Surgery For Chronic Subdural Hematoma Research Articles

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.

Time-of-flight magnetic resonance angiography for detection of postoperative recurrence in patients with chronic subdural hematoma.

Chronic subdural hematoma (CSDH) is associated with postoperative recurrence. Although various factors are involved in postoperative recurrence of CSDH, blood flow, especially in the middle meningeal artery (MMA), is considered to play an important role. We investigated whether the degree of signal intensity (SI) of the MMA on time-of-flight magnetic resonance angiography (TOF MRA) and various clinical factors are involved in recurrence of CSDH. The maximum SI of both MMAs was measured on TOF MRA images within 1month before or after the initial surgery. In total, 185 patients (20 with and 165 without recurrence of CSDH) were included in the analysis. The SI ratio and dementia were significant predictors of recurrence of CSDH (SI ratio: odds ratio [95% confidence interval (CI)] = 1.71 [1.32, 2.22], p < 0.0001; dementia: odds ratio [95% CI] = 7.41 [1.83, 30.1], p = 0.005). The estimated regression coefficients in the final model were 6.14 for the SI ratio and 1.28 for dementia. The risk score was derived according to these regression coefficients as follows: score = 5 × SI ratio + 1 (dementia: yes). With a score of 5, the predicted probability of recurrence was 2% [95% CI 0.7, 5.7], whereas with scores of 8 and 10, the probability was 43.3% [27.0, 61.1] and 89.5% [65.7, 97.5], respectively, which increased the risk of recurrence. Patients with an increased SI ratio of the affected MMA on TOF MRA who underwent surgery for CSDH were significantly more likely to experience recurrence.

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.

Role of Adjunctive Tranexamic Acid in Facilitating Resolution of Chronic Subdural Hematoma after Surgery.

Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution. Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA, and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated. A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p<0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p<0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p<0.001). There was no TXA-related adverse event. The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.

A Validation Study of Kwon's Prognostic Scoring System for Chronic Subdural Hematoma

Surgery for chronic subdural hematoma is one of the most frequent operations in neurosurgical practice. Chronic subdural hematoma mostly afflicts the elderly population. In 2018, Kwon and co-workers, published the Kwon scoring system (KSS), whereby 6 clinical and radiological factors are used to facilitate, and promote quality in, surgical decision-making and counseling of relatives. The aim of this study is to validate the KSS. Patients operated on for unilateral chronic subdural hematoma at Örebro University Hospital, Sweden, between 2013 and 2019 constituted the study population. General data and the 6 outcome predictors according to the KSS were extracted from the electronic patient records. The preoperative modified Rankin Scale score and the postoperative 6-month modified Rankin Scale score were assessed. We identified 133 patients (69.2% male) with a median age of 80.2years (interquartile range 72.6-85.9). The median Glasgow Coma Scale score at admission was 15; 57.1% had motor deficits and 36.81% were disoriented. For 39.1% of the patients, the prognosis was a favorable outcome (modified Rankin Scale 0-1) at 6months. The median KSS score was 9; 63.9% of the patients scored ≥9, and 36 (42.4%) of these patients actually achieved a favorable outcome. This corresponds to a prediction model sensitivity of 0.667 and specificity of 0.424. A receiver operator characteristic curve analysis of the model yielded an area under the receiver operator characteristic curve of 0.62441. In our material, the KSS did not predict outcome precisely enough to base treatment decisions or counseling of relatives on the scores obtained.

Incidence of surgery for chronic subdural hematoma in Finland during 1997-2014: a nationwide study.

