30.3%). Burr hole craniostomy under local anesthesia and postoperative drainage was the standard treatment in both countries. Postoperative CT scanning was more common at HUH (99.3%) than at AAUH (5.2%). Reoperations were more frequent at HUH (10.9%) than at AAUH (6.1%), and in both countries, mostly due to hematoma recurrence. Medical complications were more common at HUH (6.7%) than at AAUH (1.3%). The 1-year mortality rate at HUH was 7% and at AAUH 3.5%. At the end of follow-up (> 3years), the Glasgow Outcome Scale Extended (GOSE) score was 8 in 82.9% of AAUH and 46.8% of HUH patients. The surgical treatment was similar at AAUH and HUH. The poorer outcome in Norway could largely be explained by age, comorbidity, medication, and complication rates.

Development and Validation of the Chronic Subdural HematOma Referral oUtcome Prediction Using Statistics (CHORUS) Score: A Retrospective Study at a National Tertiary Center

Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing rate of patient referrals. CSDH referral decision-making is a subjective clinical process, and our aim was to develop a simple scoring system capable of acting as a decision support tool aiding referral triage. A single tertiary center retrospective case series analysis of all CSDH patient referrals from 2015 to 2020 was conducted. Ten independent variables used in the referral process were analyzed to predict the binary outcome of either accepting or rejecting the CSDH referral. Following feature selection analysis, a multivariable scoring system was developed and evaluated. 1500 patient referrals were included. Stepwise multivariable logistic and least absolute shrinkage and selection operator regression identified age <85years, the presence of headaches, dementia, motor weakness, radiological midline shift, a reasonable premorbid quality of life, and a large sized hematoma to be statistically significant predictors of CSDH referral acceptance (P<0.04). These variables derived a scoring system ranging from -9 to 6 with an optimal cut-off for referral acceptance at any score >1 (P<0.0001). This scoring system demonstrated optimal calibration (brier score loss=0.0552), with a score >1 predicting referral acceptance with an area under the curve of 0.899 (0.876-0.922), a sensitivity of 83.838% (76.587-91.089), and a specificity of 96.000% (94.080-97.920). Certain patient specific clinical and radiological characteristics can predict the acceptance or rejection of a CSDH referral. Considering the precision of this scoring system, it has the potential for effectively triaging CSDH referrals.

The Incidence And Different Risk Factors For The Recurrence Of Chronic Subdural Hematoma: A Retrospective Study

Background and Aim: Chronic subdural hematoma is a neurosurgical condition that represents degradation of liquefied blood collected abnormally beneath the dura that typically forms within three weeks. The recurrent rates of chronic subdural hematoma after surgery varies from 5% to 30%. However, different risk factors that lead to recurrent chronic subdural hematoma remain debatable. Therefore, the present study aimed to determine the incidence and different risk factors for recurrent chronic subdural hematoma.&#x0D; Methodology: A retrospective study was conducted on 206 chronic subdural hematoma patients admitted to the Department of Neurosurgery, Lady Reading Hospital, Peshawar Pakistan for the duration from 1st July 2020 to 30th June 2022. Prior to study conduction, ethical approval was taken from the institute ethical committee. Demographic details, trauma history, surgical intervention types, antithrombotic therapy, surgical drain usage, preoperative symptoms, postoperative symptoms, and clinical outcomes were retrieved from the medical record. SPSS version 25 was used for data analysis. &#x0D; Results: Out of 206 chronic subdural hematoma patients, there were 164 (79.6%) males and 42 (20.4%) females. The overall mean age was 62.9±16.2 years. The prevalence of recurrent chronic subdural hematoma was 28 (13.6%). The incidence of previous head trauma was found in 138 (67%) patients. The prevalence of left-side, right-side, and bilateral hematoma was 82 (39.8%), 58 (28.2%), and 66 (32%) respectively. In terms of hematoma density, the incidence of homogeneous hypo-dense, homogenous iso-dense, homogeneous hyperdense type, laminar type, separated type, and trabecular type were seen in 40 (19.4%), 46 (22.3%), 16 (7.8%), 10 (4.9%), 36 (17.4%), and 58 (28.2%) respectively. The overall mean of drainage time after initial intervention was 1.6± 0.8 days. All the patients underwent successful chronic subdural hematoma surgery.&#x0D; Conclusion: The present study found that the prevalence of recurrent chronic subdural hematoma was 13.6%. Male patients are more susceptible to chronic subdural hematoma recurrence compared to female patients. Post-surgery subdural drainage duration and homogeneous hyper-dense hematoma were the independent prognosticator of recurrent chronic subdural hematoma. The risk of recurrence was lower in cases where postoperative drainage of the subdural had longer duration.

