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Prevalence of and risk factors for recurrence of chronic subdural hematoma

  • Original Article - Brain Injury
  • Published:
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Abstract

Background

Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice with substantial recurrence rate. We aimed to estimate recurrence rate of CSDH and to identify risk factors for CSDH recurrence.

Methods

We retrospectively studied consecutive cases with CSDH and performed surgical therapy in our hospital. Univariate and multivariate logistic regression analyses were performed to identify factors associated with recurrence of CSDH.

Results

A total of 226 patients with CSDH were included; 34 patients recurred after surgery with a recurrence rate of 15.0%. Univariate analysis showed that the recurrence group had more patients with homogenous hyper-dense hematoma (20.6 vs 6.3%, p = 0.035) and shorter duration of subdural drainage post-surgery (1.2 ± 1.4 vs 1.5 ± 0.9, p = 0.022) than the non-recurrence group. Logistic regression analysis revealed that duration of subdural drainage (OR = 0.66, p = 0.05) and hyper-dense of hematoma (OR = 4.94, p = 0.012) were independent predictors for CSDH recurrence.

Conclusions

Homogenous hyper-dense of hematoma and duration of subdural drainage post-surgery were independent predictors for CSDH recurrence; longer duration of postoperative subdural drainage was associated with lower risk of recurrence.

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References

  1. Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, Arjmand P, Baronia B, Reddy K, Murty N, Singh S (2014) Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 259:449–457. https://doi.org/10.1097/SLA.0000000000000255

    Article  PubMed  Google Scholar 

  2. Amirjamshidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, Shirani A, Asadollahi M, Aleali H (2007) Outcomes and recurrence rates in chronic subdural haematoma. Br J Neurosurg 21:272–275

    Article  CAS  PubMed  Google Scholar 

  3. Chon KH, Lee JM, Koh EJ, Choi HY (2012) Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir 154:1541–1548. https://doi.org/10.1007/s00701-012-1399-9

    Article  PubMed  Google Scholar 

  4. Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ (2017) Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg 127:1117–1125. https://doi.org/10.3171/2016.8.JNS16867

    Article  PubMed  Google Scholar 

  5. Jack A, O’Kelly C, McDougall C, Findlay JM (2015) Predicting recurrence after chronic subdural haematoma drainage. Canadian J Neurological Sci Le J Canadien Des Sci Neurologiques 42:34–39. https://doi.org/10.1017/cjn.2014.122

    Article  Google Scholar 

  6. Jeong SI, Kim SO, Won YS, Kwon YJ, Choi CS (2014) Clinical analysis of risk factors for recurrence in patients with chronic subdural hematoma undergoing burr hole trephination. Korean J Neurotrauma 10:15–21. https://doi.org/10.13004/kjnt.2014.10.1.15

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kiymaz N, Yilmaz N, Mumcu C (2007) Controversies in chronic subdural hematoma: continuous drainage versus one-time drainage. Medical Sci Monitor: Int Medical J experimental Clinical Res 13:Cr240–Cr243

    Google Scholar 

  8. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH (2008) Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurgical Soc 43:11–15. https://doi.org/10.3340/jkns.2008.43.1.11

    Article  Google Scholar 

  9. Kolias AG, Chari A, Santarius T, Hutchinson PJ (2014) Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol 10:570–578. https://doi.org/10.1038/nrneurol.2014.163

    Article  PubMed  Google Scholar 

  10. Kotwica Z, Brzezinski J (1991) Chronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients. Br J Neurosurg 5:461–465

    Article  CAS  PubMed  Google Scholar 

  11. Lin CC, Lu YM, Chen TH, Wang SP, Hsiao SH, Lin MS (2014) Quantitative assessment of post-operative recurrence of chronic subdural haematoma using mean haematoma density. Brain Inj 28:1082–1086. https://doi.org/10.3109/02699052.2014.901559

    Article  PubMed  Google Scholar 

  12. Lind CR, Lind CJ, Mee EW (2003) Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains. J Neurosurg 99:44–46. https://doi.org/10.3171/jns.2003.99.1.0044

