Abstract
Purpose
To identify predictive factors with an impact on the outcome of surgical treatment of non-acute subdural haematomas (NASH).
Methods
One hundred eleven patients who underwent an evacuation of 132 NASH by means of burr hole or craniotomy from January 2014 to December 2018 were retrospectively analyzed. We evaluated the impact of factors that could possibly predict the result of surgical treatment. The assessment was focused on the impact of factors, such as age, gender, pre-operative clinical symptoms, timing and extent of surgical procedure, intake of anticoagulants and antiplatelet drugs, morphological type, recurrence, side localization or bilateral occurrence of NASH. Patients’ functional outcome was quantified using the Glasgow Outcome Score (GOS) with a follow-up period of 3 months.
Results
Morphological type of NASH did not have any significant impact on the final GOS. The risk factors associated with less favorable GOS included preoperative intake of anticoagulants and preoperative finding of phatic disorder, quantitative disorder of consciousness and disorientation. Preoperative intake of antiplatelet drugs or anticoagulants and craniotomy were risk factors for postoperative development of a surgically significant acute extracerebral haematoma. The complications occurred significantly more often after a craniotomy when compared to the burr hole evacuation (p = 0.0163), but the incidence of recurrence of NASH was significantly lower (p = 0.0439).
Conclusion
The risk factors for the surgical treatment of NASH included preoperative intake of antithrombotic drugs and evacuation of NASH through craniotomy. Craniotomy resulted in a significantly lower incidence of recurrence.
Similar content being viewed by others
Change history
18 November 2019
A Correction to this paper has been published: https://doi.org/10.1007/s00068-019-01268-1
References
Santarius T, Kirkpatrick PJ, Kolias AG, et al. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg. 2010;57:112–22.
Ducruet AF, Grobelny BT, Zacharia BE, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155–69. https://doi.org/10.1007/s10143-011-0349-y.
Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 1981;54(5):637–45. https://doi.org/10.3171/jns.1981.54.5.0637.
Murakami H, Hirose Y, Sagoh M, et al. Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of trombomodulin in the mechanism. J Neurosurg. 2002;96(5):877–84. https://doi.org/10.3171/jns.2002.96.5.0877.
Weigel R, Schilling L, Schmiedek P. Specific pattern of growth factor distribution in chronic subdural hematoma (CSH): evidence for an angiogenic disease. Acta Neurochir (Wien). 2001;143(8):811–8.
Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg. 2001;95(2):256–62. https://doi.org/10.3171/jns.2001.95.2.0256.
Jennet B, Snoek J, Bond MR, et al. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981;44(4):285–93.
Ro HW, Park SK, Jang DK, et al. Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma. Acta Neurochir (Wien). 2016;158(1):135–9. https://doi.org/10.1007/s00701-015-2625-z.
Motiei-Langroudi R, Stippler M, Shi S, et al. Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation. J Neurosurg. 2018;129(5):1143–50. https://doi.org/10.3171/2017.6.JNS17130.
Lee J, Park JH. Clinical characteristics of bilateral versus unilateral chronic subdural hematoma. Korean J Neurotrauma. 2014;10(2):49–544. https://doi.org/10.13004/kjnt.2014.10.2.49.
Hsieh CT, Su IC, Hsu SK, et al. Chronic subdural hematoma: differences between unilateral and bilateral occurrence. J Clin Neurosci. 2016;34:252–8. https://doi.org/10.1016/j.jocn.2016.09.015.
You W, Zhu Y, Wang Y, et al. Prevalence of and risk factors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien). 2018;160(5):893–9. https://doi.org/10.1007/s00701-018-3513-0.
Hammer A, Tregubow A, Kerry G, et al. Predictors for recurrence of chronic subdural hematoma. Turk Neurosurg. 2017;27(5):756–62. https://doi.org/10.5137/1019-5149.JTN.17347-16.1.