Significance of Temporal Muscle Thickness in Chronic Subdural Hematoma.

Reduced temporal muscle thickness (TMT) was verified as an independent negative prognostic parameter for outcome in brain tumor patients. Independent thereof, chronic subdural hematoma (CSDH) is a neurosurgical condition with high recurrence rates and unreliable risk models for poor outcome. Since sarcopenia was associated with poor outcome, we investigated the possible role of TMT and the clinical course of CSDH patients. This investigation is a single-center retrospective study on patients with CSDH. We analyzed the radiological and clinical data sets of 171 patients with surgically treated CSDH at a University Hospital from 2017 to 2020. Our analysis showed a significant association between low-volume TMT and increased hematoma volume (p &lt; 0.001), poor outcome at discharge (p &lt; 0.001), and reduced performance status at 3 months (p &lt; 0.002). TMT may represent an objective prognostic parameter and assist the identification of vulnerable CSDH patients.

Outcomes of chronic subdural hematoma and their correlations with old age

Objective: This study explored the prognostic factors of chronic subdural hematoma in patients who underwent burr hole drainage, both overall and in elderly patients.Methods: This study enrolled 120 patients with chronic subdural hematoma who underwent burr hole drainage at a single center between January 2016 and December 2020. Old age was defined as &gt;65 years, and a good prognosis was defined as a decrease in the modified Rankin scale from admission to the last follow-up. Factors correlated with good prognosis in elderly patients compared with total patients were evaluated using the chi-square test and logistic regression analysis.Results: Among the 120 patients, 66 (55.0%) were ≥65 years old, and 76 (63.3%) had severe symptoms on admission. Old age (≥65) was the only factor significantly correlated with severe symptoms (P=0.021; odds ratio [OR], 2.618; 95% confidence interval [CI], 1.154–5.942). The following variables were significantly associated with the prognosis in both groups: diabetes (total: P=0.008; OR, 0.207; 95% CI, 0.064–0.664; old age: P=0.011; OR, 0.017; 95% CI, 0.044–0.672) and severe symptoms on admission (total: P&lt;0.001; OR, 6.994; 95% CI, 2.771–17.399; old age: P=0.007; OR, 6.177; 95% CI, 1.656–23.046).Conclusion: No difference in prognostic factors was observed between the overall patients and elderly patients with chronic subdural hematoma who underwent burr hole drainage. In both groups, patients without diabetes or with severe symptoms during hospitalization showed better recovery after burr hole drainage.

BILATERAL CHRONIC SUBDURAL HEMATOMA – CLINICAL PRESENTATION, RISK FACTORS, MANAGEMENT AND OUTCOME: A SINGLE CENTRE EXPERIENCE FROM NORTH-EASTERN INDIA

