Preoperative Hematoma Volume Research Articles

Non-acute subdural hematoma: estimation of recurrence using CT-volumetric measurements.

To identify risk factors for unilateral non-acute subdural hematomas NASH recurrence, as well as to perform volumetric quantitative analysis of hematoma, postoperative pneumocephalus and extent of hematoma evacuation. Recurrence of NASH increases morbidity and mortality and has negative socio-economic consequences. Its accurate prediction could improve patient specific care. Records of 102 patients after unilateral NASH evacuation during the period from 2014 to 2020 with a 4-month follow-up were evaluated. Impacts of preoperative clinical signs and factors on the incidence of NASH recurrence were evaluated, namely those of age, gender, timing of surgery, hematoma side, surgical technique (number of burr holes, trepanation versus craniotomy), duration of drainage, antithrombotic agents, morphological type of hematoma, preoperative hematoma volume (PHV), post-evacuation hematoma cavity volume (PHCV), pneumocephalus volume (PCV) and extent of hematoma evacuation (EHE) on the incidence of NASH recurrence were evaluated. An overall recurrence rate of 13.7 % was observed. Preoperative hematoma volume, postoperative hematoma cavity volume and postoperative pneumocephalus volume had a significant impact on incidence of recurrence. Pre- and postoperative volumetric evaluations, of patients with NASH, particularly the measurements of preoperative hematoma volume and postoperative volume of hematoma cavity and pneumocephalus have a potential to improve the prediction of clinically significant recurrence (Tab. 6, Fig. 3, Ref. 51). Text in PDF www.elis.sk Keywords: subdural hematoma, recurrence, pneumocephalus, risk factors.

Derivation of a Clinical Score for Prediction of Recurrence Following Evacuation of Chronic Subdural Hematoma: A Retrospective Cohort Study at a National Referral Centre

Chronic subdural hematoma (cSDH) is a common pathology, and recurrence is a common complication, which may be predicted by certain patient and radiologic factors. Empiric radiologic surveillance has been shown to convey no benefit. A retrospective review of a prospectively collated database was performed. Preoperative and postoperative noncontrast computed tomography scans were reviewed. Radiologic appearance, preoperative hematoma volume, patient age, presence of bilateral hematomas, maximal hematoma thickness, and therapeutic coagulopathy were assessed as predictors. Receiver operating characteristic curve analysis, logistic regression, and LASSO regression were used to select potential predictors. A multivariate model was then fitted, and a score was derived. A total of 142 patients were included. Maximal hematoma thickness >12 mm (P= 0.02) and age >65 years (P= 0.01) were found to correlate with the likelihood of recurrence. Bilateral hematomas and a hyperdense or mixed density appearance were also identified on LASSO regression. Bilateral hematomas (P= 0.19), hyperdense or mixed density (P= 0.66), maximum thickness >12 mm (P= 0.01), and age >65 years (P= 0.02) were included in the multivariate model. A 6-point score was derived. A score of>3 had a sensitivity of 89% (95% confidence interval [CI] 78%-97%) and specificity of 26% (95% CI, 17%-34%) for predicting recurrence, with recurrence significantly more likely in patients with a score of 4-6 versus those with a score of 0-3 (P= 0.02). Certain radiologic findings may predict the recurrence of cSDH following evacuation. The score derived may be useful in identifying patients who might benefit from routine postoperative surveillance imaging.

Efficacy of the Direct Aspiration-Irrigation Maneuver for the Treatment of Chronic Subdural Hematoma: A Single Hospital's Experience.

ObjectiveThe traditional methods for managing symptomatic chronic subdural hematoma (CSDH) at our hospital include evacuation via single burr-hole irrigation with continuous closed subdural drainage (SBID). The single burr-hole aspiration and irrigation technique with continuous closed subdural drainage (SBAID) is an attractive alternative method. The goal of this study was to evaluate the radiographic and clinical outcomes of SBAID compared with traditional SBID methods.MethodsA database of 51 CSDH patients treated with the SBAID method and 35 CSDH patients treated with the SBID method was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcomes were collected. Predictors of recurrence requiring reoperation and other outcomes were analyzed.ResultsCompared to the patients in the SBID group, the patients in the SBAID group had a shorter mean duration of surgery (56.6±5.6 minutes vs 59.5±4.8 minutes, respectively, P=0.02); a shorter mean interval from procedure to discharge (6.2±1.2 days vs 6.8±1.3 days, respectively, P=0.046); no significant difference in preoperative hematoma volume (106.4±21.7 cm3 vs 101.3±16.3 cm3, respectively, P=0.25); and a smaller subdural space volume 48 hours after the operation (43.6±7.4 cm3 vs 47.4±9.1 cm3, respectively, P=0.03).In addition, symptomatic hematoma recurrence developed in one patient in the SBAID group and five patients in the SBID group (P=0.03). The in-hospital mortality rates of the SBAID and SBID groups were 2% (1 of 51) and 6% (2 of 35), respectively; this difference was not statistically significant (P=0.35).ConclusionsThe SBAID method results in a remarkably low recurrence rate and good outcomes. This method should be considered for patients presenting with symptomatic CSDHs.