The number of surgeries performed for chronic subdural hematoma (CSDH) has increased. However, these changes have been poorly reported. The authors aimed to assess the national incidence of surgeries for CSDH in Finland during an 18-year time period from 1997 to 2014. They hypothesized that the incidence of CSDH surgeries has continued to increase, particularly among the elderly. A nationwide register-based follow-up study was performed using the Finnish Care Register for Health Care. All adult patients undergoing primary CSDH surgeries during 1997-2014 were included. The study population was followed up from the time of CSDH surgery until death or the end of follow-up on December 31, 2017. The incidences of CSDH surgery per 100,000 person-years were calculated separately in each age group and sex. Age standardization was performed for those 20 years of age and older with weights from the 2013 European Standard Population. Negative binomial regression models were used to assess changes in incidence rate ratios (IRRs) during the study period. In total, 9280 patients were identified. The age-standardized incidence of CSDH surgery increased from 12.2 to 16.5 per 100,000 person-years during 1997-2014. The age- and sex-adjusted incidence of CSDH surgery increased by 30% (IRR 1.30, 95% CI 1.20-1.41). The age- and sex-adjusted incidence increased more in the older age groups, with an IRR of 1.24 for those aged 60-69 years, 1.32 for those 70-79 years, 1.46 for those 80-89 years, and 1.85 for those aged 90 years or older. The adjusted incidence did not increase for those aged 18-59 years. The sex difference (2:1 men/women) was consistent throughout the study period, with a higher incidence among men. One year after the primary surgery, 19% of the population had a resurgery, and the 1-year case fatality rate was 15%. The median age of patients increased from 73 to 76 years. During the past 2 decades, the age- and sex-adjusted incidence of CSDH surgery has increased in Finland, with major increases for those aged 60 years or older. This increase is likely to continue in parallel with the aging population and increased life expectancies.

Influence of nutritional status on the clinical outcome of patients with chronic subdural hematoma: a prospective multicenter clinical study

ABSTRACT Background: Elderly patients present a higher risk of developing chronic subdural hematomas (CSDHs) together with increased risk of malnutrition. The nutritional status may affect outcomes, response to treatments, and prognosis. Influence on other kinds of diseases was investigated showing an increased risk of mortality, morbidity, and adverse outcomes. However, no studies are available on its possible role for the outcome of patients with CSDH. This study aims to evaluate a possible relationship between the nutritional status and the clinical outcome of patients who underwent CSDH surgery. Methods: This is a multicenter prospective study enrolling all patients treated for CSDH. Demographic and clinical data were collected. For nutritional status evaluation, we used the Mini Nutritional Assessment (MNA). Chi-square test was used for comparing clinical variables of patients and logistic regression analysis was used for defining the impact of the aforementioned variables on the clinical outcome. Results: We enrolled 178 patients. Modified Rankin scale (mRS) was 0–2 pre-operatively in 23.6% of patients and post-operatively in 61.2% of patients. Total assessment MNA score was >23.5 in 47.8% of patients. Ninety-three patients (52.2%) presented a normal nutritional status, 63 (35.4%) were at risk of malnutrition and 22 (12.4%) were malnourished. The mean follow-up was 2.6 months. Malnourished patients were at higher risk of a worse outcome (OR 81; CI = 9-750). Conclusion: This study suggests that nutritional status represents a strong predictor of outcome. Our results, albeit preliminary, demonstrated malnutrition is correlated to the risk of worse clinical outcome for patients undergoing surgery for chronic subdural hematoma. Further investigations with wider casuistry and multiple nutritional scores are required to validate our data.

410 Total Hospital Cost of Middle Meningeal Artery Embolization Compared to Surgery for Chronic Subdural Hematomas: A Propensity Matched Analysis

