Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of Time Interval between Trauma Onset and Burr Hole Surgery on Recurrence of Late Subacute or Chronic Subdural Hematoma

  • Kim, Dae-in (Department of Neurosurgery, Eulji General Hospital, College of Medicine, Eulji University) ;
  • Kim, Jae-hoon (Department of Neurosurgery, Eulji General Hospital, College of Medicine, Eulji University) ;
  • Kang, Hee-in (Department of Neurosurgery, Eulji General Hospital, College of Medicine, Eulji University) ;
  • Moon, Byung-gwan (Department of Neurosurgery, Eulji General Hospital, College of Medicine, Eulji University) ;
  • Kim, Joo-seung (Department of Neurosurgery, Eulji General Hospital, College of Medicine, Eulji University) ;
  • Kim, Deok-ryeong (Department of Neurosurgery, Eulji General Hospital, College of Medicine, Eulji University)
  • Received : 2016.03.29
  • Accepted : 2016.07.20
  • Published : 2016.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Although subdural hematoma (SDH) is commonly treatable by burr hole surgery in the late subacute or chronic stage, there is no clear consensus regarding appropriate management and exact predictive factors for postoperative recurrence also remain unclear. The aim of this study was to evaluate risk factors associated with recurrence of SDH that requires burr hole surgery in the late subacute or chronic stage. We also identified the appropriate timing of surgery for reducing the recurrence. Methods : We retrospectively reviewed 274 patients with SDH in the late subacute or chronic stage treated with burr hole surgery in our hospital between January 2007 and December 2014. Excluding patients with acute intracranial complications or unknown time of trauma onset left 216 patients included in the study. Results : Of 216 patients with SDH in the late subacute or chronic stage, recurrence was observed in 36 patients (16.7%). The timing of the operation in patients with late subacute stage (15-28 days) resulted in a significant decrease in recurrence (RR, 0.33; 95% CI, 0.17-0.65; p=0.001) compared to chronic stage (>28 days). Otherwise, no significant risk factors were associated with recurrences including comorbidities and surgical details. Conclusion : The results indicated that time from trauma onset to burr hole surgery may be important for decreasing the risk of recurrence. Therefore, unless patients can be treated conservatively without surgery, prompt surgical management is recommended in patients diagnosed as having late subacute or chronic subdural hematoma treatable by burr hole surgery, even when neurological deficits are unclear.

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. 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
  3. Aoki N, Tsutsumi K : Symptomatic subacute subdural haematoma following spontaneous acute subdural haematoma. Acta Neurochir (Wien) 102 : 149-151, 1999
  4. Baechli H, Nordmann A, Bucher HC, Gratzl O : Demographics and prevalent risk factors of chronic subdural haematoma : results of a large single-center cohort study. Neurosurg Rev 27 : 263-266, 2004
  5. Bradley WG Jr : MR appearance of hemorrhage in the brain. Radiology 189 : 15-26, 1993 https://doi.org/10.1148/radiology.189.1.8372185
  6. Bradley WG Jr, Schmidt PG : Effect of methemoglobin formation on the MR appearance of subarachnoid hemorrhage. Radiology 156 : 99-103, 1985 https://doi.org/10.1148/radiology.156.1.4001427
  7. Chon KH, Lee JM, Koh EJ, Choi HY : Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 154 : 1541-1548, 2012 https://doi.org/10.1007/s00701-012-1399-9
  8. Drapkin AJ : Chronic subdural hematoma : pathophysiological basis for treatment. Br J Neurosurg 5 : 467-473, 1991 https://doi.org/10.3109/02688699108998475
  9. 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
  10. Dumont TM, Rughani AI, Goeckes T, Tranmer BI : Chronic subdural hematoma : a sentinel health event. World Neurosurg 80 : 889-892, 2013 https://doi.org/10.1016/j.wneu.2012.06.026
  11. Fujisawa H, Nomura S, Kajiwara K, Kato S, Fujii M, Suzuki M : Various magnetic resonance imaging patterns of chronic subdural hematomas : indicators of the pathogenesis? Neurol Med Chir (Tokyo) 46 : 333-338; discussion 338-339, 2006 https://doi.org/10.2176/nmc.46.333
  12. Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez-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
  13. Godlewski B, Pawelczyk A, Pawelczyk T, Ceranowicz K, Wojdyn M, Radek M : Retrospective analysis of operative treatment of a series of 100 patients with subdural hematoma. Neurol Med Chir (Tokyo) 53 : 26-33, 2013 https://doi.org/10.2176/nmc.53.26
  14. Gomori JM, Grossman RI : Mechanisms responsible for the MR appearance and evolution of intracranial hemorrhage. Radiographics 8 : 427-440, 1988 https://doi.org/10.1148/radiographics.8.3.3380989
  15. Goto H, Ishikawa O, Nomura M, Tanaka K, Nomura S, Maeda K : Magnetic resonance imaging findings predict the recurrence of chronic subdural hematoma. Neurol Med Chir (Tokyo) 55 : 173-178, 2015 https://doi.org/10.2176/nmc.oa.2013-0390
