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Open Access 01-02-2013 | Clinical Article - Brain Injury

Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients

Authors: Milo Stanišić, John Hald, Inge Andre Rasmussen, Are Hugo Pripp, Jugoslav Ivanović, Frode Kolstad, Jarle Sundseth, Mark Züchner, Karl-Fredrik Lindegaard

Published in: Acta Neurochirurgica | Issue 2/2013

Abstract

Background

Chronic subdural haematoma (CSDH) is a common entity in neurosurgery with a considerable postoperative recurrence rate. Computerised tomography (CT) scanning remains the most important diagnostic test for this disorder. The aim of this study was to characterise the relationship between the recurrence of CSDH after treatment with burr-hole irrigation and closed-system drainage technique and CT scan features of these lesions to assess whether CT findings can be used to predict recurrence.

Methods

We investigated preoperative and postoperative CT scan features and recurrence rate of 107 consecutive adult surgical cases of CSDH and assessed any relationship with univariate and multivariate regression analyses.

Results

Seventeen patients (15.9 %) experienced recurrence of CSDH. The preoperative haematoma volume, the isodense, hyperdense, laminar and separated CT densities and the residual total haematoma cavity volume on the 1st postoperative day after removal of the drainage were identified as radiological predictors of recurrence. If the preoperative haematoma volume was under 115 ml and the residual total haematoma cavity volume postoperatively was under 80 ml, the probability of no recurrence was very high (94.4 % and 97.4 % respectively).

Conclusions

These findings from CT imaging may help to identify patients at risk for postoperative recurrence.

Weigel R, Schmiedek P, Krauss JK (2003) Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:937–943PubMedCrossRef

Ko B-S, Lee J-K, Seo B-R, Moon S-J, Kim J-H, Kim S-H (2008) Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc 42:11–15CrossRef

Kurokawa Y, Ishizaki E, Inaba K (2005) Bilateral chronic subdural hematoma cases showing rapid and progressive aggravation. Surg Neurol 64:444–449PubMedCrossRef

Mori K, Maeda M (2001) Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41:371–381CrossRef

Rust T, Kiemer N, Erasmus A (2006) Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci 13:823–827PubMedCrossRef

Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S (2008) Independent predictors for recurrence of chronic subdural hematoma: a revive of 343 consecutive surgical cases. Neurosurgery 63:1125–1129PubMedCrossRef

Tsai TH, Lieu AS, Hwang SL, Huang TY, Hwang YF (2010) A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitating factors and postoperative outcomes. J Trauma 68:571–575PubMedCrossRef

Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S (2003) Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. J Neurosurg 98:1217–1221PubMedCrossRef

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

10.

Baé ME, Wessling H, Salca HC, Echeverría PH (2011) Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence. Acta Neurochir (Wein) 153:1097–1103CrossRef

11.

Havenbergh TV, Calenbergh FV, Goffin J, Plets C (1996) Outcome of chronic subdural hematoma: analysis of prognostic factors. Br J Neurosurg 10:27–34CrossRef

12.

Matsumoto K, Akagi K, Abekura M, Ryujin H, Ohkawa M, Iwasa N, Akiyama C (1999) Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage. Neurol Res 21:277–280PubMed

13.

Stanisic M, Lund-Johansen M, Mahesparan R (2005) Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien) 147:1249–1256CrossRef

14.

Taussky P, Fandino J, Landolt H (2008) Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg 22:279–282PubMedCrossRef

15.

Delgado PD, Cogolludo FJ, Mateo O, Cancela P, Garcia R, Carrillo R (2000) Early prognosis in chronic subdural haematomas. Multivariate analysis of 137 cases. Rev Neurol 30:811–817PubMed

16.

Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R (2005) Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 107:223–229PubMedCrossRef

17.

Nakaguchi H, Tanishima T, Yoshimasu N (2001) Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 95:256–262PubMedCrossRef

18.

Nomura S, Kashiwagi S, Fujisawa H, Ito H, Nakamura K (1994) Characterization of local hyperfibrinolysis in chronic subdural hematomas by SDS-PAGE and immunoblot. J Neurosurg 81:910–913PubMedCrossRef

19.

Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M (2001) Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo) 41:382–386CrossRef

20.

Tokmak M, Iplikcioglu AC, Bek S, Gökduman CA, Erdal M (2007) The role of exudation in chronic subdural hematomas. J Neurosurg 107:290–295PubMedCrossRef

21.

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 87:870–875PubMedCrossRef

22.

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 21:272–275PubMedCrossRef

23.

Lee KS, Bae WK, Doh JW, Bae HG, Yun IG (1998) Origin of chronic subdural haematoma and relation to traumatic subdural lesions. Brain Inj 12:901–910PubMedCrossRef

24.

Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H (2002) A comparative study of the treatment of chronic subdural hematoma- burr hole drainage versus burr hole irrigation. Surg Neurol 57:405–410PubMedCrossRef

25.

Nakaguchi H, Yoshimasu N, Tanishima T (2003) Relationship between the natural history of chronic subdural hematoma and enhancement of the inner membrane on post-contrast CT scan [in Japanese with Eng abstract]. No Shinkei Geka 31:157–164PubMed

26.

Ramachandran R, Hegde T (2007) Chronic subdural hematomas- causes of morbidity and mortality. Surg Neurol 67:367–373PubMedCrossRef

27.

Nakaguchi H, Tanishima T, Yoshimasu N (2000) Relationship between drainage catheter location and postoperative recurrence of chronic subdural hamatoma after burr-hole irrigation and closed-system drainage. J Neurosurg 93:791–795PubMedCrossRef

28.

Sucu HK, Gokmen M, Gelal F (2005) The value of XYZ/2 technique compared with computer-assisted volumetric analysis to estimate the volume of chronic subdural hematoma. Stroke 36:998–1000PubMedCrossRef

29.

Sundstrøm T, Helland CA, Aarhus M, Wester K (2011) What is the pressure in chronic subdural hematomas? A prospective, population-based study. J Neurotrauma 28:1–6CrossRef

30.

Spallone A, Giuffre R, Gagliardi FM, Vagnozzi R (1989) Chronic subdural hematoma in extremely aged patients. Eur Neurol 29:18–22PubMedCrossRef

31.

Fukuhara T, Gotoh M, Asari S, Ohmoto T, Akioka T (1996) The relationship between brain surface elastance and brain reexpansion after evacuation of chronic subdural hematoma. Surg Neurol 45:570–574PubMedCrossRef

32.

Shiomi N, Sasajima H, Mineura K (2001) Relationship of postoperative residual air and recurrence in chronic subdural hematoma [in Japanese with Eng abstract]. No Shinkei Geka 29:39–44PubMed

33.

Abouzari M, Roshidi A, Sodagari N, Aleall H, Behzadi M (2008) The relationship between the level of consciousness and sedimentation level in CT scan of chronic subdural hematoma. J Neuroimaging 18:463–464PubMedCrossRef

34.

Fujisawa H, Nomura S, Tsuchida E, Ito H (1998) Serum protein exudation in chronic subdural hematomas: a mechanism for hematoma enlargement? Acta Neurochir (Wien) 140:161–166CrossRef

Title: Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients
Authors: Milo Stanišić
John Hald
Inge Andre Rasmussen
Are Hugo Pripp
Jugoslav Ivanović
Frode Kolstad
Jarle Sundseth
Mark Züchner
Karl-Fredrik Lindegaard
Publication date: 01-02-2013
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-012-1565-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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