Short-term outcomes of endoscopic evacuation of supratentorial spontaneous intracerebral hematoma: Early experience from developing country.

Background: Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage (ICH). However, the technique still needs improvement.Methods: We report our early clinical experience of using this technique to evacuate supratentorial spontaneous intracerebral hematomas and evaluate its short-term outcomes.Results: The study included 15 patients, basal ganglia hematoma was the most common location 62.5%, mean preoperative hematoma volume was 61.07 cc, mean ICH score was 3, and mean rate of hematoma evacuation was 89.27%. Factors that could be related to mortality were Glasgow Coma Score (GCS) on admission (P = 0.001), ICH score (P = 0.004); postoperative GCS (P < 0.001), postoperative hematoma volume (P = 0.006); intraventricular extension (P = 0.001), and rate of evacuation (P = 0.001).Conclusion: Endoscopic technique is a safe surgical option for evacuation of spontaneous supratentorial ICH. This minimally invasive technique could be helpful to provide better short-term outcomes for selected patients. However, in our experience, this minimally invasive technique did not change the outcome for cases presented with poor GCS on admission 4/15. Our results warrant a future prospective, randomized, controlled efficacy trial.

Definition and time course of pericavity edema after minimally invasive endoscopic intracerebral hemorrhage evacuation

BackgroundPerihematomal edema (PHE) volume correlates with intracerebral hemorrhage (ICH) volume and is associated with functional outcome. Minimally invasive surgery (MIS) for ICH decreases clot burden and PHE. MIS may therefore...

Prediction Models for Recurrence of Chronic Subdural Hematoma in Patients Underwent Twist-Drill Craniostomy Combined With Urokinase Instillation.

The recurrence of chronic subdural hematoma (CSDH) is high post-treatment. In this study, we aimed to construct individualized models for prediction of the postoperative recurrence of CSDH in patients underwent twist-drill craniostomy combined with urokinase (UK) instillation. In total, 183 patients with CSDH were retrospectively enrolled. In summary, 21 candidate factors were retrieved from past medical records. The least absolute shrinkage and selection operator regression was adopted to reduce the high dimensionality of data. Four predictors: preoperative hematoma volume, encephalatrophy, brain re-expansion, and UK instillation frequency were filtered from the 21 candidate factors using the least absolute shrinkage and selection operator method. Binary logistic regression model was employed to establish preoperative and postoperative prediction models. The preoperative model included preoperative hematoma volume and encephalatrophy whereas the postoperative model included brain re-expansion and UK instillation frequency. The predictive performance of the nomograms was evaluated by the receiver operating characteristic curve and calibration chart. Area under curve of the preoperative and postoperative models were 0.755 (95% confidence interval: 0.690-0.889) and 0.782 (95% confidence interval: 0.720-0.936), respectively, indicating good discrimination ability. The calibration results showed good fitting between the predicted probability and the actual probability. Finally, a decision curve analysis revealed excellent clinical performance of the proposed nomograms. Functionally, the preoperative model was used to identify high-risk patients with CSDH and application of UK, while the postoperative model was applied to guide physician-patients communication during follow-up. These 2 prediction models provide a basis for further clinical and experimental studies.

