Incidence Of Chronic Subdural Hematoma Research Articles

Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures.

Chronic subdural haematoma (CSDH) is a rare clinical complication of neurosurgical procedures. CSDH occurs sporadically after aneurysm clipping surgery and revascularisation surgery but the risk factors are not known. The present study reviewed 6613 consecutive neurosurgical procedures performed from January 1987 to July 2001, and identified 621 cases of CSDH. Fifty of these 621 cases had a past history of neurological disorders treated by neurosurgery. This study evaluated these 50 cases in order to elucidate the clinical and radiological characteristics of CSDH after neurosurgery and to investigate the etiology for identifying in the risk factors of CSDH as a postoperative complication. The incidence of CSDH after neurosurgery was 0.8% (50/6613). Twenty-seven of the 50 patients with a past history of neurosurgery had undergone aneurysm clipping surgery. The incidence after clipping surgery was 2.4%. Twelve of these 27 cases also underwent ventriculoperitoneal shunting. Three patients had postoperative CSDH after arachnoid cyst opening and/or shunting. The incidence was highest at 7.5%. Three patients had postoperative CSDH after brain tumour surgery. The incidence was low at 0.4%. However, the ventricular cerebrospinal fluid (CSF) space was opened during tumour removal in 2 of these 3 patients. Communication of the subarachnoid space to the subdural space is considered to be one of the causative factors and excessive CSF shunting facilitates formation of CSDH after neurological surgery. Repair of arachnoid tearing during neurosurgery and avoidance of excessive CSF shunting may reduce the risk of CSDH after neurosurgery.

Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage.

Despite the high incidence of chronic subdural haematoma (SDH), to date relatively few authors have undertaken a systematic analysis of the results attained following burr-hole craniostomy and closed-system drainage on the basis of a study involving a large patient population defined according to clear-cut criteria. Between 1980 and 1993, surgery was performed on 212 patients with a chronic SDH. In a retrospective study, the condition of each patient was assessed at the time of admission on the basis of the Bender Scale and the results 4 weeks after discharge were classified according to the Glasgow Outcome Scale (GOS). At admission, 165 patients (78%) were in a satisfactory condition (Stage 1 or 2); 47 (22%) were at Stage 3 or 4, i.e. stuporous or comatose. Nine (4%) of the patients died; none of these deaths was attributable to the operation. In addition to significant extracerebral disease (2.4%), CT revealed ischaemic cerebral infarctions in three patients (1.4%) after removal of the SDH. The operative morbidity was 4.2%. In 22% of the patients, surgical intervention was required to remove a recurring SDH. In 90% of the patients, the results achieved could be graded as 'very good' or 'good' (GOS 1 or 2). The results were related to the condition at admission (p < 0.001) and the patient's age (p < 0.05). Factors that did not have a significant effect on the outcome included whether the SDH formation was bilateral or unilateral, the extent of neomembranous organization of the haematoma, and the amount of primary cerebral expansion following decompression. We were able to confirm the results of previous studies that the method used is a highly effective treatment, with a low incidence of complications.

Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect.

The epidemiological aspect of chronic subdural hematoma (CSH) in the elderly who are 65 years old or elder was evaluated on Awaji Island with about 170,000 inhabitants. The overall incidence of CSH was 13.1 per 100,000/year, 3.4 in people under 65 years old, and 58.1 in the elderly. The elderly were 17.7% of all inhabitants. If these incidences of CSH are extrapolated to all of Japan in the year 2020, the incidence will be 16.3 per 100,000/year. This suggests that CSH may become the most common neurosurgical condition.

Clinical study of chronic subdural hematoma and hygroma in two hospitals for elderly patients with dementia

The authors have investigated the incidence of chronic subdural hematoma and hygroma (CSH) in two hospitals for elderly patients with dementia syndrome over a period of three years and nine months. All observed patients had been in the hospital for 2 weeks or more and had had brain computed tomography (CT) on admission. The total of 613 patients included 212 males and 401 females. Based on the CT findings observed in patients on admission, the authors found 47 patients with CSH. This was equivalent to 7.7% of all patients observed. After admission, almost all patients had brain CT twice per year, with a mean of 2.2 CT examinations during the observation period. Sixteen patients who had no CSH on admission developed CSH. Thus a total of 63 (10.3%) demented patients demonstrated CSH during the observation period. It was assumed that the high incidence of CSH in this study may be due to the practice of performing routine CT examinations in hospitalized patients and the fact that demented patients are prone to fall and hit their heads. From the investigation of past history, tastes, and patterns of daily behavior, we found the risk factors for CSH development to be male sex, alcohol abuse and wandering as a symptom of dementia. We performed CT examinations on all patients who showed subjective or objective neuro-symptoms related to the central nervous system, but we could find only 2 patients with high-density lesions in the subdural space that indicated acute bleeding. This was only 3.1% (2/65) of all patients who developed subdural effusion.(ABSTRACT TRUNCATED AT 250 WORDS)