INTRODUCTION: Fewer treatment failures have been found with middle meningeal artery (MMA) embolization compared to surgical evacuation for chronic subdural hematomas (cSDH). METHODS: All patients who presented with a cSDH to a single center from January 1st, 2018 to December 31, 2020 were retrospectively reviewed. Patients with one-year of post-treatment hospital cost data were included. Patients were placed into two cohorts based on initial treatment: surgery versus MMA embolization. Total hospital cost was obtained by the hospital financial department. A propensity match analysis(matching for age, sex, Charlson Comorbidity Index(CCI), presenting symptoms, previous trauma, use of pre-operative anticoagulants/antiplatelets(AC/AP), and maximal diameter of cSDH on pre-treatment CT image) was performed. The primary outcome was the mean hospital cost difference between surgery and MMA embolization after propensity match analysis. RESULTS: One-hundred-and-seventy patients met inclusion criteria, 48(28%) in the MMA and 122(72%) in the surgical cohort. There was no significant difference between the groups in mean age, CCI, preoperative AC/AP use, and initial presenting symptoms. The surgical cohort was found to have larger pre-treatment cSDHs (20.5mm,sD 6.7) and longer index hospital admissions (9.8 days,sD 7) compared to the MMA cohort(cSDH size:16.9 mm,sD 4.6; hospital days: 5.7,sD 2.4) (p&lt;0.001). A higher percentage of patients in the surgical cohort required an unplanned additional hematoma treatment (N=20, 16.4%) and hospital readmission(N=34, 28%) compared to the MMA group (additional treatment and hospital readmission:N=2, 4%)(p=0.04 and p=0.004, respectively). There was no significant difference in complications between the two cohorts. After propensity matching, the total hospital cost for the surgical cohort(N=28, $59,809,sD $27,730) was significantly higher compared to MMA embolization (N=28, $44,273, sD $17,622) (p=0.015). Linear regression analysis found an unexpected additional treatment as the only variable significant for total hospital cost in the match cohort (difference of $20,772,sD $10,037) (p=0.04). CONCLUSION: MMA embolization is associated with a decreased hospital cost compared to surgery. This lower cost is directly related to the decreased need for additional treatment interventions in the MMA group. This analysis further supports the overall clinical and financial efficacy of MMA embolization in select cSDH patients.

119 Impact of an Early Mobilization Protocol on the Reduction of Medical Complications After Surgery for Chronic Subdural Hematoma – GET-UP Trial Interim 1 Year Overview

INTRODUCTION: Timing for mobilization after chronic subdural hematoma (CSDH) surgery is highly heterogeneous among neurosurgical centers. No high-quality evidence addresses this question. METHODS: Our aim is to recruit a total of 208 patients. Patients are randomized to either an early mobilization group (EMG) where mobilization is required within the first 12 hours post-surgery; or to a bed rest group (BRG) where they remain recumbent for 48 hours after surgery. The primary outcome is medical complications after surgery and until discharge. Secondary outcomes include evaluation of the functional status at 1 year post-op, using Glasgow Outcome Scale Extended (GOS-E) and Short Form 36 Health Survey (SF-36). RESULTS: We present results of the interim analysis at one year post-op referring to the first 104 randomized patients. A total of 52 patients were randomized to each group. Two patients were lost to follow up at one year. No significant baseline demographic differences were observed. A good outcome was considered when patients achieved GOS-E 5 or higher. At one year we observed a tendency towards better outcome in the EMG group with 71% of the patients having a GOS E = 5 against 54% in the BRG group (p = 0.073). Mortality at 1 year demonstrated a tendency to be lower in the EMG group (21% against 30% in the BRG group, p = 0.305). When we analyze our results based on the SF-36 questionnaire, a tendency toward better performance in the EMG is apparent, especially in the physical performance (p = 0.048), mental health (p = 0.037), vitality (p = 0.043) and general health (p = 0.002) subdivisions. CONCLUSION: GET-UP Trial is performing in accordance with the established protocol. This interim analysis’ results validate the methodology and do not pose security concerns even after 1 year follow-up. Active recruitment is ongoing.

Impact of an early mobilization protocol on medical complications after surgery for chronic subdural hematoma – get up trial preliminary results and quality of life evaluation

Impact of an early mobilization protocol on medical complications after surgery for chronic subdural hematoma – get up trial preliminary results and quality of life evaluation

Adjuvant Corticosteroids With Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.

