J Korean Neurosurg Soc.  2015 Apr;57(4):271-275. 10.3340/jkns.2015.57.4.271.

Incidence and Risk Factors of Chronic Subdural Hematoma after Surgical Clipping for Unruptured Anterior Circulation Aneurysms

• Lee WJ
• Jo KI
• Yeon JY
• Hong SC
• Kim JS

• KMID: 1956425
• DOI: http://doi.org/10.3340/jkns.2015.57.4.271

Abstract

OBJECTIVE
Chronic subdural hematoma (CSDH) is a rare complication of unruptured aneurysm clipping surgery. The purpose of this study was to identify the incidence and risk factors of postoperative CSDH after surgical clipping for unruptured anterior circulation aneurysms.
METHODS
This retrospective study included 518 patients from a single tertiary institute from January 2008 to December 2013. CSDH was defined as subdural hemorrhage which needed surgical treatment. The degree of brain atrophy was estimated using the bicaudate ratio (BCR) index. We used uni- and multivariate analyses to identify risk factors correlated with CSDH.
RESULTS
Sixteen (3.1%) patients experienced postoperative CSDH that required burr hole drainage surgery. In univariate analyses, male gender (p<0.001), size of aneurysm (p=0.030), higher BCR index (p=0.004), and the use of antithrombotic medication (p=0.006) were associated with postoperative CSDH. In multivariate analyses using logistic regression test, male gender [odds ratio (OR) 4.037, range 1.287-12.688], high BCR index (OR 5.376, range 1.170-25.000), and the use of antithrombotic medication (OR 4.854, range 1.658-14.085) were associated with postoperative CSDH (p<0.05). Postoperative subdural fluid collection and arachnoid plasty were not showed statistically significant difference in this study.
CONCLUSION
The incidence of CSDH was 3.1% in unruptured anterior circulation aneurysm surgery. This study shows that male gender, degree of brain atrophy, and the use of antithrombotic medication were associated with postoperative CSDH.

Keyword

Chronic subdural hematoma; Unruptured aneurysm; Clipping; Risk factor; Incidence; Anterior circulation

MeSH Terms

Aneurysm*
Arachnoid
Atrophy
Brain
Drainage
Hematoma, Subdural
Hematoma, Subdural, Chronic*
Humans
Incidence*
Logistic Models
Male
Multivariate Analysis
Retrospective Studies
Risk Factors*
Surgical Instruments*

Figure

• 

  Fig. 1 A : Dissected arachnoid space. Fibrillar (B) and fibrin (C) glue were applied to seal the arachnoid space.

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