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Bilateral Chronic Subdural Hematoma is Associated with Rapid Progression and Poor Clinical Outcome
Yuji Agawa1, Yohei Mineharu, Shoichi Tani
1Department of Neurosurgery, Kobe City Medical Center General Hospital.
Insights
Chronic subdural hematoma (CSDH) is often considered benign, but outcomes vary. Bilateral CSDH significantly increases the risk of poor outcomes, including brain herniation, warranting prompt surgical intervention.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Medicine
Background:
- Chronic subdural hematoma (CSDH) is generally viewed as a benign condition.
- However, comprehensive data on its clinical outcomes, particularly concerning laterality, remain limited.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients undergoing surgery for CSDH.
- To specifically analyze the impact of hematoma laterality (unilateral vs. bilateral) on patient outcomes.
Main Methods:
- Retrospective review of 368 CSDH cases operated between June 2005 and June 2012.
- Analysis of clinical variables including age, sex, laterality, symptoms, consciousness level, and risk factors (malignancy, anticoagulants).
Main Results:
- Six patients (1.4%) experienced poor outcomes (morbidity/mortality at 7 days post-op).
- Bilateral CSDH was significantly associated with poor outcomes (p=0.041) and higher rates of brain herniation (5.7% vs 0.3%, p=0.01).
- No significant differences in recurrence rates were observed between unilateral and bilateral CSDH.
Conclusions:
- Bilateral CSDH presents a higher risk of poor outcomes, particularly brain herniation, compared to unilateral CSDH.
- Urgent surgical decompression via trephination may be advisable for bilateral CSDH due to rapid progression and worse prognosis.
Abstract:
Chronic subdural hematoma (CSDH) has been recognized as a benign disease, but its clinical outcome is not well documented. This study aims to expand the knowledge base regarding the outcome of CSDH. We retrospectively reviewed clinical characteristics of CSDH operated in the Kobe City Medical Center General Hospital between June 2005 and June 2012. Variants included age at onset, sex, laterality, presence of headache, consciousness level, and risk factors for hemorrhage such as malignancy or intake of anticoagulants. A total of 368 cases were analyzed. Six patients (1.4%) had a poor outcome, defined as any morbidity or mortality at 7 days postoperatively. Bilateral hematoma was significantly associated with a poor outcome (p = 0.041). Warfarin use and malignancy, albeit statistically not significant, were more frequently observed in patients with a poor outcome. Bilateral CSDH was observed in 53 patients (14.4%). Age at onset, sex, history of malignancy, anticoagulant use, and antiplatelet use did not differ between bilateral and unilateral CSDH. Recurrence rate was not different between bilateral and unilateral CSDH (14.2% vs. 11.3%), but poor outcome as a result of brain herniation was significantly higher in bilateral than in unilateral hematomas (5.7% vs. 0.3%, p = 0.01). Bilateral CSDH was associated with rapid progression and showed worse outcome as a result of brain herniation in comparison with unilateral CSDH. Urgent trephination surgery for decompression of hematoma pressure may be recommended for bilateral CSDH.