The use of adjuvant corticosteroids with surgery for chronic subdural hematoma (CSDH) has received considerable attention in recent years. However, there is no conclusive evidence regarding its effectiveness and safety for CSDH. Therefore, we performed a meta-analysis and systematic review to evaluate the effectiveness and safety of corticosteroids as an adjuvant treatment for the treatment of CSDH. We comprehensively searched electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) to identify relevant trials that investigated the efficacy and safety of adjuvant corticosteroids with surgery for CSDH, published from inception until May 2021. Outcome measures included recurrence rate, all-cause mortality, good functional outcome, length of hospitalization, and adverse events. We used the Cochrane risk of bias method to evaluate the quality of randomized controlled trials (RCTs), and the Newcastle Ottawa Scale to evaluate the quality of observational studies. We included nine studies, consisting of three RCTs and six observational studies, that compared corticosteroids as an adjuvant treatment to surgery with surgery alone. Pooled results revealed that the risk of recurrence was significantly reduced in patients who received adjuvant corticosteroids with surgery compared to those who underwent surgery alone (relative risk [RR] = 0.52, 95% confidence interval [CI] = 0.39–0.69, p < 0.00001). However, no statistically significant difference was observed between these groups in all-cause mortality (RR = 0.91, 95% CI = 0.37–2.23, p = 0.83), good functional outcome (RR = 1.03, 95% CI = 0.96–1.10, p = 0.47), length of hospitalization (MD = 0.35, 95% CI = –2.23 to 1.67, p = 0.83), and infection rates (RR = 0.99, 95% CI = 0.64–1.53, p = 0.95). Adjuvant corticosteroids with surgery reduce the risk of recurrence of CDSH, but do not improve the all-cause mortality or functional outcome, as compared to surgery alone. These findings support the use of adjuvant corticosteroids with surgery for CSDH patients. Further high-quality RCTs are required to confirm the efficacy and safety of adjuvant corticosteroids in the treatment of CSDH patients.

Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis

BackgroundMiddle meningeal artery (MMA) embolization results in fewer treatment failures than surgical evacuation for chronic subdural hematomas (cSDHs). We compared the total 1-year hospital cost for MMA embolization versus surgical...

Chronic subdural hematoma associated with dural metastasis leads to early recurrence and death: A single-institute, retrospective cohort study

The prevalence of chronic subdural hematoma (CSDH) associated with dural metastasis is uncertain, and appropriate treatment strategies have not been established. This study aimed to investigate the characteristics of and appropriate treatment strategies for CSDH associated with dural metastasis. We retrospectively reviewed the charts of 214 patients who underwent surgery for CSDH. The patients were divided into the dural metastasis group (DMG; n = 5, 2.3%) and no dural metastasis group (No-DMG; n = 209, 97.3%). Patient characteristics, treatment, and outcomes were compared between the two groups. Active cancer was detected in 31 out of 214 patients, 5 of whom (16.1%) had dural metastasis. In-hospital death (80.0% vs. 0%; p < 0.001) and recurrence within 14 days (80.0% vs. 2.9%; p < 0.001) and 60 days (80.0% vs. 13.9%; p = 0.002) were significantly prevalent in the DMG. All patients in the DMG developed subdural hematoma re-accumulation requiring emergent surgery because of brain herniation, and patients in the DMG had significantly worse recurrence-free survival (p < 0.001). This relationship remained significant (p < 0.001) even when the analysis was limited to the active cancer cohort (n = 31). CSDH associated with dural metastasis leads to early recurrence and death because of the difficulty in controlling subdural hematoma re-accumulation by common drainage procedures. Depending on the primary cancer status, withdrawal of active treatment and change to palliative care should be discussed after diagnosing CSDH associated with dural metastasis.

Minimal Invasive Surgery for Chronic Subdural Hematoma

Objective: To assess significant improvement in terms of the Glasgow Coma Scale in patients subjected to minimally invasive surgery for a chronic subdural hematoma.&#x0D; Materials and Methods: A total of 80 patients with chronic subdural hematoma (CSDH) were enrolled in a sequential fashion using a retrospective study design. The patients were treated with minimally invasive surgery (MIS) and assessed at the end of the 2nd postoperative day (POD) for any significant improvement in the Glasgow coma scale (GCS).&#x0D; Results: There were 76.25% male and 23.75% female patients. A maximum number of patients (42.5%) were found with a GCS ranging from 9/15 – 11/15 (Class B) followed by Class A having GCS 12-13 (36.25%) and then Class C with GCS 5 – 8 (21.25% patients). In 86.2% and 13.7&amp; of the patients, positive and negative outcomes were recorded. Maximum favorable surgical outcome was observed in 51-60 years of age group. In the majority of male patients, a favorable surgical outcome was reported. Similarly, a favorable surgical outcome was observed in Class B (GCS 9-11). There existed an insignificant difference between favorable surgical outcome vs. age groups, gender, and GCS class at baseline.&#x0D; Conclusion: This study found that CSDH using the MIS approach is linked to a high frequency of positive outcomes in terms of GCS improvement. A lower admission GCS score and older age are linked to a lower frequency of favorable outcomes and a higher likelihood of bad outcomes.

