Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Predictive Factors for Recurrence after Burr-Hole Craniostomy of Chronic Subdural Hematoma

  • Kim, Sang Uk (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Dong Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Young Il (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yang, Seung Ho (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cho, Chul Bum (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2016.10.10
  • Accepted : 2017.03.10
  • Published : 2017.11.01
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Abstract

Objective : Chronic subdural hematoma is a common and relatively benign disease. However, recurrence is common after surgical treatment, and the recurrence rate varies from 5% to 33%. The aim of this study was to investigate the predictive factors for recurrence of chronic subdural hematoma. Methods : We analyzed data from 248 patients with chronic subdural hematoma who were treated by burr-hole craniostomy with a closed drainage system for hematoma evacuation in this five-year retrospective study. Results : Thirty-one (12.6%) patients underwent re-operation for recurrence of chronic subdural hematoma. Univariate analysis revealed that anticoagulation (p=0.0279), headache (p=0.0323), and preoperative midline shifting (p=0.0321) showed significant differences with respect to recurrent chronic subdural hematoma. We performed a multivariate logistic regression analysis and found that diabetes mellitus (odds ratio [OR], 2.618; 95% confidence interval [CI], 1.0899-6.2898; p=0.0314), anticoagulation (OR, 6.739; 95% CI, 1.1287-40.2369; p=0.0364), headache (OR, 2.951; 95% CI, 1.1464-7.5964; p=0.0249), and preoperative midline shifting (OR, 1.0838; 95% CI, 1.0040-1.1699; p=0.0391) were independent predictive factors for recurrence of chronic subdural hematoma. Conclusion : We showed that diabetes mellitus, anticoagulation, headache, and preoperative midline shifting were independent predictors of recurrence of chronic subdural hematoma.

