Article
Evaluation of a grading system for prediction of chronic subdural haematoma recurrence requiring reoperation after twist-drill craniostomy
Evaluation eines Bewertungssystems zur Vorhersage von revisionsbedürftigen Rezidiven bei chronischen Subduralhämatomen nach Minibohrlochtrepanation
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Authors
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Christina Wolfert
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Alisa von Seydlitz-Kurzbach
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Silvia Hernández-Durán
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Vesna Malinova
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Christian von der Brelie
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Chronic subdural haematoma (cSDH) often causes mass effect and results in focal neurological deficits and / or reduced level of consciousness. Several techniques for cSDH evacuation have been described so far whereas twist-drill craniostomy (TDC) under local anesthesia represents the least invasive surgical approach. Drainage of the cSDH via TDC might be sufficient to interrupt the pathophysiological vicious circle of osmotic hematoma expansion but the rate of patients requiring reoperation (RrR) is high. This study aims to evaluate a score to predict reoperation after TDC.
Methods: We evaluated our patients who underwent TDC from 01/2014 to 09/2019 using the cSDH grading system from Stanisic et al. Preoperative (>130ml: 1 point) and postoperative residual hematoma volume (>200ml: 2 points, 80 – 200ml: 1 point and <80ml: 0 points) were calculated in 0.6 mm axial CT scans. Radiographic appearance (isodense, hyperdense, laminar or separated subtypes [2 points], hypodense, gradation and trabecular subtypes [0 points]) was categorized. Recurrence of cSDH and (if required) further surgeries were documented. Receiver operative characteristic (ROC) curve evaluated the predictive value of the grading system.
Results: A total of 203 patients with mean age of 75 years (range 31-95) were included, 136 of which were male (67%). Single TDC was successful in 79 patients (38.9%), of which n=31 (15.3%) were categorized with 0 points, n=24 (11.8%) with 1 point, n=15 (7.4%) with 2 points, n=5 (2.5%) with 3 points, n=5 (2.5%) with 4 points, and n=0 (0%) with 5 points. RrR was observed in n=124 patients (61.1%). The applied grading system performed well in predicting the RrR risk in patients (AUC=.73). A total score >1 point exhibited a sensitivity of 78% and a specificity of 54% for identifying patients requiring more than a single TDC.
Conclusion: RrR rate in cSDH treated with TDC is high. However, there might be a subgroup of patients for whom TDC might be a suitable therapy option. Incorporation of objective tools such as the cSDH grading system leads to a recognition of individual factors and can allow a stratification of the risk of recurrent surgery in cSDH.