Complications Following Comparison of Surgery for Chronic Subdural Hematoma, With and Without Postoperative Drainage Tube

Objectives: Chronic subdural hematoma (CSDH) is one of the most common entities treated in neurosurgery. Postoperative subdural drainage employed after burr hole evacuation for treating CSDH reduces recurrence, but whether it leads to increased surgical complications compared to no postoperative drainage is debatable. The present study was designed to assess whether postoperative subdural drainage leads to increased surgical complications following burr hole evacuation of CSDH compared to no drainage.&#x0D; Materials and Methods: The medical records of 69 patients treated with burr hole evacuation for chronic subdural hematoma between July 2013 to April 2014 were retrospectively analyzed. The patients were divided into two groups. In group A patients, postoperative subdural drainage had been employed following burr hole evacuation of CSDH, while in group B patients there was no drainage. The two groups were then compared for the development of surgical complications other than recurrence.&#x0D; Results: Sixteen patients developed complications. Acute Subdural hematoma formed in 3 patients. There was intraparenchymal drain insertion in 6 patients. An empyema developed in 2 patients, while one patient each developed an Extradural hematoma, fits, contusion, and hemorrhagic infarction. All the complications occurred in the group A patients receiving postoperative subdural drainage. Postoperative subdural drainage tube was found to be significantly associated (p = 0.0017) with complications.&#x0D; Conclusion: We conclude that postoperative subdural drainage following burr hole evacuation of chronic subdural hematoma is associated with increased surgical complications compared to no drainage.

Exploratory Analysis of Preoperative and Postoperative Risk Stratification Tools to Identify Acute Kidney and Myocardial Injury in Patients Undergoing Surgery for Chronic Subdural Haematoma.

Exploratory Analysis of Preoperative and Postoperative Risk Stratification Tools to Identify Acute Kidney and Myocardial Injury in Patients Undergoing Surgery for Chronic Subdural Haematoma.

Subdural Air Increases Postoperative Recurrence of Chronic Subdural Hematoma After Initial Burr-hole Surgery Only in the Very Elderly: A Pilot Study

Numerous randomized controlled trials have identified risk factors increasing the postoperative recurrence of chronic subdural hematoma (CSDH). Postoperative subdural air is frequently seen on computed tomography imaging. The aim of this study was to test the hypothesis that the presence of significant subdural air postoperatively is related to recurrence of CSDH after burr-hole surgery. A single-center, retrospective pilot study analyzed patients 20 years and older who underwent initial burr-hole surgery for CSDH. Data from 452 consecutive patients were included. Significant subdural air was considered to be present when the subdural air area was >4 cm2 in 1 axial CT slice. Correlation of the recurrence and the number of slices that included significant subdural air at postoperative day (POD) 1 was evaluated. Other classic predictive factors were also investigated. The recurrence rate was 13.0% in these 452 cases. After univariate analyses of all the variables, multivariate analysis for age, sex, cerebral infarction, number of slices containing significant subdural air, and maximum depth of the subdural space confirmed that older age and male sex were independent risk factors for recurrence (P= 0.032 and 0.047, respectively). After subdividing cases into older (≥75 years of age)/younger and male/female subgroups, the presence of significant subdural air at POD 1 was identified as an independent risk factor for recurrence in older adults (P= 0.025, OR= 1.12). Although this is a pilot study, it is suggested that significant postoperative subdural air increases recurrence after initial burr-hole surgery for CSDH in adults ≥75 years of age.