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References

  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. Neurosurg 61 : 794-797; discussion 797, 2007 https://doi.org/10.1227/01.NEU.0000298908.94129.67
  2. Amirjamshidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, et al. : Outcomes and recurrence rates in chronic subdural haematoma. Br J Neurosurg 21 : 272-275, 2007 https://doi.org/10.1080/02688690701272232
  3. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G; American College of Chest Physicians : Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133(6 Suppl) : 160S-198S, 2008 https://doi.org/10.1378/chest.08-0670
  4. Baechli H, Nordmann A, Bucher HC, Gratzl O : Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 27 : 263-266, 2004
  5. Brodbelt A, Warnke P : Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 75 : 1209-1210; author reply 1210, 2004
  6. Cenic A, Bhandari M, Reddy K : Management of chronic subdural hematoma: a national survey and literature review. Can J Neurol Sci 32 : 501-506, 2005 https://doi.org/10.1017/S0317167100004510
  7. Cheung N, Mitchell P, Wong TY : Diabetic retinopathy. Lancet 376 : 124-136, 2010 https://doi.org/10.1016/S0140-6736(09)62124-3
  8. Chon KH, Lee JM, Koh EJ, Choi HY : Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 154 : 1541-1548, 2012 https://doi.org/10.1007/s00701-012-1399-9
  9. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Andersen KN, et al. : Erratum to: the surgical management of chronic subdural hematoma. Neurosurg Rev 38 : 771-771, 2015 https://doi.org/10.1007/s10143-015-0644-0
  10. El-Kadi H, Miele VJ, Kaufman HH : Prognosis of chronic subdural hematomas. Neurosurg Clin N Am 11 : 553-567, 2000
  11. Ernestus RI, Beldzinski P, Lanfermann H, Klug N : Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol 48 : 220-225, 1997 https://doi.org/10.1016/S0090-3019(97)80031-6
  12. Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez-Rumbo R : Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 107 : 223-229, 2005 https://doi.org/10.1016/j.clineuro.2004.09.015
  13. Gorelick PB, Weisman SM : Risk of hemorrhagic stroke with aspirin use: an update. Stroke 36 : 1801-1807, 2005 https://doi.org/10.1161/01.STR.0000174189.81153.85
  14. Hamilton MG, Frizzell JB, Tranmer BI : Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurg 33 : 67-72, 1993
  15. Harper L, Barkhof F, Fox NC, Schott JM : Using visual rating to diagnose dementia: a critical evaluation of MRI atrophy scales. J Neurol Neurosurg Psychiatry 86 : 1225-1233, 2015 https://doi.org/10.1136/jnnp-2014-310090
  16. Huang YH, Yang KY, Lee TC, Liao CC : Bilateral chronic subdural hematoma: what is the clinical significance? Int J Surg 11 : 544-548, 2013 https://doi.org/10.1016/j.ijsu.2013.05.007
  17. Jung YG, Jung NY, Kim E : Independent predictors for recurrence of chronic subdural hematoma. J Korean Neurosurg Soc 57 : 266-270, 2015 https://doi.org/10.3340/jkns.2015.57.4.266
  18. Kayaci S, Kanat A, Koksal V, Ozdemir B : Effect of inner membrane tearing in the treatment of adult chronic subdural hematoma: a comparative study. Neurol Med Chir (Tokyo) 54 : 363-373, 2014 https://doi.org/10.2176/nmc.oa.2013-0147
  19. Lee JK, Choi JH, Kim CH, Lee HK, Moon JG : Chronic subdural hematomas : a comparative study of three types of operative procedures. J Korean Neurosurg Soc 46 : 210-214, 2009 https://doi.org/10.3340/jkns.2009.46.3.210
  20. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC : Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg 113 : 615-621, 2010 https://doi.org/10.3171/2009.9.JNS08825
  21. Lind CR, Lind CJ, Mee EW : Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains. J Neurosurg 99 : 44-46, 2003 https://doi.org/10.3171/jns.2003.99.1.0044
  22. Lindvall P, Koskinen LO : Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas. J Clin Neurosci 16 : 1287-1290, 2009 https://doi.org/10.1016/j.jocn.2009.01.001
  23. Markwalder TM : Chronic subdural hematomas: a review. J Neurosurg 54 : 637-645, 1981 https://doi.org/10.3171/jns.1981.54.5.0637
  24. Nakaguchi H, Tanishima T, Yoshimasu N : Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage. J Neurosurg 93 : 791-795, 2000 https://doi.org/10.3171/jns.2000.93.5.0791
  25. Ohba S, Kinoshita Y, Nakagawa T, Murakami H : The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 36 : 145-149; discussion 149-150, 2013 https://doi.org/10.1007/s10143-012-0396-z
  26. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M : Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo) 41 : 382-386, 2001 https://doi.org/10.2176/nmc.41.382
  27. Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H : A comparative study of the treatment of chronic subdural hematoma--burr hole drainage versus burr hole irrigation. Surg Neurol 57 : 405-409; discussion 410, 2002 https://doi.org/10.1016/S0090-3019(02)00720-6
  28. Park HR, Lee KS, Shim JJ, Yoon SM, Bae HG, Doh JW : Multiple densities of the chronic subdural hematoma in CT scans. J Korean Neurosurg Soc 54 : 38-41, 2013 https://doi.org/10.3340/jkns.2013.54.1.38
  29. Quinones-Hinojosa A, Gulati M, Singh V, Lawton MT : Spontaneous intracerebral hemorrhage due to coagulation disorders. Neurosurg Focus 15 : E3, 2003
  30. Ramachandran R, Hegde T : Chronic subdural hematomas--causes of morbidity and mortality. Surg Neurol 67 : 367-372; discussion 372-373, 2007 https://doi.org/10.1016/j.surneu.2006.07.022
  31. Ro HW, Park SK, Jang DK, Yoon WS, Jang KS, Han YM : Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma. Acta Neurochir (Wien) 158 : 135-139, 2016 https://doi.org/10.1007/s00701-015-2625-z
  32. Robinson RG : Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg 61 : 263-268, 1984 https://doi.org/10.3171/jns.1984.61.2.0263
  33. Schwarz F, Loos F, Dunisch P, Sakr Y, Safatli DA, Kalff R, et al. : Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas. Clin Neurol Neurosurg 138 : 66-71, 2015 https://doi.org/10.1016/j.clineuro.2015.08.002
  34. Spallone A, Giuffre R, Gagliardi FM, Vagnozzi R : Chronic subdural hematoma in extremely aged patients. Eur Neurol 29 : 18-22, 1989 https://doi.org/10.1159/000116370
  35. 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) 147 : 1249-1256; discussion 1256-1257, 2005 https://doi.org/10.1007/s00701-005-0616-1
  36. Tanaka Y, Ohno K : Chronic subdural hematoma - an up-to-date concept. J Med Dent Sci 60 : 55-61, 2013
  37. 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 63 : 1125-1129; discussion 1129, 2008 https://doi.org/10.1227/01.NEU.0000335782.60059.17
  38. Tugcu B, Tanriverdi O, Baydin S, Hergunsel B, Gunaldi O, Ofluoglu E, et al. : Can recurrence of chronic subdural hematoma be predicted? A retrospective analysis of 292 cases. J Neurol Surg A Cent Eur Neurosurg 75 : 37-41, 2014
  39. 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 98 : 1217-1221, 2003 https://doi.org/10.3171/jns.2003.98.6.1217
  40. Yamashima T, Yamamoto S, Friede RL : The role of endothelial gap junctions in the enlargement of chronic subdural hematomas. J Neurosurg 59 : 298-303, 1983 https://doi.org/10.3171/jns.1983.59.2.0298
  41. Yu GJ, Han CZ, Zhang M, Zhuang HT, Jiang YG : Prolonged drainage reduces the recurrence of chronic subdural hematoma. Br J Neurosurg 23 : 606-611, 2009 https://doi.org/10.3109/02688690903386983

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