Artikel
Management and outcome of recurrent chronic subdural haematoma – a single-centre experience and volumetric analysis
Management und Therapie-Ergebnisse bei Rezidiv deschronischen Subduralhämatoms – eine monozentrische Studie und volumetrische Analyse
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Mai 2019 |
---|
Gliederung
Text
Objective: To evaluate surgical management of recurrent chronic subdural hematomas (CSDH) and postoperative outcomes, and to identify possible predictors of recurrence.
Methods: Of all 319 patients treated surgically for chronic subdural hematoma at the authors’ institution between 2014 and 2016, 51 patients presented with recurrent hematoma and underwent repeat surgery. Pertinent clinical data were collected from the respective patients’ charts. Imaging data were acquired from the hospital’s PACS network. Hematoma volume was calculated using an established computer software and CSDH morphology was assessed using the classification described by Nakaguchi et al. Statistical analysis was performed using standard methods.
Results: 37 males and 14 females (median age 78 yrs.) were included in this analysis. 20 (39.2%) of cases had left-sided, 16 (31.4%) right-sided and 29.4% bilateral hematomas. Initially, all patients had burr hole trephinations. Only four patients (4.4%) received anticoagulants prior to recurrence. Surgical management of recurrent CSDH consisted of burr hole trephinations in 41 (80.4%) and a small craniotomy in 10 cases (19.6%). A new burr hole was placed in 26 patients (61.9%). A subdural drain was inserted in 48 (94.1%) patients during the initial operation and in 47 cases during repeat surgery (92.2%). Median Karnofsky Performance Index prior to repeat surgery was 80 (compare: 90 at discharge). 29 patients (56.9%) presented with a neurological deficit (compare: 5 [9.8%] at discharge). Overall 12 patients (23.5%) required a third surgery after an average of 19 (median: 9) days. Postoperative residual CSDH volume after repeat surgery strongly correlated with recurrence (non-recurrent vs. recurrent, means±SD: 80.5±36.3 vs. 117.9±38.1 ml, P=0.016 & Kaplan Meier estimates for time to second recurrence, P=0.014; ROC analysis: AUC=0.76).
Conclusion: Surgical management of recurrent chronic subdural hematomas remains a challenge. Many patients suffer a second recurrence requiring surgical treatment. Postoperative hematoma volume after repeat CSDH surgery is a strong predictor of further operations.