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Published on: July 3, 2014
Factors associated with success of conservative therapy in chronic subdural hematoma: a single-center retrospective
Merijn Foppen1,2, Roger Lodewijkx3,4, Harssh Verdan Bandral3,4
1Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.foppen@amsterdamumc.nl.
Insights
Conservative therapy for chronic subdural hematoma (cSDH) is successful in 60% of selected patients. Smaller hematoma volume and hypodense type predict success, avoiding surgery and its complications.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Conservative therapy is a viable option for asymptomatic or mildly symptomatic chronic subdural hematoma (cSDH).
- Factors influencing the success of conservative management for cSDH are not well-defined.
Purpose of the Study:
- To determine the success rate of conservative therapy in patients with cSDH.
- To identify clinical and radiological factors associated with successful conservative management of cSDH.
Main Methods:
- A retrospective monocenter cohort study included 159 patients with cSDH treated conservatively between 2012 and 2022.
- Success was defined as no need for surgical intervention during follow-up.
- Logistic regression analyses were used to identify factors associated with treatment success.
Main Results:
- Conservative therapy was successful in 96 (60%) patients.
- Smaller hematoma volume (OR 0.79) and hypodense hematoma type (OR 3.57) were significantly associated with successful conservative management.
- The 30-day mortality rate was 5%, with clinical deterioration being the primary reason for crossover to surgery (97% of cases).
Conclusions:
- Conservative therapy is a safe and potentially effective primary treatment for selected cSDH patients, with a success rate of 60%.
- Smaller hematoma volume and hypodense hematoma type are favorable predictors for conservative treatment success.
- Further research on patient selection criteria is warranted to optimize conservative management strategies for cSDH.
Introduction:
Conservative therapy is a viable option for patients with chronic subdural hematoma (cSDH) who express no, or only mild symptoms. It is not clear which factors are associated with success of conservative therapy. This study aims to determine conservative therapy's success rate and to identify features possibly associated with success.
Methods:
A monocenter retrospective cohort study, including cSDH patients treated conservatively (wait-and-watch) from 2012 to 2022, was performed. The primary outcome was success of conservative therapy, defined as 'no crossover to surgery' during the follow-up period. Secondary outcomes were (1) factors associated with success, analyzed with univariate and multivariable logistic regression analyses, (2) 30-day mortality (3) time to crossover and (4) reasons for crossover.
Results:
We included 159 patients. Conservative therapy was successful in 96 (60%) patients. Hematoma volume (OR 0.79, 95% CI 0.69-0.92) and hypodense hematoma type (OR 3.57, 95% 1.38-9.23) were associated with success. Thirty-day mortality rate was 5% and the median duration between diagnosis and surgery was 19 days (IQR 8-39). Clinical deterioration was the most frequent reason for crossover (in 61/63 patients, 97%) and was accompanied by radiological hematoma progression in 42 patients (67%).
Conclusion:
In this selected group of patients, conservative therapy was successful in 60%. Smaller hematoma volume and hypodense hematoma type were associated with success. As time until crossover was approximately three weeks, deploying conservative therapy as primary treatment seems safe and could be rewarding as surgical complications can be avoided. Improvement in patient selection in future cohorts remains warranted.
