gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Cerebral perfusion impairment in chronic subdural hematoma

Meeting Abstract

  • P.J. Slotty - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • M.A. Kamp - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Neurochirurgische Klinik, Westfälische-Wilhelms-Universität Münster
  • S. Macht - Institut für Radiologie, Heinrich-Heine-Universität Düsseldorf
  • H.J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • B. Turowski - Institut für Radiologie, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 008

DOI: 10.3205/12dgnc396, URN: urn:nbn:de:0183-12dgnc3964

Published: June 4, 2012

© 2012 Slotty et al.
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Outline

Text

Objective: Chronic subdural hematoma (cSDH) is a frequent disorder in the elderly. Although well investigated, numerous aspects including pathophysiology of clinical symptoms remain unclear. Perfusion deficits are likely to induce the transient neurologic symptoms often seen in cSDH, next to toxic effects of the subdural liquid. Aim of the present study was to quantify cerebral perfusion impairment in chronic subdural hematoma.

Methods: Prior to surgery patients were examined neurologically (including NIHS stroke score) and investigated by CT perfusion imaging. Hematoma volume, localization and hematoma configuration were recorded. Clinical and radiological data was correlated.

Results: 34 patients were included in this survey. Mean hematoma volume was 91.8 cm3 (16.2–241.6 cm3, SD 49.5). Whole brain mean transit time (MTT) was slightly elevated (mean 36.6s, SD 5.8) in comparison to healthy individuals. Hematoma volume and cerebral blood volume (CBV) in the underlying hemisphere correlated marginally (p = 0.067). Perfusion parameters as determined in the area below the hematoma (ABH) and the corresponding contralateral cortex (MAC) differed significantly regarding cerebral blood flow (CBF) (mean 88.8 vs. 70.4, p < 0.01) and also CBV (mean 29.4 vs. 22.5, p < 0.01). On the other hand, MTT and rise time (Tmax) in these regions were almost symmetrical (MTT mean 35.0 vs. 34.8, p = 0.914; Tmax mean 16.0 vs. 15.4, p = 0.587), suggesting active autoregulation.

Conclusions: Local brain perfusion autoregulation is active in the cortical area below cSDH. MTT is known to be the factor kept constant by autoregulation. CBV and CBF are significantly upregulated in the cortical area below cSDH indicating the effect of autoregulation in tissue at risk of ischemia. Cerebral autoregulation seems to be intact in cSDH. Whether compression or toxic effects of the subdural liquid induce changes in perfusion remains unclear so far.