Korean J Neurotrauma.  2014 Apr;10(1):15-21. 10.13004/kjnt.2014.10.1.15.

Clinical Analysis of Risk Factors for Recurrence in Patients with Chronic Subdural Hematoma Undergoing Burr Hole Trephination

• Jeong SI
• Kim SO
• Won YS
• Kwon YJ
• Choi CS

• KMID: 2156092
• DOI: http://doi.org/10.13004/kjnt.2014.10.1.15

Abstract

OBJECTIVE
Chronic subdural hematoma (CSDH) is one of the most common types of intra-cranial hemorrhages usually associated with trauma. Surgical treatment is the treatment of choice and burr hole trephination (BHT) is widely performed. The recurrence rate in the patients with CSDH is 3.7-30%. This study investigated the risk factors associated with the recurrence of patients with CSDH who underwent BHT.
METHODS
One hundred twenty-five patients with CSDH underwent BHT. Eight of 125 patients (6.4%) underwent reoperation for recurrent CSDH. We retrospectively analyzed demographic, clinical and radiological findings, catheter tip location and drainage duration as the risk factors for the recurrence of CSDH.
RESULTS
Recurrence of CSDH in the high- or mixed-density groups was significantly higher than those in the low- or iso-density groups (p<0.001). Placement of catheter tip at the temporoparietal area was associated with a significantly higher recurrence rate of CSDH than placement at the frontal area (p=0.006) and the brain re-expansion rate (BRR) was much lower than placement at the frontal area (p<0.001).
CONCLUSION
The operation may be delayed in high- and mixed-density groups, unless severe symptoms or signs are present. In addition, placing the catheter tip at the frontal area helps to reduce the incidence of postoperative recurrence of CSDH and to increase the BRR.

Keyword

Chronic subdural hematoma; Recurrence; Catheter tip location; Computed tomography

MeSH Terms

Brain
Butylated Hydroxytoluene
Catheters
Drainage
Hematoma, Subdural, Chronic*
Hemorrhage
Humans
Incidence
Recurrence*
Reoperation
Retrospective Studies
Risk Factors*
Trephining*
Butylated Hydroxytoluene

Figure

• 

  FIGURE 1 Brain CT showing classification of hematoma density. A: Low-density (4-14 HU). B: Iso-density (14-24 HU). C: High-density (≥24 HU). D: Mixed-density. HU: Hounsfield unit.

• 

  FIGURE 2 Skull radiographs showing catheter tip position after BHT. The location was classified into two areas: frontal area (A, B) and temporoparietal area (C, D). BHT: burr hole trephination.

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