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[Chronic subdural hematoma with bleeding tendency; clinical analysis of 11 surgical cases]
1Department of Neurosurgery, Fukushima Medical School, Japan.
Insights
Surgical intervention for chronic subdural hematoma (CSDH) with bleeding tendency (BT) can yield excellent outcomes. Careful pre-operative assessment of blood conditions is crucial for determining surgical candidacy in CSDH with BT patients.
Area of Science:
- Neurosurgery
- Hematology
Background:
- Chronic subdural hematoma (CSDH) with a bleeding tendency (BT) presents unique clinical challenges.
- Traditional conservative management for CSDH with BT has often been associated with poor prognoses.
Observation:
- Eleven patients with CSDH and BT underwent surgical evacuation over 12 years.
- Patients were categorized into three groups based on the etiology of BT: primary, secondary to underlying disease, or anticoagulant-induced.
Findings:
- Surgical outcomes were excellent for patients with primary BT (hemophilia A) and anticoagulant-induced BT (warfarin).
- In patients with secondary BT, outcomes varied; while some with critical underlying diseases (e.g., advanced cancers with DIC) did not survive, others with conditions like leukemia showed dramatic CSDH recovery.
Implications:
- This study advocates for surgical treatment of CSDH with BT, challenging conservative approaches.
- Thorough pre-operative evaluation of blood parameters is essential to identify suitable surgical candidates and optimize patient outcomes.
Abstract:
Eleven patients with chronic subdural hematoma (CSDH) with bleeding tendency (BT) were surgically treated in the last 12 years. To study the clinical problem of CSDH with BT, 11 surgical cases were divided into 3 groups, Group A; CSDH with primary BT (1 case of hemophilia A), Group B; CSDH with BT secondary to a basic disease (3 cases of leukemia, 2 cases of malignant tumor with DIC, 1 case of chronic renal failure and 1 case of liver cirrhosis), Group C; CSDH with BT by anticoagulants (warfarin) (2 cases of replacement of mitral valve, 1 case of A-C bypass). Evacuation of the hematoma was performed by means of one or two burr holes with irrigation of the hematoma cavity and a drainage tube was placed in the subdural space. The outcome was excellent in Groups A and C. In Group B, two patients with DIC due to gastric cancer and prostatic cancer died, and 3 patients with leukemia recovered dramatically from CSDH, but the poor course of the disease itself resulted in death. The outcome of other patients in Group B was excellent. Since CSDH with BT is often fatal, those patient had usually been treated conservatively. However, from this analysis, we stress that CSDH with BT should be surgically treated after checking the blood conditions carefully to determine whether or not the patient has need for surgery.