The microsurgical treatment for primary hypertensive brainstem hemorrhage: Experience with 52 patients

ObjectiveThis study aims to investigate the effect of minimal invasive microsurgery in treating primary hypertensive brainstem hemorrhage (PHBH). Methods52 patients of PHBH (≥3.5 ml) who have taken the minimal invasive microsurgery with neuronavigation guidance were included between Jan. 2011 and Dec. 2018. The volume/location/type of hematoma, preoperative Glasgow Coma Scale (GCS), postoperative Glasgow Outcome Scale (GOS) and hemorrhagic dilatation of the fourth ventricle were analyzed during the follow-up period ranged from 3 to 57 months. ResultsAmong all the patients, 18 achieved complete hematoma evacuation (≥95%), 31 achieved subtotal evacuation (≥90%), 3 achieved premodinantly evacuation (>75%). No rebleeding during or after surgery within 24 h were found. 45 patients survived after 3 months, the mean preoperative hematoma volume decreased from 7.1 ± 2.6 ml–0.9 ml (p < 0.05), 19 patients got GOS Grade V/Ⅳ. It is shown the volume less than 10 ml always led to better outcome while massive and bilateral hematoma were related with poor prognosis. ConclusionThe microsurgical hematoma evacuation under neuronavigation assistance is a rapid, effective, and safe technique for the removal of PHBH, especially for the volume less than 10 ml.

Burr hole drainage without irrigation for chronic subdural hematoma.

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions, with different strategies for treatment. Most recent trials favor the use of drainage to reduce the recurrence rate. However, few reports have discussed the efficacy of burr hole drainage without irrigation for treating CSDH. This study aimed to examine the efficacy of burr hole drainage without irrigation in a series of 385 symptomatic CSDH lesions.Methods: This retrospective study included a series of 385 symptomatic CSDH lesions in 309 patients, who underwent burr hole drainage without irrigation, between September 2009 and August 2017 at the Department of Neurosurgery, Yao Tokushukai General Hospital, Japan. The risk of recurrence was evaluated based on the patients’ age, sex, preoperative magnetic resonance imaging (MRI) findings, preoperative anticoagulants, hematoma drainage rate, and bilaterality.Results: Of the 385 lesions, 41 cases (16 with inadequate follow-up periods and 25 with contraindications for MRI) were excluded from the analysis. The overall recurrence rate in the index study was 4.9% (17/344 lesions). The effects of the preoperative hematoma volume and nonhyperintensity on T1-weighted imaging on the recurrence rate were significant.Conclusion: Our findings indicated that burr hole drainage without irrigation is a good surgical modality in patients with CSDH, and preoperative MRI findings can evaluate the risk of recurrence.

Take it seriously or not: postoperative pneumocephalus in CSDH patients?

Background: Pneumocephalus is a common finding after burr-hole drainage of chronic subdural hematoma (CSDH). Its effects have not been specifically studied.Methods: A retrospective analysis was performed in 140 patients with CSDH with single burr-hole drainage. The pre- and postoperative volumes of intracranial hematoma and the postoperative volume of pneumocephalus were calculated and analyzed with their relationships with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores.Results: The preoperative hematoma volume and the patient ages are positively correlated with the 1-day postoperative pneumocephalus volume (p < 0.001, p < 0.01). There is no correlation between postoperative pneumocephalus volume and GCS/GOS scores (p > 0.05) and there is no difference of GCS/GOS scores or CSDH recurrence rate between patients with and without pneumocephalus (p > 0.05). The age and the volume of 1-day postoperative pneumocephalus are positively correlated with the absorbing rate of pneumocephalus (p < 0.01, p < 0.001).Conclusions: The pneumocephalus at a certain range has no effect on the prognosis of patients with CSDH and requires no specific intervention due to its self-absorbing capacity in the normal progress after surgery.HighlightsNo correlation between postoperative pneumocephalus volume and GCS/GOS scores.No difference of GCS/GOS or recurrence between patients with pneumocephalus or not.Pneumocephalus at certain range has no effect on the prognosis of patients.

Double-crescent sign as a predictor of chronic subdural hematoma recurrence following burr-hole surgery.