    Article  PubMed  Google Scholar 

  13. Lindvall P, Koskinen LO (2009) Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas. J Clinical Neuroscience: Official J Neurosurgical Soc Australasia 16:1287–1290. https://doi.org/10.1016/j.jocn.2009.01.001

    Article  CAS  Google Scholar 

  14. Nakaguchi H, Tanishima T, Yoshimasu N (2001) Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 95:256–262. https://doi.org/10.3171/jns.2001.95.2.0256

    Article  CAS  PubMed  Google Scholar 

  15. Ohba S, Kinoshita Y, Nakagawa T, Murakami H (2013) The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 36:145–149. https://doi.org/10.1007/s10143-012-0396-z

    Article  PubMed  Google Scholar 

  16. Santarius T, Hutchinson PJ (2004) Chronic subdural haematoma: time to rationalize treatment? Br J Neurosurg 18:328–332

    Article  CAS  PubMed  Google Scholar 

  17. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet (London, England) 374:1067–1073

    Article  Google Scholar 

  18. Schwarz F, Loos F, Dunisch P, Sakr Y, Safatli DA, Kalff R, Ewald C (2015) Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas. Clin Neurol Neurosurg 138:66–71. https://doi.org/10.1016/j.clineuro.2015.08.002

    Article  PubMed  Google Scholar 

  19. Stanisic M, Hald J, Rasmussen IA, Pripp AH, Ivanovic J, Kolstad F, Sundseth J, Zuchner M, Lindegaard KF (2013) Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients. Acta Neurochir 155:323–333. https://doi.org/10.1007/s00701-012-1565-0

    Article  PubMed  Google Scholar 

  20. Stanisic M, Pripp AH (2017) A reliable grading system for prediction of chronic subdural hematoma recurrence requiring reoperation after initial burr-hole surgery. Neurosurgery 81:752–760. https://doi.org/10.1093/neuros/nyx090

    Article  PubMed  PubMed Central  Google Scholar 

  21. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S (2008) Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery 63:1125–1129. https://doi.org/10.1227/01.NEU.0000335782.60059.17

    Article  PubMed  Google Scholar 

  22. Tsutsumi K, Maeda K, Iijima A, Usui M, Okada Y, Kirino T (1997) The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma. J Neurosurg 87:870–875. https://doi.org/10.3171/jns.1997.87.6.0870

    Article  CAS  PubMed  Google Scholar 

  23. Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M (1990) Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurgery 26:771–773. https://doi.org/10.1227/00006123-199005000-00006

    Article  CAS  PubMed  Google Scholar 

  24. Weigel R, Schmiedek P, Krauss JK (2003) Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:937–943. https://doi.org/10.1136/jnnp.74.7.937

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Yu GJ, Han CZ, Zhang M, Zhuang HT, Jiang YG (2009) Prolonged drainage reduces the recurrence of chronic subdural hematoma. Br J Neurosurg 23:606–611. https://doi.org/10.3109/02688690903386983

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors sincerely thank all the doctors in the neurosurgery department of the First Affiliated Hospital of Zhejiang University College of Medicine for their help in conducting this research.

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Author notes

  1. Wendong You and Yuanrun Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China

    Wendong You, Yuanrun Zhu, Yadong Wang, Wenchao Liu, Hao Wang, Liang Wen & Xiaofeng Yang

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  1. Wendong You
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  2. Yuanrun Zhu
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  3. Yadong Wang
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  4. Wenchao Liu
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  7. Xiaofeng Yang
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Corresponding author

Correspondence to Xiaofeng Yang.

Ethics declarations

The study was approved by the ethics committee of the First Affiliated Hospital, College of Medicine, Zhejiang University, and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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You, W., Zhu, Y., Wang, Y. et al. Prevalence of and risk factors for recurrence of chronic subdural hematoma. Acta Neurochir 160, 893–899 (2018). https://doi.org/10.1007/s00701-018-3513-0

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  • DOI: https://doi.org/10.1007/s00701-018-3513-0

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