E Suero Molina1, L Borscheid2, M Freistühler3, S Zawy Alsofy4, W Stummer2, S Schipmann2. 1. Department of Neurosurgery, University Hospital of Münster, Germany. Electronic address: eric.suero@ukmuenster.de. 2. Department of Neurosurgery, University Hospital of Münster, Germany. 3. Controlling Department, University Hospital of Münster, Münster, Germany. 4. Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
Abstract
BACKGROUND: Chronic subdural hematoma (CSDH) is a frequent disease in neurosurgical practice. However, a considerable recurrence rate keeps this condition challenging to treat. We aimed to provide a simple tool for risk assessment in these patients. METHODS: We conducted a retrospective analysis of surgically treated patients with chronic subdural hematomas. In addition to patients' demographics, radiological assessment included volume, thickness, midline shift and density of hematomas. Statistically significant variables in univariate analysis were further analyzed in a multivariate logistic regression model to create a risk score for recurrence of CSDH. RESULTS: A total of 148 patients were identified and included for analysis. 50.7 % (n = 75) were older than 76 years of age. The overall hematoma recurrence rate requiring surgery was 23.6 % (n = 35). Preoperative thrombocytopenia, postoperative midline shift >6 mm, hematoma volume >80 mL and overall hematoma density >45 Hounsfield Units (HU), were significantly more frequent in the recurrence group. Furthermore, after multivariate assessment, postoperative hematoma density and volume were independent risk factors and included in the risk assessment tool. Patients were divided into 3 risk groups corresponding to the total scores. CONCLUSION: We provide a risk-score assessment for predicting recurrence of subdural hematoma. The risk-score comprises postoperative hematoma volume and density. This tool could ease decision making in follow-up evaluation and indication for recurrence surgery. Yet, further prospective evaluation is required to assess the clinical value of this tool.
BACKGROUND:Chronic subdural hematoma (CSDH) is a frequent disease in neurosurgical practice. However, a considerable recurrence rate keeps this condition challenging to treat. We aimed to provide a simple tool for risk assessment in these patients. METHODS: We conducted a retrospective analysis of surgically treated patients with chronic subdural hematomas. In addition to patients' demographics, radiological assessment included volume, thickness, midline shift and density of hematomas. Statistically significant variables in univariate analysis were further analyzed in a multivariate logistic regression model to create a risk score for recurrence of CSDH. RESULTS: A total of 148 patients were identified and included for analysis. 50.7 % (n = 75) were older than 76 years of age. The overall hematoma recurrence rate requiring surgery was 23.6 % (n = 35). Preoperative thrombocytopenia, postoperative midline shift >6 mm, hematoma volume >80 mL and overall hematoma density >45 Hounsfield Units (HU), were significantly more frequent in the recurrence group. Furthermore, after multivariate assessment, postoperative hematoma density and volume were independent risk factors and included in the risk assessment tool. Patients were divided into 3 risk groups corresponding to the total scores. CONCLUSION: We provide a risk-score assessment for predicting recurrence of subdural hematoma. The risk-score comprises postoperative hematoma volume and density. This tool could ease decision making in follow-up evaluation and indication for recurrence surgery. Yet, further prospective evaluation is required to assess the clinical value of this tool.
Authors: Giancarlo Mignucci-Jiménez; Alejandro J Matos-Cruz; Irakliy Abramov; Sahin Hanalioglu; Melissa S Kovacs; Mark C Preul; Caleb E Feliciano-Valls Journal: Surg Neurol Int Date: 2022-06-03
Authors: Dana C Holl; Ana Mikolic; Jurre Blaauw; Roger Lodewijkx; Merijn Foppen; Korné Jellema; Niels A van der Gaag; Heleen M den Hertog; Bram Jacobs; Joukje van der Naalt; Dagmar Verbaan; K H Kho; C M F Dirven; Ruben Dammers; Hester F Lingsma; David van Klaveren Journal: Acta Neurochir (Wien) Date: 2022-05-03 Impact factor: 2.816