Subdural hygroma has been reported as a causative factor in the development of a chronic subdural hematoma (CSDH) following a head trauma and/or neurosurgical procedure. In some CSDH cases, the presence of a 2-layered space delineated by the same or similar density of CSF surrounded by a superficial, residual hematoma is seen on CT imaging after evacuation of the hematoma. The aims of the present study were to test the hypothesis that the double-crescent sign (DCS), a unique imaging finding described here, is associated with the postoperative recurrence of CSDH, and to investigate other factors that are related to CSDH recurrence. The authors retrospectively analyzed data from 278 consecutive patients who underwent single burr-hole surgery for CSDH between April 2012 and March 2017. The DCS was defined as a postoperative CT finding, characterized by the following 2 layers: a superficial layer demonstrating residual hematoma after evacuation of the CSDH, and a deep layer between the brain's surface and the residual hematoma, depicted as a low-density space. Correlation of the recurrence of CSDH with the DCS was evaluated by multivariate logistic regression modeling. The authors also investigated other classic predictive factors including age, sex, past history of head injury, hematoma laterality, anticoagulant and antiplatelet therapy administration, preoperative hematoma volume, postoperative residual hematoma volume, and postoperative brain reexpansion rate. A total of 277 patients (320 hemispheres) were reviewed. Fifty (18.1%) of the 277 patients experienced recurrence of CSDH within 3 months of surgery. CSDH recurred within 3 months of surgery in 32 of the 104 hemispheres with a positive DCS. Multivariate logistic analyses revealed that the presence of the DCS (OR 3.36, 95% CI 1.72-6.57, p < 0.001), large postoperative residual hematoma volume (OR 2.88, 95% CI 1.24-6.71, p = 0.014), anticoagulant therapy (OR 3.03, 95% CI 1.02-9.01, p = 0.046), and bilateral hematoma (OR 3.57, 95% CI 1.79-7.13, p < 0.001) were significant, independent predictors of CSDH recurrence. In this study, the authors report that detection of the DCS within 7 days of surgery is an independent predictive factor for CSDH recurrence. They therefore advocate that clinicians should carefully monitor patients for postoperative DCS and subsequent CSDH recurrence.

A Grading System For The Prediction Of Unilateral Chronic Subdural Hematoma Recurrence After Initial Single Burr Hole Evacuation.

Background and purposePrevious studies have identified many risk factors related to the recurrence of chronic subdural hematomas (CSDHs). Among these factors, there may be deviations in measuring the midline shift, preoperative hematoma volume (PreHV), postoperative hematoma residual volume, and postoperative pneumocephalus in bilateral CSDHs. The aims of this study were to eliminate the impact of complicated situations on parameter measurement and to identify actual predictors for CSDH recurrence, and finally, to develop a grading system to predict unilateral CSDH (uCSDH) recurrence.Patients and methodsA total of 342 patients with uCSDH were identified. Predictors of uCSDH recurrence were obtained from univariable and multivariable logistic regression models. A prognostic grading system was developed based on the results of multivariable logistic regression and receiver operating characteristic (ROC) analyses. All patients were scored according to the grading system, and differences in the recurrence rate were reanalyzed according to the scores.ResultsAge, antiplatelet or anticoagulant use, midline shift, severe brain atrophy, drainage volume, and the ratio of the postoperative pneumocephalus volume (PostPV) to the postoperative hematoma cavity volume (PostHCV) were identified as independent risk factors for predicting the recurrence of uCSDH. The cut-off values of age, drainage volume, midline shift, and the ratio of the PostPV to the PostHCV were 67 years, 101 mL, 11.2 mm, and 31.61%, respectively. The recurrence rates were 1.7%, 12.4%, 19.4%, 53.3%, and 58.3% for scores of 0–1, 2, 3, 4, and 5–6, respectively, which significantly increased as the score increased (P<0. 001).ConclusionThe prognostic grading system for uCSDH on the basis of multivariable logistic regression and ROC analyses is applicable and reliable.

Prospective Study on the Efficacy of Orally Administered Tranexamic Acid and Goreisan for the Prevention of Recurrence After Chronic Subdural Hematoma Burr Hole Surgery

This prospective study investigated whether tranexamic acid and Goreisan effectively prevent recurrence after burr hole surgery for chronic subdural hematoma. A total of 297 patients with chronic subdural hematoma underwent initial burr hole surgery at our hospital from April 2014 to March 2018. Of these, 206 patients (250 hematomas) consented to participate in this study. Patients were randomly divided into the nonadministration, tranexamic acid, and Goreisan groups based on age. The oral administration intervention was implemented from the day after surgery, after which there was a 3-month follow-up. Recurrence rates were measured, and head computed tomography scan was used to measure the volume of residual hematoma 1 day, 1 week, and 1, 2, and 3 months after surgery. A total of 193 patients (232 hematomas) were followed-up for 3 months (82 hematomas in the nonadministration group, 72 hematomas in the tranexamic acid group, and 78 hematomas in the Goreisan group). There were no significant between-group differences in demographic characteristics, current drug treatment, comorbidities, hematoma, operation side (bilateral or unilateral), preoperative hematoma volume, and recurrence rates. At 1, 2, and 3 months, the residual hematoma volume was significantly smaller in the tranexamic acid group than in the other 2 groups. Oral administration of tranexamic acid or Goreisan does not minimize recurrence after chronic subdural hematoma burr hole surgery; however, tranexamic acid can reduce the hematoma volume.