Stanisic M, Pripp AH. A reliable grading system for prediction of chronic subdural hematoma recurrence requiring reoperation after initial burr-hole surgery. Neurosurgery. 2017;81(5):752–60. https://doi.org/10.1093/neuros/nyx090.
Altaf I, Shams S, Vohra AH. Radiolological predictors of recurrence of chronic subdural hematoma. Pak J Med Sci. 2018;34(1):194–7. https://doi.org/10.12669/pjms.341.13735.
Wang Y, Zhou J, Fan C, et al. Influence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: a meta-analysis. J Clin Neurosci. 2017;38:79–83. https://doi.org/10.1016/j.jocn.2016.12.001.
Poon MTC, Al-Shahi SR. Association between antithrombotic drug use before chronic subdural haematoma and outcome after drainage: a systematic review and meta-analysis. Neurosurg Rev. 2018;41(2):439–45. https://doi.org/10.1007/s10143-017-0860-x.
Motoie R, Karashima S, Otsuji R, et al. Recurrence in 787 patients with chronic subdural hematoma: retrospective cohort investigation of associated factors including direct oral anticoagulant use. World Neurosurg. 2018;118:e87–e91. https://doi.org/10.1016/j.wneu.2018.06.124.
Scerrati A, Mangiola A, Rigoni F, et al. Do antiplatelet and anticoagulant drugs modify outcome of patients treated for chronic subdural hematoma? Still a controversial issue. J Neurosurg Sci. 2018. https://doi.org/10.23736/S0390-5616.18.04311-4.
Glancz LJ, Poon MTC, Coulter IC, et al. Does drain position and duration influence outcomes in patients undergoing burr-hole evacuation of chronic subdural hematoma? lessons from a UK Multicenter Prospective Cohort Study. Neurosurgery. 2018. https://doi.org/10.1093/neuros/nyy366.
Goyal RK, Nayak B, Maharshi R, et al. Management of chronic subdural hematoma: burr hole versus twist drill—a prospective study. Asian J Neurosurg. 2018;13(2):319–23. https://doi.org/10.4103/ajns.AJNS_99_16.
Yan C, Yang MF, Huang YW. A reliable nomogram model to predict the recurrence of chronic subdural hematoma after burr hole surgery. World Neurosurg. 2018;118:e356–e366366. https://doi.org/10.1016/j.wneu.2018.06.191.
You CG, Zheng XS. Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma. Clin Neurol Neurosurg. 2018;166:56–60. https://doi.org/10.1016/j.clineuro.2018.01.029.
Haron S, Bogduk N, Hansen M. A retrospective analysis of chronic subdural haematoma recurrence rates following burr hole trephination versus minicraniotomy. J Clin Neurosci. 2019;59:47–50. https://doi.org/10.1016/j.jocn.2018.11.009.
Kocaman U, Yilmaz H. Description of a modified technique (mini craniotomy-basal membranotomy) for chronic subdural hematoma surgery and evaluation of the contribution of basal membranotomy performed as part of this technique to cerebral expansion. World Neurosurg. 2019;122:e1002–e10061006. https://doi.org/10.1016/j.wneu.2018.10.196.
Heringer LC, Sousa UO, Oliveira MF, et al. The number of burr holes and use of a drain do not interfere with surgical results of chronic sudbural hematomas. Arq Neuropsiquiatr. 2017;75(11):809–12. https://doi.org/10.1590/0004-282X20170136.
Acknowledgements
This work was supported by project named The application of PACS (Picture Archiving and Communication System) in research and development, ITMS 26,210,120,004. All authors agree to the publication of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors hereby certify that they have no conflicts of interest to declare in connection with this study.
Rights and permissions
About this article
Cite this article
René, O., Martin, H., Pavol, S. et al. Factors influencing the results of surgical therapy of non-acute subdural haematomas. Eur J Trauma Emerg Surg 47, 1649–1655 (2021). https://doi.org/10.1007/s00068-019-01258-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-019-01258-3