Korean J Neurotrauma.  2018 Oct;14(2):76-79. 10.13004/kjnt.2018.14.2.76.

Expanding Subdural Hematomas in the Subacute Stage and Treatment via Catheter Drainage

Affiliations
  • 1Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. sunchulh@schmc.ac.kr

Abstract


OBJECTIVE
Rapid expansion of subacute subdural hematomas (saSDHs) is an uncommon complication in the course of acute subdural hematomas (SDHs). The current study evaluated relevant factors and treatment methods for saSDHs with neurologic deterioration and mass effect.
METHODS
A saSDHs was chronologically defined as an SDH occurring 4 to 21 days after head trauma. All cases of surgically treated SDHs were retrieved from the head trauma bank at our institution. Twenty-three patients with expanding saSDHs who met the following criteria were enrolled in the study: defined age of the hematoma, clinical deterioration, and radiological expansion of the hematoma. Cases were analyzed according to demographic factors, trauma mechanism, medical co-morbidity, and surgical method.
RESULTS
Expanding saSDHs occurred more often in older (≥60 years old) than in younger patients (69.6% vs. 30.4%, respectively); they also occurred more often in men than in women (64% vs. 36%, respectively). Antiplatelet or anticoagulant therapy was used in 52% of patients. The Glasgow Coma Scale score was 13 at the time of the trauma and deteriorated to 11 at the time of surgery. The mean time from the trauma to development of the expanding saSDH from an SDH was 13.3 days. Regarding surgical methods, closed-system drainage was performed in 22 patients, and only one patient underwent craniotomy with hematoma removal. All patients exhibited neurological improvements after surgery.
CONCLUSION
An expanding saSDH usually occurs around 13 days after trauma in older adults. Minimal trephination with closed-system drainage can be used to manage an expanding saSDHs.

Keyword

Catheter drainage; Subacute; Subdural hematoma; Trephination

MeSH Terms

Adult
Catheters*
Craniocerebral Trauma
Craniotomy
Demography
Drainage*
Female
Glasgow Coma Scale
Hematoma
Hematoma, Subdural*
Hematoma, Subdural, Acute
Humans
Male
Methods
Trephining

Cited by  1 articles

Delayed Operation of Acute Subdural Hematoma in Subacute Stage by Trephine Drainage using Urokinase
Hyeon Gu Kang, Kyu Yong Cho, Rae Seop Lee, Jun Seob Lim
Korean J Neurotrauma. 2019;15(2):103-109.    doi: 10.13004/kjnt.2019.15.e32.


Reference

1. Aoki N, Oikawa A, Sakai T. Symptomatic subacute subdural hematoma associated with cerebral hemispheric swelling and ischemia. Neurol Res. 1996; 18:145–149. PMID: 9162869.
Article
2. Choi YH, Han SR, Lee CH, Choi CY, Sohn MJ, Lee CH. Delayed burr hole surgery in patients with acute subdural hematoma: Clinical analysis. J Korean Neurosurg Soc. 2017; 60:717–722. PMID: 29142632.
3. Godlewski B, Pawelczyk A, Pawelczyk T, Ceranowicz K, Wojdyn M, Radek M. Retrospective analysis of operative treatment of a series of 100 patients with subdural hematoma. Neurol Med Chir (Tokyo). 2013; 53:26–33. PMID: 23358166.
Article
4. Izumihara A, Orita T, Tsurutani T, Kajiwara K. Natural course of non-operative cases of acute subdural hematoma: sequential computed tomographic study in the acute and subacute stages. No Shinkei Geka. 1997; 25:307–314. PMID: 9125713.
5. Izumihara A, Yamashita K, Murakami T. Acute subdural hematoma requiring surgery in the subacute or chronic stage. Neurol Med Chir (Tokyo). 2013; 53:323–328. PMID: 23708224.
Article
6. Kim BJ, Park KJ, Park DH, Lim DJ, Kwon TH, Chung YG, et al. Risk factors of delayed surgical evacuation for initially nonoperative acute subdural hematomas following mild head injury. Acta Neurochir (Wien). 2014; 156:1605–1613. PMID: 24943910.
Article
7. Kuwahara S, Fukuoka M, Koan Y, Miyake H, Ono Y, Moriki A, et al. Subdural hyperintense band on diffusion-weighted imaging of chronic subdural hematoma indicates bleeding from the outer membrane. Neurol Med Chir (Tokyo). 2005; 45:125–131. PMID: 15782003.
Article
8. Kuwahara S, Fukuoka M, Koan Y, Miyake H, Ono Y, Moriki A, et al. Diffusion-weighted imaging of traumatic subdural hematoma in the subacute stage. Neurol Med Chir (Tokyo). 2005; 45:464–469. PMID: 16195646.
9. Lee KS. History of chronic subdural hematoma. Korean J Neurotrauma. 2015; 11:27–34. PMID: 27169062.
Article
10. Lee KS, Shim JJ, Yoon SM, Doh JW, Yun IG, Bae HG. Acute-on-chronic subdural hematoma: Not uncommon events. J Korean Neurosurg Soc. 2011; 50:512–516. PMID: 22323938.
Article
11. Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg. 2011; 114:72–76. PMID: 20868215.
Article
12. Morinaga K, Matsumoto Y, Hayashi S, Omiya N, Mikami J, Sato H, et al. Subacute subdural hematoma: findings in CT, MRI and operations and review of onset mechanism. No Shinkei Geka. 1995; 23:213–216. PMID: 7700488.
13. Morinaga K, Matsumoto Y, Omiya N, Mikami J, Ueda M, Sato H, et al. Subacute subdural hematoma-report of 4 cases and a review of the literature. No To Shinkei. 1990; 42:131–136. PMID: 2192749.
14. Okumura Y, Shimomura T, Park YS. A study of acute subdural hematoma developing into hematoma with capsule formation. No Shinkei Geka. 1998; 26:691–698. PMID: 9743998.
15. Scotti G, Terbrugge K, Melançon D, Bélanger G. Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg. 1977; 47:311–315. PMID: 894336.
Article
16. Singla A, Jacobsen WP, Yusupov IR, Carter DA. Subdural evacuating port system (SEPS)-minimally invasive approach to the management of chronic/subacute subdural hematomas. Clin Neurol Neurosurg. 2013; 115:425–431. PMID: 22763191.
Article
17. Son S, Yoo CJ, Lee SG, Kim EY, Park CW, Kim WK. Natural course of initially non-operated cases of acute subdural hematoma: the risk factors of hematoma progression. J Korean Neurosurg Soc. 2013; 54:211–219. PMID: 24278650.
18. Takeuchi S, Takasato Y, Otani N, Miyawaki H, Masaoka H, Hayakawa T, et al. Subacute subdural hematoma. Acta Neurochir Suppl. 2013; 118:143–146. PMID: 23564121.
Article
19. Yoon JW, Park IS, Park H, Kang DH, Park KB, Lee CH, et al. A study of the progression from acute subdural hematoma to chronic stage requiring surgical treatment. Korean J Neurotrauma. 2013; 9:74–80.
Article
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