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Published on: October 2, 2014
Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma
Hyeong Woo Ro1, Sang Kyu Park2, Dong Kyu Jang1
1Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
Insights
Predictive factors for chronic subdural hematoma (CSDH) surgical outcomes include younger age, isodense hematomas, and prompt treatment. Good brain expansion correlates with fewer recurrences and better functional outcomes after burr-hole drainage.
Area of Science:
- Neurosurgery
- Radiology
- Geriatrics
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical issue, particularly in elderly populations.
- Burr-hole drainage (BHD) is a standard surgical treatment for CSDH.
Purpose of the Study:
- To identify predictive factors for surgical and functional outcomes following BHD for CSDH.
- To evaluate the relationship between hematoma characteristics and patient outcomes.
Main Methods:
- A retrospective study of 130 CSDH patients treated with BHD (2012-2014).
- Patient data included symptoms, clinical grade, time to surgery, hematoma density, and midline shift.
- Outcomes assessed via brain expansion rate and modified Rankin Scale (mRS) at 0, 3, and 6 months post-surgery.
Main Results:
- Younger age (<75 years), isodense hematoma on CT, and short symptom-to-surgery duration predicted good brain expansion.
- Good brain expansion was associated with reduced recurrence rates.
- Younger age, isodense hematoma, and good initial clinical grade correlated with favorable functional outcomes (mRS).
Conclusions:
- Younger patients, those with isodense hematomas, and shorter symptom durations experience better outcomes after BHD for CSDH.
- Membranectomy may benefit patients with long-standing or hypodense hematomas to improve expansion and functional scores.
Background:
Chronic subdural hematoma (CSDH) is a frequently encountered neurosurgical condition, especially in the elderly. We investigated predictive factors for surgical and functional outcomes after burr-hole drainage (BHD) surgery.
Methods:
All patients with CSDH treated by BHD between January 2012 and December 2014 were included in this study. All patients were classified by symptom, clinical grade, time, location, hematoma density, midline shift, and other characteristics. Pre- and postoperative CT evaluation was performed at 0, 3, and 6 months. Clinical grades were classified as described in Markwalder et al. Surgical and clinical outcomes were evaluated with the brain expansion rate and modified Rankin Scale (mRS). Brain expansion rate was calculated as the ratio between post- and pre-operative hematoma thickness. Recurrence was defined as the occurrence of symptoms and hematoma on CT within 6 months.
Results:
This study included 130 patients over 2 years. Among the variable parameters, young age (<75), iso-density of hematoma on CT, and short duration from symptom to surgery were correlated with good brain expansion. Patients with good brain expansion had fewer recurrences. In terms of mRS, young age, iso-density, and good clinical grade were correlated with good functional outcomes.
Conclusions:
Clinicians should be more aware of general conditions and medical problems, especially in elderly patients. Membranectomy should be considered in patients with a long duration of symptoms or hypo-dense hematomas to promote good brain expansion and good mRS scores.