Volume and Midline Shift as Preoperative Computed Tomography Imaging Predictors of Postoperative Chronic Subdural Hematoma Recurrence: Retrospective Review of 345 Patients With 412 Operative Subdural Sides

Abstract INTRODUCTION The treatment and management of chronic subdural hematoma (cSDH) is highly variable, with recurrent surgery resulting in increased elderly morbidity, and economic burden to patients and the healthcare system. By conducting a retrospective review of patients with cSDH who underwent evacuation, we will provide a better understanding of predictive factors of recurrence, thereby optimizing a surgeon's management and treatment. METHODS We conducted a retrospective review of 345 patients with a total of 412 sides of cSDH, who received either burr-hole craniostomy or a craniotomy with closed system drainage. We reviewed the immediate preoperative and postoperative computed tomography (CT) scan, and defined recurrence as repeat surgical intervention on the side of initial evacuation. We performed a per-patient and per-side analysis of the collected data. RESULTS A total of 49 (11.9%) patients and 51 sides (12.4%) experienced a recurrent cSDH requiring re-evacuation. In the per-patient analysis, the preoperative hematoma volume [CI 1.082 (1.013-1.155)] and midline shift at the third ventricle [CI 1.118 (1.1028-1.215)] were predictors of recurrence. This was also observed in the per-side analysis at CI 1.088 (1.021-1.159) and CI 1.130 (1.045-1.222), respectively. On the per-patient side, comorbidities (diabetes, liver disease, alcohol abuse, antiplatelet/anticoagulant medication) and other demographic factors (gender, age) were not linked to recurrence. If a patient had a bilateral hematoma and both sides were operated on, it was found to be protective of recurrence with a CI of 0.111 (0.025-0.486). CONCLUSION Larger preoperative volumes and a greater midline shift significantly increased the risk of re-evacuation for cSDH, while other demographic and CT characteristics did not. Therefore, this may represent that a high-risk subgroup can be used as a target for preventative therapy.

Endoscopic Hematoma Evacuation for Intracerebral Hemorrhage Under Local Anesthesia: Factors That Affect the Hematoma Removal Rate

Recent advances in endoscopic surgery have led to more patients being able to undergo endoscopic removal of hypertensive intracerebral hemorrhage (HICH). However, because of the minimal invasiveness, endoscopic HICH removal through a narrow surgical window can result in a low removal rate. The goal of the present study was to investigate the factors that affect the removal rate of HICH evacuation. The data from 28 patients with supratentorial HICH who had undergone endoscopic hematoma evacuation were retrospectively analyzed. The inclusion criteria were spontaneous supratentorial HICH with a hematoma volume >30 mL, admission to the hospital within 24 hours of ictus, and a Glasgow coma scale score of ≥4. Of the 28 patients, 9 were women and 19 were men, ranging in age from 41 to 86 years (mean, 60.7 ± 12.7). The hematoma location was the basal ganglia in 25 patients and subcortical in 3 patients. The mean preoperative hematoma volume was 62.4 ± 22.5 mL. The hematoma removal rate was <60% for 11 patients (poor evacuation group) and ≥60% for in 17 patients (good evacuation group). Comparing the 2 groups, chronic renal failure treated with hemodialysis (P= 0.0072, χ2 test), liver cirrhosis (P=0.023, χ2 test), and surgeon experience with ≥10 cases of endoscopic HICH removal (P= 0.016, χ2 test) were significant factors related to the HICH removal rate. To achieve a good removal rate, surgeons should have experience performing the endoscopic procedure. Also, patients with end-stage chronic renal failure or liver cirrhosis should be excluded.

Contralateral progression after unilateral evacuation of bilateral chronic subdural hematomas: the volume relation ratio as prognostic factor?

