Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

  • Oh, Hyuk-Jin (Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC)) ;
  • Seo, Youngbeom (Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC)) ;
  • Choo, Yoon-Hee (Department of Neurosurgery, Yeungnam University Hospital, Yeungnam Universtiy College of Medicine) ;
  • Kim, Young Il (Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC)) ;
  • Kim, Kyung Hwan (Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC)) ;
  • Kwon, Sae Min (Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC)) ;
  • Lee, Min Ho (Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC)) ;
  • Chong, Kyuha (Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC))
  • Received : 2021.06.07
  • Accepted : 2021.07.21
  • Published : 2022.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Chronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence. Methods : We enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women. Results : The median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017). Conclusion : This is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.

Keywords

Acknowledgement

This work was supported by funding from the Soonchunhyang University Research Fund and the Yeungnam University Grant (219A580025).

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. Adhiyaman V, Chattopadhyay I, Irshad F, Curran D, Abraham S : Increasing incidence of chronic subdural haematoma in the elderly. QJM 110 : 375-378, 2017 https://doi.org/10.1093/qjmed/hcw231
  3. Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, et al. : Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 259 : 449-457, 2014 https://doi.org/10.1097/SLA.0000000000000255
  4. Asghar M, Adhiyaman V, Greenway MW, Bhowmick BK, Bates A : Chronic subdural haematoma in the elderly--a North Wales experience. J R Soc Med 95 : 290-292, 2002
  5. Balser D, Farooq S, Mehmood T, Reyes M, Samadani U : Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg 123 : 1209-1215, 2015 https://doi.org/10.3171/2014.9.JNS141550
  6. Bartek J Jr, Sjavik K, Stahl F, Kristiansson H, Solheim O, Gulati S, et al. : Surgery for chronic subdural hematoma in nonagenarians: a Scandinavian population-based multicenter study. Acta Neurol Scand 136 : 516-520, 2017 https://doi.org/10.1111/ane.12764
  7. Blaauw J, Jacobs B, den Hertog HM, van der Gaag NA, Jellema K, Dammers R, et al. : Neurosurgical and perioperative management of chronic subdural hematoma. Front Neurol 11 : 550, 2020 https://doi.org/10.3389/fneur.2020.00550
  8. Brennan PM, Kolias AG, Joannides AJ, Shapey J, Marcus HJ, Gregson BA, et al. : The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg 127 : 732-739, 2017 https://doi.org/10.3171/2016.8.jns16134
  9. Chen CC, Chen SW, Tu PH, Huang YC, Liu ZH, Yi-Chou Wang A, et al. : Outcomes of chronic subdural hematoma in patients with liver cirrhosis. J Neurosurg 130 : 302-311, 2018 https://doi.org/10.3171/2017.8.JNS171103
  10. Choi J, Pyen J, Cho S, Kim J, Koo Y, Whang K : Influence of antithrombotic medication on the risk of chronic subdural hematoma recurrence after burr-hole surgery. J Korean Neurosurg Soc 63 : 513-518, 2020 https://doi.org/10.3340/jkns.2019.0194
  11. Chung KC, Song JW; WRIST Study Group : A guide to organizing a multicenter clinical trial. Plast Reconstr Surg 126 : 515-523, 2010 https://doi.org/10.1097/PRS.0b013e3181df64fa
  12. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Andersen KN, et al. : The surgical management of chronic subdural hematoma. Neurosurg Rev 35 : 155-169; discussion 169, 2012 https://doi.org/10.1007/s10143-011-0349-y
  13. Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ : Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 14 : 108, 2017 https://doi.org/10.1186/s12974-017-0881-y
  14. Edlmann E, Holl DC, Lingsma HF, Bartek J Jr, Bartley A, Duerinck J, et al. : Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach. Acta Neurochir (Wien) 162 : 763-776, 2020 https://doi.org/10.1007/s00701-020-04218-8
  15. Feghali J, Yang W, Huang J : Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg 141 : 339-345, 2020 https://doi.org/10.1016/j.wneu.2020.06.140
  16. Jack A, O'Kelly C, McDougall C, Findlay JM : Predicting recurrence after chronic subdural haematoma drainage. Can J Neurol Sci 42 : 34-39, 2015 https://doi.org/10.1017/cjn.2014.122
  17. Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R : Predicting outcome in individual patients after severe head injury. Lancet 1 : 1031-1034, 1976
  18. Jung YS, Kim YE, Go DS, Yoon SJ : Projecting the prevalence of obesity in South Korea through 2040: a microsimulation modelling approach. BMJ Open 10 : e037629, 2020 https://doi.org/10.1136/bmjopen-2020-037629
  19. Kanazawa T, Takahashi S, Minami Y, Jinzaki M, Toda M, Yoshida K : Prediction of postoperative recurrence of chronic subdural hematoma using quantitative volumetric analysis in conjunction with computed tomography texture analysis. J Clin Neurosci 72 : 270-276, 2020 https://doi.org/10.1016/j.jocn.2019.11.019
  20. Kang MS, Koh HS, Kwon HJ, Choi SW, Kim SH, Youm JY : Factors influencing recurrent chronic subdural hematoma after surgery. J Korean Neurosurg Soc 41 : 11-15, 2007
