Zhongrun Qian1, Dianxu Yang1, Fei Sun2, Zhenguo Sun2. 1. a Department of Neurosurgery , Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China. 2. b Department of Neurosurgery , The Affiliated Xuzhou Hospital of Medical College of Southeast University , Xuzhou , Jiangsu , China.
Abstract
OBJECTIVE: Chronic subdural hematomas (CSDHs) are often found in neurosurgery, and display a recurrence rate of up to 37%. This study aimed to determine potential risk factors contributing to unilateral CSDH recurrence, and evaluate the role of postoperative management with dexamethasone (DX) in reducing recurrence. METHODS: Between January 2010 and May 2015, a total of 242 consecutive patients with CSDH treated with burr-hole trephination were included in this study. Univariate and multivariate analyses were performed to determine risk factors potentially associated with the recurrence of CSDH. Then, patients at high risk were divided into DX and non-DX treatment groups, respectively. Chi-square test was used to assess the potential role of DX. RESULTS: CSDH recurrence was recorded in 39 patients (16.1%). Among various risk factors, advanced age (p = .01), preoperative midline displacement exceeding 10 mm (p < .001), and hematomas presenting with separated type (p = .03) were significantly associated with CSDH recurrence. Interestingly, patients who accepted therapy with DX had a lower rate of second drainage procedure (p = .017). In addition, DX effectively reduced disease recurrence in patients with the separated type of hematoma (p = .047), and seemed to be beneficial to those with advanced age and midline shift exceeding 10 mm, although statistical significance was not achieved. CONCLUSION: These findings indicated that advanced age, midline displacement, and mixed density hematoma are independent factors for unilateral CSDH recurrence. When the above factors are detected in patients, additional DX administration should be recommended after operation.
OBJECTIVE:Chronic subdural hematomas (CSDHs) are often found in neurosurgery, and display a recurrence rate of up to 37%. This study aimed to determine potential risk factors contributing to unilateral CSDH recurrence, and evaluate the role of postoperative management with dexamethasone (DX) in reducing recurrence. METHODS: Between January 2010 and May 2015, a total of 242 consecutive patients with CSDH treated with burr-hole trephination were included in this study. Univariate and multivariate analyses were performed to determine risk factors potentially associated with the recurrence of CSDH. Then, patients at high risk were divided into DX and non-DX treatment groups, respectively. Chi-square test was used to assess the potential role of DX. RESULTS:CSDH recurrence was recorded in 39 patients (16.1%). Among various risk factors, advanced age (p = .01), preoperative midline displacement exceeding 10 mm (p < .001), and hematomas presenting with separated type (p = .03) were significantly associated with CSDH recurrence. Interestingly, patients who accepted therapy with DX had a lower rate of second drainage procedure (p = .017). In addition, DX effectively reduced disease recurrence in patients with the separated type of hematoma (p = .047), and seemed to be beneficial to those with advanced age and midline shift exceeding 10 mm, although statistical significance was not achieved. CONCLUSION: These findings indicated that advanced age, midline displacement, and mixed density hematoma are independent factors for unilateral CSDH recurrence. When the above factors are detected in patients, additional DX administration should be recommended after operation.
Authors: Elena I Fomchenko; Emily J Gilmore; Charles C Matouk; Jason L Gerrard; Kevin N Sheth Journal: Curr Treat Options Neurol Date: 2018-06-23 Impact factor: 3.598
Authors: Ellie Edlmann; Susan Giorgi-Coll; Peter C Whitfield; Keri L H Carpenter; Peter J Hutchinson Journal: J Neuroinflammation Date: 2017-05-30 Impact factor: 8.322
Authors: Ellie Edlmann; Eric P Thelin; Karen Caldwell; Carole Turner; Peter Whitfield; Diederik Bulters; Patrick Holton; Nigel Suttner; Kevin Owusu-Agyemang; Yahia Z Al-Tamimi; Daniel Gatt; Simon Thomson; Ian A Anderson; Oliver Richards; Monica Gherle; Emma Toman; Dipankar Nandi; Phillip Kane; Beatrice Pantaleo; Carol Davis-Wilkie; Silvia Tarantino; Garry Barton; Hani J Marcus; Aswin Chari; Antonio Belli; Simon Bond; Rafael Gafoor; Sarah Dawson; Lynne Whitehead; Paul Brennan; Ian Wilkinson; Angelos G Kolias; Peter J A Hutchinson Journal: Sci Rep Date: 2019-04-10 Impact factor: 4.379
Authors: Ishita P Miah; Dana C Holl; Wilco C Peul; Robert Walchenbach; Nyika Kruyt; Karlijn de Laat; Radboud W Koot; Victor Volovici; Clemens M F Dirven; Fop van Kooten; Kuan H Kho; Heleen M den Hertog; Joukje van der Naalt; Bram Jacobs; Rob J M Groen; Hester F Lingsma; Ruben Dammers; Korné Jellema; Niels A van der Gaag Journal: Trials Date: 2018-10-20 Impact factor: 2.279
Authors: Laurence Johann Glancz; Michael Tin Chung Poon; Peter John Hutchinson; Angelos Georgiou Kolias; Paul Martin Brennan Journal: Acta Neurochir (Wien) Date: 2020-04-27 Impact factor: 2.216
Authors: Ishita P Miah; Yeliz Tank; Frits R Rosendaal; Wilco C Peul; Ruben Dammers; Hester F Lingsma; Heleen M den Hertog; Korné Jellema; Niels A van der Gaag Journal: Neuroradiology Date: 2020-10-22 Impact factor: 2.804