DOI QR코드

DOI QR Code

What Determines the Laterality of the Chronic Subdural Hematoma?

  • Kim, Byoung-Gu (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) ;
  • Lee, Kyeong-Seok (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) ;
  • Shim, Jae-Jun (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) ;
  • Yoon, Seok-Mann (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) ;
  • Doh, Jae-Won (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) ;
  • Bae, Hack-Gun (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital)
  • Received : 2010.03.03
  • Accepted : 2010.05.23
  • Published : 2010.06.28

Abstract

Objective : Chronic subdural hematomas (CSDH) are more common on the left hemisphere than on the right. We verified this left predilection of CSDH and tried to explain the reason for this discrepancy. Methods : We investigated the laterality of CSDH in 182 patients who were treated from January 2005 to December 2009. We examined the symmetry of the cranium and the location of the lesion. Results : CSDH was more common on the left-side. The cranium was symmetric in 63 patients, asymmetric in 119 patients. The asymmetric crania were flat on the right-side in 77 patients, on the left-side in 42 patients. The density of the CSDHs was hypodense in 29 patients, isodense 132 patients, and the others in 21 patients. Bilateral hematomas were more common in the hypodense group. In the right flat crania, the hematoma was more commonly located on the opposite side of the flat side. While in the left flat crania, the hematoma was more common on the same side. Conclusion : CSDHs occurred more frequently on the left side. The anatomical asymmetry of the cranium influences the left predilection of CSDH.

Keywords

References

  1. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H, et al. : The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery 61 : 794-797; discussion 797, 2007 https://doi.org/10.1227/01.NEU.0000298908.94129.67
  2. Akhaddar A, Bensghir M, Elmoustarchid B, Abouqal R, Boucetta M : Influence of cranial morphology on the location of chronic subdural hematoma. Acta Neurochir (Wien) 151 : 1235-1240, 2009 https://doi.org/10.1007/s00701-009-0357-7
  3. Chiu HC, Damasio AR : Human cerebral asymmetries evaluated by computed tomography. J Neurol Neurosurg Psychiatry 43 : 873-878, 1980 https://doi.org/10.1136/jnnp.43.10.873
  4. Foerch C, Misselwitz B, Sitzer M, Berger K, Steinmetz H, Neumann- Haefelin T, et al. : Differences in recognition of right and left hemisphere stroke. Lancet 366 : 392-393, 2005 https://doi.org/10.1016/S0140-6736(05)67024-9
  5. Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martínez- Rumbo R : Chronic subdural haematoma : surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 107 : 223-229, 2005 https://doi.org/10.1016/j.clineuro.2004.09.015
  6. Good CD, Johnsrude I, Ashburner J, Henson RN, Friston KJ, Frackowiak RS : Cerebral asymmetry and the effects of sex and handedness on brain structure : a voxel-based morphometric analysis of 465 normal adult human brains. Neuroimage 14 : 685-700, 2001 https://doi.org/10.1006/nimg.2001.0857
  7. Herve PY, Crivello F, Perchey G, Mazoyer B, Tzourio-Mazoyer N : Handedness and cerebral anatomical asymmetries in young adult males. Neuroimage 29 : 1066-1079, 2006 https://doi.org/10.1016/j.neuroimage.2005.08.031
  8. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH : Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc 43 : 11-15, 2008 https://doi.org/10.3340/jkns.2008.43.1.11
  9. Koff E, Naeser MA, Pieniadz JM, Foundas AL, Levine HL : Computed tomographic scan hemispheric asymmetries in right- and lefthanded male and female subjects. Arch Neurol 43 : 487-491, 1986 https://doi.org/10.1001/archneur.1986.00520050059023
  10. Kovalev VA, Kruggel F, von Cramon DY : Gender and age effects in structural brain asymmetry as measured by MRI texture analysis. Neuroimage 19 : 895-905, 2003 https://doi.org/10.1016/S1053-8119(03)00140-X
  11. Le May M, Kido DK : Asymmetries of the cerebral hemispheres on computed tomograms. J Comput Assist Tomogr 2 : 471-476, 1978 https://doi.org/10.1097/00004728-197809000-00018
  12. Lee KS, Bae WK, Bae HG, Doh JW, Yun IG : The computed tomographic attenuation and the age of subdural hematomas. J Korean Med Sci 12 : 353-359, 1997
  13. Lee KS, Bae WK, Yoon SM, Doh JW, Bae HG, Yun IG : Location of the chronic subdural hematoma : role of the gravity and cranial morphology. Brain Inj 15 : 47-52, 2001
  14. Lee KS, Bae WK, Yoon SM, Doh JW, Bae HG, Yun IG : Location of the traumatic subdural hygroma : role of gravity and cranial morphology. Brain Inj 14 : 355-361, 2000 https://doi.org/10.1080/026990500120646
  15. Lee KS, Doh JW, Bae HG, Yun IG : Relations among traumatic subdural lesions. J Korean Med Sci 11 : 55-63, 1996
  16. MacFarlane MR, Weerakkody Y, Kathiravel Y : Chronic subdural hematomas are more common on the left than on the right. J Clin Neurosci 16 : 642-644, 2009 https://doi.org/10.1016/j.jocn.2008.07.074
  17. Miele VJ, Sadrolhefazi A, Bailes JE : Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma. Surg Neurol 63 : 420-423; discussion 423, 2005 https://doi.org/10.1016/j.surneu.2004.06.023
  18. Mori K, Maeda M : Surgical treatment of chronic subdural hematoma in 500 consecutive cases : clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41 : 371-381, 2001 https://doi.org/10.2176/nmc.41.371
  19. Nakajima H, Yasui T, Nishikawa M, Kishi H, Kan M : The role of postoperative patient posture in the recurrence of chronic subdural hematoma : a prospective randomized trial. Surg Neurol 58 : 385-387; discussion 387, 2002 https://doi.org/10.1016/S0090-3019(02)00921-7
  20. Park SH, Lee SH, Park J, Hwang JH, Hwang SK, Hamm IS : Chronic subdural hematoma preceded by traumatic subdural hygroma. J Clin Neurosci 15 : 868-872, 2008 https://doi.org/10.1016/j.jocn.2007.08.003
  21. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. : Use of drains versus no drains after burr-hole evacuation of chronic subdural hematoma : a randomised controlled trial. Lancet 374 : 1067-1073, 2009 https://doi.org/10.1016/S0140-6736(09)61115-6

Cited by

  1. Multiple Densities of the Chronic Subdural Hematoma in CT Scans vol.54, pp.1, 2013, https://doi.org/10.3340/jkns.2013.54.1.38
  2. Frontal sinus asymmetry: Is it an effect of cranial asymmetry? X-ray analysis of 469 normal adult human frontal sinus vol.6, pp.4, 2010, https://doi.org/10.4103/0976-3147.168436
  3. Chronic subdural hematoma vol.11, pp.4, 2010, https://doi.org/10.4103/1793-5482.145102
  4. Clinical Course and Results of Surgery for Chronic Subdural Hematomas in Patients on Drugs Affecting Hemostasis vol.60, pp.2, 2010, https://doi.org/10.3340/jkns.2015.1212.005
  5. Outcome of single burr hole under local anesthesia in the management of chronic subdural hematoma vol.34, pp.1, 2010, https://doi.org/10.1186/s41984-019-0033-z
  6. Unilateral chronic subdural hematoma due to spontaneous intracranial hypotension: a report of four cases vol.34, pp.6, 2010, https://doi.org/10.1080/02688697.2019.1667482