Unilateral evacuation of bilateral chronic subdural hematomas (bcSDHs) is associated with higher retreatment rates than an initial bilateral intervention. One reason for that is a possible progression in the size of the contralateral side after unilateral treatment. Thus, the authors focused their study on finding predictors of the need for contralateral retreatment. All patients who had undergone unilateral or bilateral evacuation of bcSDHs in the Department of Neurosurgery at the University Hospital of St. Poelten during a 5-year period (7/2012 to 6/2017) were retrospectively identified. The preoperative hematoma volume was calculated using the XYZ/2 method. Of a total of 103 patients with bcSDHs, 61 patients underwent bilateral evacuation and 42 patients underwent unilateral evacuation. The retreatment rate after bilateral evacuation was significantly lower than that after unilateral evacuation (14.8% vs 31%, respectively; p = 0.049). Contralateral retreatment after unilateral evacuation was necessary in 9 patients (21.4%). The preoperative contralateral hematoma volume was significantly higher in those patients who needed contralateral retreatment after initial unilateral evacuation (68.4 cm3 vs 27.4 cm3, respectively; p < 0.001). Furthermore, the so-called volume relation ratio created by dividing the smaller by the larger hematoma volume was significantly higher when contralateral retreatment became necessary (0.56 vs 0.21, respectively; p < 0.001). Patients needing evacuation of bcSDHs should be considered for primary bilateral evacuation if the hematoma volume on the smaller side is greater than 40 cm3 and the subsequent volume relation ratio is greater than 0.4.

A Reliable Nomogram Model to Predict the Recurrence of Chronic Subdural Hematoma After Burr Hole Surgery

We established a reliable nomogram model to predict the recurrence of chronic subdural hematoma (CSDH) after burr hole surgery. We retrospectively analyzed 514 patients who were treated in our hospital between January 2010 and November 2017 and included 231 patients in this study. We used univariate and binary logistic regression analysis to identify the significantly related predictors for recurrence. Subsequently, we established the nomogram model using these predictors and validated it. The total rate of recurrence after initial surgery for CSDH was 14.29% (33/231) during the following 3 months. We found that preoperative hematoma volume (greater than 121 mL), postoperative residual cavity volume (greater than 72 mL), computed tomography scan imaging type (hyper- and mixed-density type), and age (older than 65 years of age) were significantly related to recurrence. We used 50% recurrence rate as the classification cutoff, with the corresponding points of 252 to validate the nomogram model. The accuracy of predicting the recurrence of CSDH calculated by the binary logistic regression model was 91.7%. The sensitivity and specificity of the nomogram were 87.88% and 84.85%, respectively. This nomogram model had a high precision to predict the recurrence of CSDH. It needs more external and prospective validation in the future. We expect this model could be used in different neurosurgical problems as well.

Burr-Hole Craniostomy with T-Tube Drainage as Surgical Treatment for Chronic Subdural Hematoma

We sought to investigate the effect of burr-hole craniostomy with T-tube drainage to treat chronic subdural hematoma (CSDH). Eighty-seven patients with CSDH who were recruited from January 2012 to June 2017 at the Department of Neurosurgery, The First Affiliated Hospital of Xi'an Medical University, were divided into 2 groups according to the method of drainage: T-tube drainage system (n= 45) and conventional subdural drainage system (n= 42). Retrospective analysis of clinical data and efficacy was performed between the 2 groups. There were no significant differences in age, preoperative Markwalder grade scale, preoperative hematoma volume, hospitalization days, and discharge Markwalder grade scale between the 2 groups (P > 0.05). The incidence of postoperative complications and hematoma recurrence in the group of patients with T-tube drainage was significantly reduced when compared with conventional subdural drainage systems (P < 0.05). Both methods were effective in the treatment of CSDH; however, we found a lower overall surgical complication rate following treatment with burr-hole craniostomy and T-tube drainage. This indicates that it may be a better therapeutic option for management of CSDH.

Artificial neural network predicts hemorrhagic contusions following decompressive craniotomy in traumatic brain injury.

This study aimed to explore relevant factors of hemorrhagic contusions following decompressive craniotomy (DC) in traumatic brain injury (TBI) and create an artificial neural network (ANN) prediction model of the risk factors of hemorrhagic contusions. This study analyzed 425 patients with TBI who underwent DC in the Neurosurgery Department of Shaoxing People's Hospital between 2009 and 2014. Patients were divided into two groups according to the first postoperative CT scans: hemorrhage group and non-hemorrhage group. Gender, age, preoperative situations (Initial Rotterdam CT Score, GCS Score, pupillary response, laboratory data and preoperative hematoma), the time gap between trauma and DC, postoperative CT scans, and Glasgow Outcome Scale (GOS) scores were recorded. ANN was used to predict hematoma. Correlation analysis was used to state the relationship between increased hemorrhage volumes and GOS scores. The ANN prediction model was established. This model included 11 parameters: initial Rotterdam CT score, GCS score, C-reactive protein, age, the time gap between trauma and DC, pupillary response, platelet count, bone-flap size, glucose level, hernia magnitude and preoperative hematoma volume. The overall predictive accuracy of the model was 73.0%. Initial Rotterdam CT scores and GCS scores may predict the risk of expansion contusions following DC. The ANN prediction model has a high accuracy to forecast hemorrhage.

