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Peripheral blood eosinophil and classification of residual hematoma help predict the recurrence of chronic subdural
Sichao Chen1, Linqian Shao1, Li Ma1
1Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Peripheral blood eosinophils and postoperative residual hematoma classification predict chronic subdural hematoma recurrence. Identifying these factors aids in understanding and potentially preventing CSDH reoccurrence after surgery.
Area of Science:
- Neurosurgery
- Hematology
- Medical Diagnostics
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with increasing incidence.
- High postoperative recurrence rates present a significant clinical challenge in CSDH management.
- The role of peripheral blood eosinophils and classification of postoperative residual hematoma in CSDH recurrence is not well-established.
Purpose of the Study:
- To investigate the predictive value of peripheral blood eosinophils for CSDH recurrence.
- To determine if the classification of postoperative residual hematoma impacts CSDH recurrence rates.
- To identify independent predictors of CSDH recurrence following burr-hole surgery.
Main Methods:
- Retrospective analysis of 258 CSDH patients undergoing burr-hole surgery.
- Preoperative complete blood count with differential to assess eosinophil levels.
- Evaluation of clinical, laboratory, and radiographic factors, including residual hematoma classification, for recurrence prediction using univariable and multivariable analyses.
Main Results:
- Univariable analysis identified several factors associated with CSDH recurrence, including eosinophil counts and residual hematoma characteristics.
- Multivariable analysis revealed that peripheral blood eosinophil count (<0.15 × 10^9/L), residual hematoma classification (gradation and separated types), preoperative midline shift (≥9.5 mm), postoperative brain re-expansion rate (<41%), and hematoma density types are independent predictors of recurrence.
- Specific thresholds for residual cavity volume, air volume, hematoma volume, and width also showed correlation with recurrence in univariable analysis.
Conclusions:
- Peripheral blood eosinophil levels and the classification of postoperative residual hematoma are significant predictors of CSDH recurrence after burr-hole surgery.
- These findings may improve the understanding of CSDH recurrence mechanisms.
- The study suggests potential for incorporating these factors into risk stratification and management strategies for CSDH.
Abstract:
Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in neurosurgical practice, whose incidence has increased markedly in recent years. However, CSDH still troubles clinicians with a high postoperative recurrence rate. The presence of eosinophils has been confirmed in some CSDH surgical specimens. Furthermore, postoperative residual hematoma has not been classified, and its association with the recurrence of CSDH remains unknown. The present study aimed to test the hypothesis that the peripheral blood eosinophils and the classification of postoperative residual hematoma are significant for the prediction of CSDH recurrence after burr-hole surgery. A retrospective review of 258 CSDH patients who received burr-hole surgery was performed. A complete blood picture with differential count was taken before surgery. Clinical, laboratory, and radiographic factors predicting CSDH recurrence were identified in univariable and multivariable analyses. Univariable analysis showed that the percentage of eosinophils, peripheral blood eosinophil count <0.15 × 109/L, gradation and separated types, postoperative volume of the residual cavity ≥70 ml, residual air volume ≥28 ml, residual hematoma volume ≥55 ml, residual hematoma width ≥1.4 cm, postoperative midline shift ≥5.6 mm, postoperative brain re-expansion rate <41%, postoperative low-density type, and postoperative high-density type correlated with the recurrence of CSDH. Multivariable analysis, however, showed that peripheral blood eosinophil count <0.15 × 109/L, gradation and separated types, preoperative midline shift ≥9.5 mm, postoperative brain re-expansion rate <41%, postoperative low-density type, and postoperative high-density type are independent predictors for the recurrence of CSDH. We expect that peripheral blood eosinophils and the classification of postoperative residual hematoma may facilitate our understanding of the recurrence of CSDH after initial surgery.
