Article
Early reoperation after surgical treatment of chronical subdural hematomas. A comparison of different surgical approaches
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Authors
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Mehran Boroumand
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Eberhard Uhl
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Malgorzata Kolodziej
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Marcus Reinges
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Karsten Schöller
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Marco Stein
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Despite several publications on the treatment of chronic subdural hematoma (CSDH), the optimal surgical approach is still controversial, and a standard therapy does not exist. The purpose of this study is to compare three different surgical approaches for the treatment of CSDH.
Methods: In this retrospective study the data of 198 patients with 224 CSDH were analyzed. The patients were analyzed by the type of surgical hematoma evacuation: 86 patients (43.4%) with one burr hole (1 BH), 41 patients (20.7%) with two burr holes (2 BH), and 71 patients (35.9%) with craniotomy. The maximum hematoma diameter (MHD) was measured pre-operatively and postoperatively. The relation between clinical data and early reoperation was evaluated by univariate and multivariate statistical analysis.
Results: The rate of reoperation during the acute stay in the group with 1 BH, 2 BH, and in the craniotomy group was 36%, 14.6%, and 15.5%, respectively. In patients with anticoagulation or antiplatelet therapy an increased rate of reoperations was observed (33.7% vs. 17.4%; P=0.008). Patients with reoperations were older compared to patients without reoperations (77.3±6.4 years vs 71.5±15.2 years; P=0.034). Postoperative seizures were detected in 8.6-14.6% without significant statistical differences between all groups. The median decrease in MHD for 1 BH, 2 BH, and craniotomy was 10mm (IQR: 5-16mm), 10mm (IQR: 5-18.5mm), and 11,5mm (IQR: 6-16mm), respectively. Patients with 1 BH and 2 BH were more often treated with a closed-system drainage (95.3% vs. 78.9%; P< 0.001). The median length of stay (LOS) for 1 BH, 2 BH, and craniotomy was 13 days (IQR: 7.5-17days), 13 days (IQR: 7.25-19.5 days), and 15 days (9-20 days), respectively. Patients with 1 and 2 BH had a higher Glasgow outcome scale (GOS) at discharge compared to the craniotomy group (4; IQR: 3-4 vs. 3; IQR: 1.5-3.75; P=0.020).
Conclusion: The reduction of the CSDH was comparable for the three analyzed methods. The recurrence rate during the acute hospital stay was increased in the 1 BH group. However, patients with less invasive approaches like 1 or 2 BH had a better outcome and had a decreased LOS compared to the craniotomy group.