Efficacy analysis of neural endoscopic and surgical operation in patients with cerebral hemorrhage induced by hypertension

Objective To discuss the efficacy of neural endoscopic and surgical operation in patients with cerebral hemorrhage induced by hypertension. Methods Sixty cases with cerebral hemorrhage induced by hypertension admitted at the People′s Hospital of Bortala from January 2015 to June 2016 were divided into the control group(n=32) and research group(n=28) according to cerebral hemorrhage surgical method.The patients of the control group were given conventional surgical operation treatment while the observation group were given neural endoscopic treatment.The operative time and intraoperative blood loss, and situation of hematoma absorption before and after operation and prognosis between the two groups were compared. Results The operative time and intraoperative blood loss of the two groups were respectively (132.6±35.4) min, (49.8±12.3) ml and (236.5±46.2) min, (263.5±49.8) ml, the observation group were obviously lower than that of the control group, the differences were statistically significant(t=6.532, 9.548, all P<0.05). The preoperative hematoma volume, postoperative hematoma volume and hematoma clearance of the two groups were respectively (6.8±1.5) ml, (82.7±6.3)% and (16.3±3.1) ml, (57.8±5.2)%, the postoperative hematoma volume of observation group were obviously lower than that of the control group while the hematoma clearance obviously increased, the differences were statistically significant(t=6.584, -5.263, all P<0.05). The ADL assessment in patients of observation group was better than the control group and the death rate was lower than that of control group, the differences were statistically significant(3.6%(1/28) vs.21.9%(7/32), χ2=10.580, 4.329, all P<0.05). Conclusion The efficacy of neural endoscopic applied in patients with cerebral hemorrhage induced by hypertension is remarkable, it causes little damage to the body and can obviously improve the effect of prognosis, it is worth popularization and application. Key words: Endoscopic; Surgical operation; Hypertension; Cerebral hemorrhage; Prognosis

Analysis of prognostic factors for hypertensive cerebral hemorrhage in patients with hypertensive intracerebral hemorrhage in basal ganglia region by surgical operation

Objective To analyze the related influence factors on the prognosis of hypertensive cerebral hemorrhage in basal ganglia with operation treatment, provide the basis for clinical prevention and treatment. Methods 80 patients for treatment of hypertensive cerebral hemorrhage were selected.By a retrospective study, we collected the clinical data and postoperative following-up data, status, complications, and observed the postoperative recovery. Statistical different hypertension, preoperative breaking into the ventricle, disturbance of consciousness, operation time and preoperative hematoma volume of the prognosis. Results In 80 patients,48 cases(60.00%)of patients has good prognosis; moderate disability, taking care of themselves life 10 cases(12.50%); severe disability, life can not take care of 9 cases(11.25%); plant survival of 5 cases(6.25%)and 8 cases of death(10.00%).22 cases of patients with brain hemorrhage again,3 cases postoperative pulmonary infection, 6 cases of secondary organ dysfunction.Poor prognosis of preoperative ventricle prognosis and disturbance of consciousness of patients was 88.26%(18/23)and 63.64%(21/33),which was higher than the preoperative without breaking into the ventricle and no disturbance of consciousness 24.54%(14/57)and 36.36%(21/33), the difference was statistically significant(χ2=10.38,9.76,P 60m L was 47.62% (20/42),which was higher than the preoperative hematoma volume 40-60m Lpatients31.38%(12/38),the difference was statistically significant(χ2=9.12,P<0.05). Conclusion It has obvious effect on surgery operation prognosis of patients with hypertensive cerebral hemorrhage, including optimal time for operation; bleeding time, intraventricular hemorrhage, disturbance of consciousness and bleeding volume.If the clinical treatment in the prevention and treatment to improve the survival and quality of life of patients with cerebral hemorrhage. Key words: Hypertension; Cerebral hemorrhage; Surgical operation; The prognosis; Influence factors