Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Predicting Factors of Chronic Subdural Hematoma Following Surgical Clipping in Unruptured and Ruptured Intracranial Aneurysm

  • Kwon, Min-Yong (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Chang-Hyun (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Lee, Chang-Young (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine)
  • Received : 2016.03.09
  • Accepted : 2016.06.08
  • Published : 2016.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The aim of this study is to analyze the differences in the incidence, predicting factors, and clinical course of chronic subdural hematoma (CSDH) following surgical clipping between unruptured (UIA) and ruptured intracranial aneurysm (RIA). Methods : We conducted a retrospective analysis of 752 patients (UIA : 368 and RIA : 384) who underwent surgical clipping during 8 years. The incidence and predicting factors of CSDH development in the UIA and RIA were compared according to medical records and radiological data. Results : The incidence of postoperative CSDH was higher in the UIA (10.9%) than in the RIA (3.1%) (p=0.000). In multivariate analysis, a high Hounsfield (HF) unit (blood clots) for subdural fluid collection (SFC), persistence of SFC ${\geq}5mm$ and male sex in the UIA and A high HF unit for SFC and SFC ${\geq}5mm$ without progression to hydrocephalus in the RIA were identified as the independent predicting factors for CSDH development (p<0.05). Conclusion : There were differences in the incidence and predicting factors for CSDH following surgical clipping between UIA and RIA. Blood clots in the subdural space and persistence of SFC ${\geq}5mm$ were predicting factors in both UIA and RIA. However, progression to hydrocephalus may have in part contributed to low CSDH development in the RIA. We suggest that cleaning of blood clots in the subdural space and efforts to minimize SFC ${\geq}5mm$ at the end of surgery is helpful to prevent CSDH following aneurysmal clipping.