  21. Kim GH, Kim BT, Im SB, Hwang SC, Jeong JH, Shin DS : Comparison of the indications and treatment results of burr-Hole drainage at the maximal thickness area versus twist-drill craniostomy at the pre-coronal point for the evacuation of symptomatic chronic subdural hematomas. J Korean Neurosurg Soc 56 : 243-247, 2014 https://doi.org/10.3340/jkns.2014.56.3.243
  22. Kim SU, Lee DH, Kim YI, Yang SH, Sung JH, Cho CB : Predictive factors for recurrence after burr-hole craniostomy of chronic subdural hematoma. J Korean Neurosurg Soc 60 : 701-709, 2017 https://doi.org/10.3340/jkns.2016.1010.003
  23. Kolias AG, Chari A, Santarius T, Hutchinson PJ : Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol 10 : 570-578, 2014 https://doi.org/10.1038/nrneurol.2014.163
  24. Kostic A, Kehayov I, Stojanovic N, Nikolov V, Kitov B, Milosevic P, et al. : Spontaneous chronic subdural hematoma in elderly people - arterial hypertension and other risk factors. J Chin Med Assoc 81 : 781-786, 2018 https://doi.org/10.1016/j.jcma.2018.03.010
  25. Kuwabara M, Sadatomo T, Yuki K, Migita K, Imada Y, Shimizu K, et al. : The effect of irrigation solutions on recurrence of chronic subdural hematoma: a consecutive cohort study of 234 patients. Neurol Med Chir (Tokyo) 57 : 210-216, 2017 https://doi.org/10.2176/nmc.oa.2016-0228
  26. Lee KS : Chronic subdural hematoma in the aged, trauma or degeneration? J Korean Neurosurg Soc 59 : 1-5, 2016 https://doi.org/10.3340/jkns.2016.59.1.1
  27. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H : The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 55 : 390-396, 1981 https://doi.org/10.3171/jns.1981.55.3.0390
  28. Mersha A, Abat S, Temesgen T, Nebyou A : Outcome of chronic subdural hematoma treated with single burr hole under local anesthesia. Ethiop J Health Sci 30 : 101-106, 2020
  29. Miah IP, Tank Y, Rosendaal FR, Peul WC, Dammers R, Lingsma HF, et al. : Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis. Neuroradiology 63 : 27-40, 2021 https://doi.org/10.1007/s00234-020-02558-x
  30. 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
  31. Nakaguchi H, Tanishima T, Yoshimasu N : Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 95 : 256-262, 2001 https://doi.org/10.3171/jns.2001.95.2.0256
  32. Neifert SN, Chaman EK, Hardigan T, Ladner TR, Feng R, Caridi JM, et al. : Increases in subdural hematoma with an aging population-the future of American cerebrovascular disease. World Neurosurg 141 : e166-e174, 2020 https://doi.org/10.1016/j.wneu.2020.05.060
  33. Oh JS, Shim JJ, Yoon SM, Lee KS : Influence of gender on occurrence of chronic subdural hematoma; is it an effect of cranial asymmetry? Korean J Neurotrauma 10 : 82-85, 2014 https://doi.org/10.13004/kjnt.2014.10.2.82
  34. Ohba S, Kinoshita Y, Nakagawa T, Murakami H : The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 36 : 145-149; discussion 149-150, 2013 https://doi.org/10.1007/s10143-012-0396-z
  35. Poon MTC, Rea C, Kolias AG, Brennan PM; British Neurosurgical Trainee Research Collaborative (BNTRC) : Influence of antiplatelet and anticoagulant drug use on outcomes after chronic subdural hematoma drainage. J Neurotrauma 38 : 1177-1184, 2021 https://doi.org/10.1089/neu.2018.6080
  36. Rauhala M, Helen P, Huhtala H, Heikkila P, Iverson GL, Niskakangas T, et al. : Chronic subdural hematoma-incidence, complications, and financial impact. Acta Neurochir (Wien) 162 : 2033-2043, 2020 https://doi.org/10.1007/s00701-020-04398-3
  37. Rauhala M, Luoto TM, Huhtala H, Iverson GL, Niskakangas T, Ohman J, et al. : The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg 22 : 1147-1157, 2019
  38. Ridwan S, Bohrer AM, Grote A, Simon M : Surgical treatment of chronic subdural hematoma: predicting recurrence and cure. World Neurosurg 128 : e1010-e1023, 2019 https://doi.org/10.1016/j.wneu.2019.05.063
  39. Shapey J, Glancz LJ, Brennan PM : Chronic subdural haematoma in the elderly: is it time for a new paradigm in management? Curr Geriatr Rep 5 : 71-77, 2016 https://doi.org/10.1007/s13670-016-0166-9
  40. Stavrinou P, Katsigiannis S, Lee JH, Hamisch C, Krischek B, Mpotsaris A, et al. : Risk factors for chronic subdural hematoma recurrence identified using quantitative computed tomography analysis of hematoma volume and density. World Neurosurg 99 : 465-470, 2017 https://doi.org/10.1016/j.wneu.2016.12.058
  41. Surve RM, Bansal S, Reddy M, Philip M : Use of dexmedetomidine along with local infiltration versus general anesthesia for burr hole and evacuation of chronic subdural hematoma (CSDH). J Neurosurg Anesthesiol 29 : 274-280, 2017 https://doi.org/10.1097/ANA.0000000000000305
  42. United Nations : World population prospects 2019: highlights. Available at : https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf
  43. Uno M, Toi H, Hirai S : Chronic subdural hematoma in elderly patients: is this disease benign? Neurol Med Chir (Tokyo) 57 : 402-409, 2017 https://doi.org/10.2176/nmc.ra.2016-0337
  44. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S : Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. J Neurosurg 98 : 1217-1221, 2003 https://doi.org/10.3171/jns.2003.98.6.1217
  45. Yang W, Huang J : Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 28 : 205-210, 2017 https://doi.org/10.1016/j.nec.2016.11.002
  46. You W, Zhu Y, Wang Y, Liu W, Wang H, Wen L, et al. : Prevalence of and risk factors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 160 : 893-899, 2018 https://doi.org/10.1007/s00701-018-3513-0