Study design: Background: Retrospective hospital-based study. Annual incidence of bilateral Chronic Subdural Hematoma (CSDH) is increasing due to an increase in the aging population, associated medical comorbidities such as hemodialysis, anticoagulant and/or antiplatelet therapy. 1. To study the clinical spectrum of Bilateral Chronic Subdural Hematoma Objectives: patients. 2. To study the treatment modalities used and outcome of the patients. A retrospective hospital-based study was carried Method: out on 50 conrmed patients of bilateral CSDH. Information of patients such as socio-demographic prole, clinical presentation, and laboratory investigations, along with treatment and outcome were recorded and analyzed. Among 50 patients, male and female were 80% and 20% res Results: pectively. The mean age of patients was 62.08 years. A history of head injury was reported by 40% of patients. The mean Glasgow coma scale (GCS) was 12.24. Common presenting symptoms were headache (76%), hemiparesis (40%), aphasia (28%), complete loss of consciousness (20%). Clinical improvement was observed in 80% while 10% had no change, 04% showed clinical deterioration and 06% of patients died during treatment. Bilateral CSDH is common Conclusion: in the elderly and prognosis is poor with increasing age. Bilateral hematoma has a higher risk of acute deterioration of clinical symptoms because of downward herniation, resulting in a poor clinical outcome. Timely interventions can improve the outcome in bilateral CSDH patients.

Comparison of One vs. Two Burr Hole Craniostomy in Chronic Subdural Hematoma Recurrence

Introduction/Objective: Chronic subdural hematoma (CSDH) is most frequent neurosurgical conditions. To find the recurrence rate of chronic subdural hematoma in patients who underwent one vs. two burr craniostomy.&#x0D; Material And Methods: A randomized controlled trial was conducted at the Neurosurgery department, Ayub Teaching Hospital, Abbottabad. In the current study, a total of 76 (38 in each group) patients were observed. ASA-I, ASA-II, ASA III patients, symptomatic radiologically proven Chronic subdural hematoma. Patients were randomly allocated into two groups of 38 patients each. randomization with blocks. Group A was treated with intraoperative epidural methylprednisolone while Group B was treated with normal saline only. Clinical information was recorded on a pre-designed proforma.&#x0D; Results: Mean age was 54 years in group A, and 56 years in group B. In group A, 74% were male and 26% of patients were female. In Group B, 76% were male and 24% were female. The group A, 5% of patients had recurrence while in Group B, 13% of patients had a recurrence. There existed a significant difference between effectiveness and not-effectiveness of one/two burr hole craniostomy among patients who were less than 40 years.&#x0D; Conclusion: The recurrence rate of chronic subdural hematoma is higher in patients undergoing two burr hole craniostomy as compared to one burr craniostomy.

Peripheral blood eosinophil and classification of residual hematoma help predict the recurrence of chronic subdural hematoma after initial surgery.

Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in neurosurgical practice, whose incidence has increased markedly in recent years. However, CSDH still troubles clinicians with a high postoperative recurrence rate. The presence of eosinophils has been confirmed in some CSDH surgical specimens. Furthermore, postoperative residual hematoma has not been classified, and its association with the recurrence of CSDH remains unknown. The present study aimed to test the hypothesis that the peripheral blood eosinophils and the classification of postoperative residual hematoma are significant for the prediction of CSDH recurrence after burr-hole surgery. A retrospective review of 258 CSDH patients who received burr-hole surgery was performed. A complete blood picture with differential count was taken before surgery. Clinical, laboratory, and radiographic factors predicting CSDH recurrence were identified in univariable and multivariable analyses. Univariable analysis showed that the percentage of eosinophils, peripheral blood eosinophil count <0.15 × 109/L, gradation and separated types, postoperative volume of the residual cavity ≥70 ml, residual air volume ≥28 ml, residual hematoma volume ≥55 ml, residual hematoma width ≥1.4 cm, postoperative midline shift ≥5.6 mm, postoperative brain re-expansion rate <41%, postoperative low-density type, and postoperative high-density type correlated with the recurrence of CSDH. Multivariable analysis, however, showed that peripheral blood eosinophil count <0.15 × 109/L, gradation and separated types, preoperative midline shift ≥9.5 mm, postoperative brain re-expansion rate <41%, postoperative low-density type, and postoperative high-density type are independent predictors for the recurrence of CSDH. We expect that peripheral blood eosinophils and the classification of postoperative residual hematoma may facilitate our understanding of the recurrence of CSDH after initial surgery.