Keywords

References

  1. Alotaibi NM, Witiw CD, Germans MR, Macdonald RL : Spontaneous subdural fluid collection following aneurysmal subarachnoid hemorrhage : subdural hygroma or external hydrocephalus? Neurocrit Care 21 : 312-315, 2014 https://doi.org/10.1007/s12028-014-0017-5
  2. Chen JC, Levy ML : Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 11 : 399-406, 2000
  3. Eguchi S, Aihara Y, Hori T, Okada Y : Postoperative extra-axial cerebrospinal fluid collection--its pathophysiology and clinical management. Pediatr Neurosurg 47 : 125-132, 2011 https://doi.org/10.1159/000330543
  4. Feng JF, Jiang JY, Bao YH, Liang YM, Pan YH : Traumatic subdural effusion evolves into chronic subdural hematoma : two stages of the same inflammatory reaction? Med Hypotheses 70 : 1147-1149, 2008 https://doi.org/10.1016/j.mehy.2007.11.014
  5. Gjerris F, Sorensen SC : Colloid osmotic and hydrostatic pressures in chronic subdural haematomas. Acta Neurochir (Wien) 54 : 53-60, 1980 https://doi.org/10.1007/BF01401943
  6. Huh PW, Yoo DS, Cho KS, Park CK, Kang SG, Park YS, et al. : Diagnostic method for differentiating external hydrocephalus from simple subdural hygroma. J Neurosurg 105 : 65-70, 2006 https://doi.org/10.3171/jns.2006.105.1.65
  7. Inamasu J, Watabe T, Ganaha T, Yamada Y, Nakae S, Ohmi T, et al. : Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms. J Clin Neurosci 20 : 1095-1098, 2013 https://doi.org/10.1016/j.jocn.2012.09.024
  8. Kanat A, Kayaci S, Yazar U, Kazdal H, Terzi Y : Chronic subdural hematoma in adults : why does it occur more often in males than females? Influence of patient's sexual gender on occurrence. J Neurosurg Sci 54 : 99-103, 2010
  9. Kristof RA, Grimm JM, Stoffel-Wagner B : Cerebrospinal fluid leakage into the subdural space : possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma. J Neurosurg 108 : 275-280, 2008 https://doi.org/10.3171/JNS/2008/108/2/0275
  10. Lee WJ, Jo KI, Yeon JY, Hong SC, Kim JS : Incidence and risk factors of chronic subdural hematoma after surgical clipping for unruptured anterior circulation aneurysms. J Korean Neurosurg Soc 57 : 271-275, 2015 https://doi.org/10.3340/jkns.2015.57.4.271
  11. Liu Y, Gong J, Li F, Wang H, Zhu S, Wu C : Traumatic subdural hydroma : clinical characteristics and classification. Injury 40 : 968-972, 2009 https://doi.org/10.1016/j.injury.2009.01.006
  12. Mino Y, Hirashima Y, Hamada H, Masuoka T, Yamatani K, Takeda S, et al. : Effect of arachnoid plasty using fibrin glue membrane after clipping of ruptured aneurysm on the occurrence of complications and outcome in the elderly patients. Acta Neurochir (Wien) 148 : 627-631; discussion 631, 2006 https://doi.org/10.1007/s00701-006-0777-6
  13. Mori K, Maeda M : Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures. Acta Neurochir (Wien) 145 : 533-539; discussion 539-540, 2003 https://doi.org/10.1007/s00701-003-0026-1
  14. Ohno T, Iihara K, Takahashi JC, Nakajima N, Satow T, Hishikawa T, et al. : Incidence and risk factors of chronic subdural hematoma after aneurysmal clipping. World Neurosurg 80 : 534-537, 2013 https://doi.org/10.1016/j.wneu.2012.09.025
  15. Park J, Cho JH, Goh DH, Kang DH, Shin IH, Hamm IS : Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery : age, sex, and aneurysm location as independent risk factors. J Neurosurg 124 : 310-317, 2016 https://doi.org/10.3171/2015.1.JNS14309
  16. Quintana LM : Chronic subdural hematoma after neurosurgical procedures. World Neurosurg 80 : 482-483, 2013 https://doi.org/10.1016/j.wneu.2012.11.015
  17. Tanaka Y, Ohno K : Chronic subdural hematoma - an up-to-date concept. J Med Dent Sci 60 : 55-61, 2013
  18. Xu J, Kobayashi S, Yamaguchi S, Iijima K, Okada K, Yamashita K : Gender effects on age-related changes in brain structure. AJNR Am J Neuroradiol 21 : 112-118, 2000
  19. Yagi K, Irie S, Inagaki T, Ishii Y, Saito O, Lee T, et al. : Intraoperative arachnoid plasty has possibility to prevent chronic subdural hematoma after surgery for unruptured cerebral aneurysms. Neurol Med Chir (Tokyo) 55 : 493-497, 2015 https://doi.org/10.2176/nmc.oa.2014-0455
  20. Yamashima T : The inner membrane of chronic subdural hematomas : pathology and pathophysiology. Neurosurg Clin N Am 11 : 413-424, 2000
  21. Yoshimoto T, Houkin K, Ishikawa T, Abe H : Arachnoid membrane closure. Prevention of postoperative cerebrospinal fluid leakage. Surg Neurol 52 : 68-71; discussion 71-72, 1999 https://doi.org/10.1016/S0090-3019(99)00051-8
  22. Yoshimoto Y, Wakai S, Hamano M : External hydrocephalus after aneurysm surgery : paradoxical response to ventricular shunting. J Neurosurg 88 : 485-489, 1998 https://doi.org/10.3171/jns.1998.88.3.0485

Cited by

  1. Study of Incidence and Factors: Risk and Preventive, of Chronic Subdural Hematoma/hygroma in Clipped Patients of Unruptured Intracranial Aneurysms – An Institutional Experience vol.13, pp.3, 2016, https://doi.org/10.4103/ajns.ajns_355_16
  2. Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms : A Systematic Review and Meta-analysis vol.76, pp.3, 2019, https://doi.org/10.1001/jamaneurol.2018.4165
  3. Racial and Ethnic Disparities in Treatment Outcomes of Patients with Ruptured or Unruptured Intracranial Aneurysms vol.6, pp.2, 2019, https://doi.org/10.1007/s40615-018-0530-x
  4. Arachnoid Plasty to Prevent and Reduce Chronic Subdural Hematoma after Clipping Surgery for Unruptured Intracranial Aneurysm : A Meta-Analysis vol.63, pp.4, 2016, https://doi.org/10.3340/jkns.2020.0036