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Independent predictors for functional outcome after drainage of chronic subdural hematoma identified using a logistic
Sotirios Katsigiannis1, Christina Hamisch1, Boris Krischek1
1Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
Insights
Age, preoperative condition, surgical technique, and recurrence impact outcomes for chronic subdural hematoma (CSDH) patients. Identifying these prognostic factors aids in predicting functional recovery after CSDH surgery.
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Chronic subdural hematoma (CSDH) frequently requires neurosurgical intervention.
- Optimal functional outcomes after CSDH surgery are not always achieved.
- Predictors of functional outcome following CSDH treatment require further investigation.
Purpose of the Study:
- To identify independent predictors of functional outcome in patients undergoing surgical treatment for CSDH.
- To avoid subjective assessments by utilizing objective data and computer-assisted analysis.
Main Methods:
- Retrospective review of 197 consecutive CSDH surgical cases.
- Univariate and multivariate analyses to correlate clinical and radiographic factors with outcomes.
- Computer-assisted 3D-volumetric analysis for imaging assessment.
Main Results:
- A favorable outcome (GOS grades 4-5) was observed in 83.2% of patients.
- Multivariate analysis identified age (>77 years), preoperative Markwalder Score, recurrence, and surgical technique as independent prognostic factors.
- Mini-craniotomy was associated with worse outcomes compared to burr-hole craniostomies.
Conclusions:
- Age, preoperative neurological status, surgical technique, and recurrence are significant independent prognostic factors for functional outcome in CSDH patients.
- These factors can inform clinical decision-making and patient counseling.
- Objective assessment methods, like 3D-volumetric analysis, are valuable in CSDH research.
Background:
Chronic subdural hematoma (CSDH) is a common indication for undergoing neurosurgery, but the outcome may remain limited despite timely surgical treatment. The factors potentially associated with the functional outcome have not been sufficiently investigated. We set out to identify independent predictors associated with the functional outcome after surgical treatment of CSDH, avoiding arbitrary classifications and thresholds or subjective imaging assessment.
Methods:
We retrospectively reviewed 197 consecutive surgical cases of CSDH. Univariate and multivariate analyses were performed to identify the relationship between clinical plus radiographic factors and outcome. Imaging analysis was performed using computer-assisted 3D-volumetric analysis.
Results:
One-hundred and sixty-four (83.2%) patients had a favorable (GOS grade 5 and 4) and 33 (16.8%) an unfavorable clinical outcome (GOS grade 1-3). The multivariate logistic regression analysis determined 4 independent prognostic factors: age over or under 77 years, preoperative clinical condition (Markwalder Score), recurrence and surgical technique applied. Patients treated with mini-craniotomy procedures had worse outcomes than those treated with single or two burr-hole craniostomies. The percentage of the hematoma drained correlated strongly with recurrence and was by itself not an independent predictor for outcome.
Conclusions:
In our study age, preoperative neurological status, surgical technique and recurrence were found to be independent prognostic factors for the functional outcome in patients with CSDH.