  16. Hayman LA, Taber KH, Ford JJ, Bryan RN : Mechanisms of MR signal alteration by acute intracerebral blood : old concepts and new theories. AJNR Am J Neuroradiol 12 : 899-907, 1991
  17. Huang KT, Bi WL, Abd-El-Barr M, Yan SC, Tafel IJ, Dunn IF, et al. : The Neurocritical and neurosurgical care of subdural hematomas. Neurocrit Care 24 : 294-307, 2016 https://doi.org/10.1007/s12028-015-0194-x
  18. Izumihara A, Orita T, Tsurutani T, Kajiwara K : [Natural course of nonoperative cases of acute subdural hematoma : sequential computed tomographic study in the acute and subacute stages]. No Shinkei Geka 25 : 307-314, 1997
  19. Izumihara A, Yamashita K, Murakami T : Acute subdural hematoma requiring surgery in the subacute or chronic stage. Neurol Med Chir (Tokyo) 53 : 323-328, 2013 https://doi.org/10.2176/nmc.53.323
  20. Kawakami Y, Chikama M, Tamiya T, Shimamura Y : Coagulation and fibrinolysis in chronic subdural hematoma. Neurosurgery 25 : 25-29, 1989 https://doi.org/10.1227/00006123-198907000-00005
  21. Kpelao E, Beketi KA, Moumouni AK, Doleagbenou A, Ntimon B, Egbohou P, et al. : Clinical profile of subdural hematomas : dangerousness of subdural subacute hematoma. Neurosurg Rev 39 : 237-240; discussion 240, 2016 https://doi.org/10.1007/s10143-015-0669-4
  22. Lee L, Ker J, Ng HY, Munusamy T, King NK, Kumar D, et al. : Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians : a multicenter study. J Neurosurg 124 : 546-551, 2016 https://doi.org/10.3171/2014.12.JNS142053
  23. McKissock W, Richardson A, Bloom WH : Subdural haematoma : a review of 389 cases. Lancet 275 : 1365-1369, 1960 https://doi.org/10.1016/S0140-6736(60)91148-X
  24. Miranda LB, Braxton E, Hobbs J, Quigley MR : Chronic subdural hematoma in the elderly : not a benign disease. J Neurosurg 114 : 72-76, 2011 https://doi.org/10.3171/2010.8.JNS10298
  25. Morinaga K, Matsumoto Y, Omiya N, Mikami J, Ueda M, Sato H, et al. : [Subacute subdural hematoma--report of 4 cases and a review of the literature]. No To Shinkei 42 : 131-136, 1990
  26. Murakami H, Hirose Y, Sagoh M, Shimizu K, Kojima M, Gotoh K, et al. : Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 96 : 877-884, 2002 https://doi.org/10.3171/jns.2002.96.5.0877
  27. 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
  28. 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
  29. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M : Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo) 41 : 382-386, 2001 https://doi.org/10.2176/nmc.41.382
  30. Okumura Y, Shimomura T, Park YS : [A study of acute subdural hematoma developing into hematoma with capsule formation]. No Shinkei Geka 26 : 691-698, 1998
  31. Pang CH, Lee SE, Kim CH, Kim JE, Kang HS, Park CK, et al. : Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma. J Neurosurg 123 : 65-74, 2015 https://doi.org/10.3171/2014.12.JNS141189
  32. Parizel PM, Makkat S, Van Miert E, Van Goethem JW, van den Hauwe L, De Schepper AM : Intracranial hemorrhage : principles of CT and MRI interpretation. Eur Radiol 11 : 1770-1783, 2001 https://doi.org/10.1007/s003300000800
  33. Park HR, Lee KS, Shim JJ, Yoon SM, Bae HG, Doh JW : Multiple densities of the chronic subdural hematoma in CT scans. J Korean Neurosurg Soc 54 : 38-41, 2013 https://doi.org/10.3340/jkns.2013.54.1.38
  34. Sajanti J, Majamaa K : High concentrations of procollagen propeptides in chronic subdural haematoma and effusion. J Neurol Neurosurg Psychiatry 74 : 522-524, 2003 https://doi.org/10.1136/jnnp.74.4.522
  35. Salvant JB Jr, Muizelaar JP : Changes in cerebral blood flow and metabolism related to the presence of subdural hematoma. Neurosurgery 33 : 387-393; discussion 393, 1993
  36. 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 haematoma : a randomised controlled trial. Lancet 374 : 1067-1073, 2009 https://doi.org/10.1016/S0140-6736(09)61115-6
  37. Son S, Yoo CJ, Lee SG, Kim EY, Park CW, Kim WK : Natural course of initially non-operated cases of acute subdural hematoma : the risk factors of hematoma progression. J Korean Neurosurg Soc 54 : 211-219, 2013 https://doi.org/10.3340/jkns.2013.54.3.211
  38. Tao Z, Ding S, Hu M, Li J : Delayed hypersensitive process in subacute subdural hematoma. J Craniofac Surg 26 : e443-e445, 2015 https://doi.org/10.1097/SCS.0000000000001889
  39. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S : Independent predictors for recurrence of chronic subdural hematoma : a review of 343 consecutive surgical cases. Neurosurgery 63 : 1125-1129; discussion 1129, 2008 https://doi.org/10.1227/01.NEU.0000335782.60059.17
  40. Vaquero J, Zurita M, Cincu R : Vascular endothelial growth-permeability factor in granulation tissue of chronic subdural haematomas. Acta Neurochir (Wien) 144 : 343-346; discussion 347, 2002 https://doi.org/10.1007/s007010200047
  41. Weigel R, Schilling L, Schmiedek P : Specific pattern of growth factor distribution in chronic subdural hematoma (CSH) : evidence for an angiogenic disease. Acta Neurochir (Wien) 143 : 811-818; discussion 819, 2001 https://doi.org/10.1007/s007010170035
  42. 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