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Published on: October 15, 2021
Neurosurgical and Perioperative Management of Chronic Subdural Hematoma
Jurre Blaauw1,2, Bram Jacobs1, Heleen M den Hertog3
1Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Insights
Bilateral Chronic Subdural Hematoma (CSDH) increases recurrence risk. Surgical approach for bilateral CSDH did not affect recurrence, but general anesthesia increased complications and hospital stay for CSDH patients.
Area of Science:
- Neurosurgery
- Anesthesiology
- Clinical Outcomes Research
Background:
- Chronic Subdural Hematoma (CSDH) is commonly treated with burr hole craniostomy.
- Management strategies for bilateral CSDH and anesthetic choices require further investigation.
Purpose of the Study:
- To evaluate the impact of surgical approach (unilateral vs. bilateral decompression) on outcomes in bilateral CSDH.
- To assess the effect of anesthesia modality (general vs. local) on CSDH patient outcomes.
Main Methods:
- Retrospective analysis of 1,029 surgically treated CSDH patients (2005-2019).
- Logistic regression used to analyze outcomes (complications, recurrence, length of stay) adjusted for clinical and radiological factors.
- Comparison of unilateral versus bilateral decompression for bilateral CSDH and general versus local anesthesia.
Main Results:
- Bilateral CSDH independently associated with higher recurrence risk (aOR 1.7).
- No significant difference in recurrence rates between unilateral and bilateral decompression for bilateral CSDH (15% vs. 17%).
- General anesthesia linked to increased complications (aOR 1.8) and longer hospital stay (aOR 8.4) compared to local anesthesia.
Conclusions:
- Bilateral CSDH is associated with increased recurrence rates.
- Surgical approach for bilateral CSDH does not significantly alter recurrence; patient-specific choices are recommended.
- General anesthesia for CSDH surgery is associated with higher complication rates and prolonged hospital admission.
Abstract:
Objective: Surgery and specifically burr hole craniostomy is the most common first choice treatment of patients with Chronic Subdural Hematoma (CSDH). However, several aspects of neurosurgical and peri-operative management are still a subject of research, such as how to treat bilateral CSDH and the anesthetic approach. We aim to investigate the effect of the surgical approach to bilateral CSDH and the effect of anesthesia modality on outcome of CSDH patients. Methods: We retrospectively included surgically treated CSDH patients between 2005 and 2019 in three hospitals in the Netherlands. The effect of the surgical approach to bilateral CSDH (unilateral vs. bilateral decompression) and anesthesia modality (general vs. local anesthesia) on outcome (complications, recurrence, and length of hospital stay over 4 days) was studied with logistic regression adjusting for potentially confounding radiological and clinical characteristics. Results: Data of 1,029 consecutive patients were analyzed, mean age was 73.5 years (±11) and 75% of patients were male. Bilateral CSDH is independently associated with an increased risk of recurrence within 3 months in logistic regression analysis (aOR 1.7, 95% CI: 1.1-2.5) but recurrence rate did not differ between primary bilateral or unilateral decompression of bilateral CSDH. (15 vs. 17%, p = 0.775). Logistic regression analysis showed that general anesthesia was independently associated with an increased risk of complications (aOR 1.8, 95% CI: 1.0-3.3) and with a length of hospital admission of over 4 days (aOR 8.4, 95% CI: 5.6-12.4). Conclusions: Bilateral CSDH is independently associated with higher recurrence rates. As recurrence rates in bilateral CSDH are similar for different surgical approaches, the optimal choice for primary bilateral decompression of bilateral CSDH could vary per patient. General anesthesia for surgical treatment of CSDH is associated with higher complication rates and longer hospital admission.
