Korean J Neurotrauma.  2014 Oct;10(2):41-48. 10.13004/kjnt.2014.10.2.41.

The Predicting Factors for Recurrence of Chronic Subdural Hematoma Treated with Burr Hole and Drainage

Affiliations
  • 1Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea. ksy8498@hanyang.ac.kr

Abstract


OBJECTIVE
Chronic subdural hematoma (CSDH) is common in elderly patients. So, with an increasing number of elderly people in the general population, there is a need to investigate risk factors which increase recurrence rate. In this study, factors affecting the postoperative recurrence are investigated based on the reoperative CSDH cases.
METHODS
Total of ninety-seven patients was enrolled in this study who had have operation for CSDH. In all patients, one burr hole trephination and drainage was the method of choice for the initial treatment of CSDH. We retrospectively evaluated several factors which affect to recurrence of CSDH.
RESULTS
Retrospective analysis was performed in 97 patients. Sixteen patients experienced reoperation within 3 months (16/97, 16.5%) for recurrence of CSDH. And, when hematoma was divided by internal architecture, heterogeneous density group seems to be have close relationship with recurrence more significantly than homogeneous density group (p=0.002). Hypertension, diabetes mellitus, early removal of drainage tube, bilaterality of hematoma also have significant relationship with recurrence.
CONCLUSION
Recurrence rate of CSDH treated with one burr hole drainage is related with some various factors. There was statistically significant difference between recurred group and non-recurred group. Not only demographic factors but also internal architecture on preoperative brain computed tomography is a significant predicting factor of recurrence in CSDH patients who underwent a surgery. In this study, heterogeneous type hematoma have significantly related with recurrence of CSDH. We should give attention to these predicting factors for more effective care.

Keyword

Hematoma, subdural, chronic; Recurrence; Risk factors

MeSH Terms

Aged
Brain
Demography
Diabetes Mellitus
Drainage*
Hematoma
Hematoma, Subdural, Chronic*
Humans
Hypertension
Recurrence*
Reoperation
Retrospective Studies
Risk Factors
Trephining

Figure

  • FIGURE 1 Classification of internal architecture on preoperative brain computed tomography. Homogeneous group-(A) hyperdensity type, (B) isodensity type, and (C) hypodensity type. Heterogeneous group-(D) separated type, (E) gradient type, and (F) mixed type.


Cited by  1 articles

Effects of Oral Streptokinase-Streptodornase on Remnant Chronic Subdural Hematomas
Min Park, Jeong Mi Kim, Hyo Joon Kim
Korean J Neurotrauma. 2015;11(2):131-134.    doi: 10.13004/kjnt.2015.11.2.131.


Reference

1. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery. 2007; 61:794–797. discussion 797. PMID: 17986941.
Article
2. Ahn SY, Kim JH, Ha SK, Kim JH, Kwon TH, Park YK, et al. Clinical analysis of risk factors associated with the recurrence of chronic subdural hematoma. J Korean Neurotraumatol Soc. 2011; 7:68–73.
Article
3. Arbit E, Patterson RH Jr, Fraser RA. An implantable subdural drain for treatment of chronic subdural hematoma. Surg Neurol. 1981; 15:175–177. PMID: 7221864.
Article
4. Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien). 2012; 154:1541–1548. PMID: 22653496.
Article
5. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol. 1997; 48:220–225. PMID: 9290707.
Article
6. Horn EM, Feiz-Erfan I, Bristol RE, Spetzler RF, Harrington TR. Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surg Neurol. 2006; 65:150–153. discussion 153-154. PMID: 16427409.
Article
7. Kang MS, Koh HS, Kwon HJ, Choi SW, Kim SH, Youm JY. Factors influencing recurrent chronic subdural hematoma after surgery. J Korean Neurosurg Soc. 2007; 41:11–15.
8. Kim HS, Heo W, Cha JH, Song JS, Rhee DY. Factor affecting recurrence of chronic subdural hematoma after burr-hole drainage. Korean J Neurotrauma. 2012; 8:73–78.
Article
9. Kim SG, Yang JC, Kim TW, Park KH. Factors that influence to chronic subdural hematoma recurrence. Korean J Neurotrauma. 2013; 9:81–86.
Article
10. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc. 2008; 43:11–15. PMID: 19096538.
Article
11. Kong WK, Kim BC, Cho KT, Hong SK. Factors affecting postoperative recurrence of chronic subdural hematoma. Korean J Neurotrauma. 2012; 8:122–127.
Article
12. Kotwica Z, Brzeziński J. Chronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients. Br J Neurosurg. 1991; 5:461–465. PMID: 1764227.
Article
13. Lee JY, Ebel H, Ernestus RI, Klug N. Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary? Surg Neurol. 2004; 61:523–527. discussion 527-528. PMID: 15165784.
Article
14. Mellergård P, Wisten O. Operations and re-operations for chronic subdural haematomas during a 25-year period in a well defined population. Acta Neurochir (Wien). 1996; 138:708–713. PMID: 8836286.
15. Mohamed EE. Chronic subdural haematoma treated by craniotomy, durectomy, outer membranectomy and subgaleal suction drainage. Personal experience in 39 patients. Br J Neurosurg. 2003; 17:244–247. PMID: 14565521.
Article
16. Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001; 41:371–381. PMID: 11561347.
Article
17. Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg. 2001; 95:256–262. PMID: 11780895.
Article
18. Nayil K, Ramzan A, Sajad A, Zahoor S, Wani A, Nizami F, et al. Subdural hematomas: an analysis of 1181 Kashmiri patients. World Neurosurg. 2012; 77:103–110. PMID: 22405391.
Article
19. Nomura S, Kashiwagi S, Fujisawa H, Ito H, Nakamura K. Characterization of local hyperfibrinolysis in chronic subdural hematomas by SDS-PAGE and immunoblot. J Neurosurg. 1994; 81:910–913. PMID: 7965121.
Article
20. Oh HJ, Lee KS, Shim JJ, Yoon SM, Yun IG, Bae HG. Postoperative course and recurrence of chronic subdural hematoma. J Korean Neurosurg Soc. 2010; 48:518–523. PMID: 21430978.
Article
21. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009; 374:1067–1073. PMID: 19782872.
Article
22. Smely C, Madlinger A, Scheremet R. Chronic subdural haematoma--a comparison of two different treatment modalities. Acta Neurochir (Wien). 1997; 139:818–825. discussion 825-826. PMID: 9351986.
23. Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien). 2005; 147:1249–1256. PMID: 16133770.
Article
24. Tokmak M, Iplikcioglu AC, Bek S, Gökduman CA, Erdal M. The role of exudation in chronic subdural hematomas. J Neurosurg. 2007; 107:290–295. PMID: 17695382.
Article
25. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery. 2008; 63:1125–1129. discussion 1129. PMID: 19008766.
26. Tsutsumi K, Maeda K, Iijima A, Usui M, Okada Y, Kirino T. The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma. J Neurosurg. 1997; 87:870–875. PMID: 9384397.
Article
27. Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M. Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurgery. 1990; 26:771–773. PMID: 2352594.
Article
28. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry. 2003; 74:937–943. PMID: 12810784.
Article
29. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S. Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. J Neurosurg. 2003; 98:1217–1221. PMID: 12816267.
Article
Full Text Links
  • KJN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr