Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Natural course of chronic subdural hematoma following surgical clipping of unruptured intracranial aneurysm by pterional approach

  • Su-Bin Kweon (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Suchel Kim (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Min-Yong Kwon (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Chang-Hyun Kim (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Sae Min Kwon (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Yong San Ko (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Chang-Young Lee (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine)
  • Received : 2023.04.27
  • Accepted : 2023.06.21
  • Published : 2023.12.31
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Abstract

Objective: Chronic subdural hematoma (CSDH) is a neurological complication following clipping surgery. However, the natural course and ideal approach for the treatment of clipping-related-CSDH (CR-CSDH) have not been clearly established. We aimed to investigate the course of CR-CSDH using chronological radiological findings. Methods: We performed a retrospective analysis of 28 (3.8%) patients who developed CSDH among 736 patients who underwent surgical clipping using pterional approach for unruptured aneurysms at our institution between December 2010 and December 2018. Patients underwent follow-up CT scan 6-8 weeks after clipping surgery and decision to pursue surgical intervention rests upon the patient's symptom based on the Markwalder's grading scale (MGS) and numeric rating scale (NRS). Results: Of the 28 patients, 3 patients (10.7%) underwent surgery, while 25 (89.2%) showed spontaneous resolution of CR-CSDH. Eighteen patients (64.2%) had mild headache with MGS of 0-1. The mean maximum hematoma volume was 41.9±30.9 ml (5.8-135 ml), and 26 patients (92.8%) had homogeneous hematoma. The mean time to hematoma resolution was 126.7±52.9 days (46-228 days). Comparing group of CR-CSDH volume ≥43 ml or a midline shift ≥5 mm, the difference in presence of linear low-density area (p=0.002) and age (p=0.026) between the conservative and operative groups were found to be statistically significant. Conclusions: Most CR-CSDH cases spontaneously resolved within 4 months. Therefore, we suggest that close observation should be performed if patient's symptoms are mild and special radiologic findings are present, despite its relatively large volume and midline shifting.

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References

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