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Management of Recurrent Subdural Hematomas.

Virendra R Desai1, Robert A Scranton1, Gavin W Britz1

  • 1Department of Neurosurgery, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA.

Neurosurgery Clinics of North America
|March 23, 2017
PubMed
Summary

Subdural hematoma recurrence after surgery is common, ranging from 2% to 37%. Identifying patient, radiologic, and surgical risk factors aids in managing these common brain injuries.

Keywords:
Chronic subdural hematomaRecurrent hematomaRecurrent subdural hematomaSubdural hematoma

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Area of Science:

  • Neurosurgery
  • Radiology
  • Neurology

Background:

  • Subdural hematomas (SDHs) frequently recur after surgical evacuation, with recurrence rates varying widely between 2% and 37%.
  • Recurrence poses a significant challenge in neurosurgical practice, necessitating a thorough understanding of associated risk factors.

Purpose of the Study:

  • To comprehensively review and categorize the risk factors associated with subdural hematoma recurrence.
  • To outline current management strategies for recurrent subdural hematomas.

Main Methods:

  • Literature review of studies reporting on subdural hematoma recurrence.
  • Categorization of risk factors into patient-related, radiologic, and surgical domains.
  • Analysis of treatment outcomes for recurrent subdural hematomas.

Main Results:

  • Patient-related factors include alcoholism, seizure disorders, coagulopathy, and prior ventriculoperitoneal shunt.
  • Radiologic factors include poor brain reexpansion, subdural air, midline shift, heterogeneous, and high-density hematomas.
  • Surgical factors involve inadequate or absent postoperative drainage.

Conclusions:

  • Recurrent subdural hematomas are often managed successfully with burr hole craniostomies and closed-system drainage.
  • Refractory cases may require craniotomy or subdural-peritoneal shunt placement.
  • Understanding risk factors is crucial for preventing and managing SDH recurrence.