Efficacy of endoscopic treatment for chronic subdural hematoma surgery

Endoscopic treatment is a potential therapeutic addition to chronic subdural hematoma (CSDH) surgery. However, the effect of endoscopic treatment remains controversial. Herein, we examined the optimal indication for endoscopic treatment in CSDH surgery. We retrospectively analyzed 380 consecutive patients with CSDH who underwent single burr-hole craniostomy. We defined postoperative rebleeding as radiological re-accumulation or increased computed tomography value of the hematoma. Reoperation was performed following further hematoma accumulation and/or neurological deterioration. Complicated CSDH was radiologically defined as a hematoma with a clot and/or fibrous septum. There were no differences in baseline characteristics or postoperative mortality and morbidity between the endoscope (97 patients) and control (283 patients) groups. The incidence of postoperative rebleeding (9.3% vs 25.1%, respectively; P = 0.001) and reoperation (0% vs 9.2%, respectively; P = 0.004) were significantly lower in the endoscope group versus controls. Multivariate analysis showed that males (odds ratio 2.14, 95% confidence interval 1.19–3.81; P = 0.012) and endoscopy (odds ratio 0.29, 95% confidence interval 0.13–0.59; P = 0.001) were independently associated with postoperative rebleeding. When CSDHs were divided into two types based on hematoma component, 175 patients exhibited complicated CSDH. There was a significant reduction in postoperative rebleeding (6.5% vs 23.0%, respectively; P = 0.010) and reoperation (0% vs 9.7%, respectively; P = 0.027) in complicated CSDH patients. Endoscopic treatment in CSDH surgery does not increase the risk of surgical complications. Complicated CSDH with a clot and/or septum may be an optimal indication for endoscopic treatment in CSDH surgery to reduce postoperative recurrence.

Post-Operative Complications of Surgery for Chronic Subdural Hematoma (SDH) and Prevention

Objective: The study aimed to determine the rate and type of complications during surgery for treatment of chronic subdural hematoma and assess ways for their prevention.&#x0D; Material and Methods: A total of 50 patients of chronic SDH were selected from the Neurosurgery Department of Bahawal Victoria Hospital. Patients were treated surgically with a single burr hole evacuation under local anesthesia, introduced a subdural drain, nursed in a head-down position for 24 hours, and given plenty of fluids orally and intravenous route. The surgical technique involved a formation of a single burr hole at the point of maximum density.&#x0D; Results: Out of 50, 43 patients recovered smoothly postoperatively and discharged on the 7th postoperative day. Two patients were re-operated due to inadequate evacuation or reaccumulation. One patient developed subdural empyema post-operatively and expired in spite of good antibiotic cover. In one patient subdural drain penetrated the brain parenchyma resulting in dysphasia. Another patient formed an intracerebral hematoma due to irrigation of the cavity with pressure. One patient with GCS 4/15 developed seizures postoperatively and expired after one hour. One patient developed gross subdural tension pneumocephalus after removing the subdural drain was re-operated and recovered.&#x0D; Conclusion: Single burr hole evacuation of chronic SDH under local anesthesia is the most accepted surgical treatment. Using proper aseptic surgical techniques, the introduction of the minimum necessary length of the subdural catheter to avoid penetration into the brain parenchyma, followed by careful irrigation of the subdural cavity can help prevent complications.

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

BackgroundWith chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. We therefore sought to determine whether statins reduce the rate of repeat surgery after CSDH drain.MethodsWe performed an analysis of all patients who underwent surgery for CSDH at our institution between 2012 and 2018. The patients were separated into those who received statins as part of their previous medication (statin group) and those who did not (control group). The medical records were reviewed for repeat surgeries and complications. Additionally, patients or their relatives were contacted via phone to obtain missing data and inquire about possible repeat surgeries at other institutions.ResultsWe identified 407 patients who received CSDH evacuation via burr hole craniotomy. In total, 123 patients were treated with statins as part of their daily medication. Repeat surgery was performed in 26 patients in the statin group (21.1%) and 57 patients in the non-statin group (20.1%, p = 0.81). Upon multivariate logistic regression analysis, neither of the variables statins, age, antithrombotic medication, Charlson comorbidity index, or Markwalder grading score yielded a statistically significant effect upon the revision rate.ConclusionsWe found no evidence for the protective effect of statins in patients who underwent surgery for CSDH. We thus conclude that statin therapy is not warranted for CSDH perioperatively.