Third Ventricle Volume Predicts Functional Outcome in Chronic Subdural Hematoma

2021 ◽  
Author(s):  
Rafael Martinez‐Perez ◽  
Michael W. Kortz ◽  
Timothy H. Ung ◽  
Natalia Rayo ◽  
Alfonso Lagares ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Subdural Hematoma ◽  
Third Ventricle ◽  
Chronic Subdural Hematoma ◽  
Ventricle Volume

scholarly journals The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom

2017 ◽  
Vol 127 (4) ◽  
pp. 732-739 ◽  
Author(s):  
Paul M. Brennan ◽  
Angelos G. Kolias ◽  
Alexis J. Joannides ◽  
Jonathan Shapey ◽  
Hani J. Marcus ◽  
...  
Keyword(s):  
United Kingdom ◽  
Clinical Research ◽  
Functional Outcome ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Bed Rest ◽  
Repeat Surgery ◽  
Symptomatic Recurrence ◽  
The United Kingdom ◽  
High Flow Oxygen

OBJECTIVESymptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH.METHODSData on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4–6) at NSU discharge < 30%.RESULTSData from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not.CONCLUSIONSThis is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-world setting the effectiveness of placing a subdural drain. This study identified a number of modifiable prognostic factors but questions the necessity of some common aspects of CSDH management, such as enforced postoperative bed rest. Future studies should seek to establish how practitioners can optimize perioperative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multicenter trainee-led research and audits. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.

Analysis of 150 Cases with Chronic Subdural Hematoma in Adult on the Factors Related to Functional Outcome

1993 ◽  
pp. 145-148
Author(s):  
Yoshitaka Okimura ◽  
Junichi Ono ◽  
Hirohide Karasudani ◽  
Katsumi Isobe ◽  
Akira Yamaura
Keyword(s):  
Functional Outcome ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma

scholarly journals Volume and Midline Shift as Preoperative Computed Tomography Imaging Predictors of Postoperative Chronic Subdural Hematoma Recurrence: Retrospective Review of 345 Patients With 412 Operative Subdural Sides

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Laila Malani Mohammad ◽  
William H McKay ◽  
Christine Meadows ◽  
Jacqueline O’Neill ◽  
Howard Yonas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subdural Hematoma ◽  
Retrospective Review ◽  
Surgical Intervention ◽  
Third Ventricle ◽  
Chronic Subdural Hematoma ◽  
Midline Shift ◽  
Computed Tomography Imaging ◽  
Patient Side ◽  
Anticoagulant Medication

Abstract INTRODUCTION The treatment and management of chronic subdural hematoma (cSDH) is highly variable, with recurrent surgery resulting in increased elderly morbidity, and economic burden to patients and the healthcare system. By conducting a retrospective review of patients with cSDH who underwent evacuation, we will provide a better understanding of predictive factors of recurrence, thereby optimizing a surgeon's management and treatment. METHODS We conducted a retrospective review of 345 patients with a total of 412 sides of cSDH, who received either burr-hole craniostomy or a craniotomy with closed system drainage. We reviewed the immediate preoperative and postoperative computed tomography (CT) scan, and defined recurrence as repeat surgical intervention on the side of initial evacuation. We performed a per-patient and per-side analysis of the collected data. RESULTS A total of 49 (11.9%) patients and 51 sides (12.4%) experienced a recurrent cSDH requiring re-evacuation. In the per-patient analysis, the preoperative hematoma volume [CI 1.082 (1.013-1.155)] and midline shift at the third ventricle [CI 1.118 (1.1028-1.215)] were predictors of recurrence. This was also observed in the per-side analysis at CI 1.088 (1.021-1.159) and CI 1.130 (1.045-1.222), respectively. On the per-patient side, comorbidities (diabetes, liver disease, alcohol abuse, antiplatelet/anticoagulant medication) and other demographic factors (gender, age) were not linked to recurrence. If a patient had a bilateral hematoma and both sides were operated on, it was found to be protective of recurrence with a CI of 0.111 (0.025-0.486). CONCLUSION Larger preoperative volumes and a greater midline shift significantly increased the risk of re-evacuation for cSDH, while other demographic and CT characteristics did not. Therefore, this may represent that a high-risk subgroup can be used as a target for preventative therapy.

scholarly journals Presenting symptoms and functional outcome of chronic subdural hematoma patients

2021 ◽  
Author(s):  
Jurre Blaauw ◽  
Ghislaine A. Meelis ◽  
Bram Jacobs ◽  
Niels A. Gaag ◽  
Korné Jellema ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Presenting Symptoms

scholarly journals Meningeal Carcinomatosis for Prostate Adenocarcinoma Mimicking Chronic Subdural Hematoma: Case Report and Literature Review

2021 ◽  
Author(s):  
Tiago Silva Holanda Ferreira ◽  
Gilnard Caminha de Menezes Aguiar ◽  
Daniel Gurgel Fernandes Távora ◽  
Lucas Alverne Freitas de Albuquerque ◽  
Stélio da Conceição Araújo Filho
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Specific Antigen ◽  
Chronic Subdural Hematoma ◽  
Radical Resection ◽  
Prostate Adenocarcinoma ◽  
Meningeal Carcinomatosis ◽  
Motor Deficits ◽  
Friable Material ◽  
The Central Nervous System

Abstract Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies.Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy.Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection.At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other key markers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma. Discussion Meningeal carcinomatosis presents clinically with headache, motor deficits, vomiting, changes in consciousness and seizures.The two most discussed mechanisms of neoplastic infiltration are the hematogenous route and retrograde drainage by the vertebral venous plexus. Conclusion Variable clinical presentations may occur in dural metastases; however, the radiological presentation as subdural hematoma is rare. There are few descriptions of cases like this one in the literature.To support the diagnosis, the previous medical history is as important as the complementary exams and the radiological findings, because the symptoms are common at the neurological emergency. To our knowledge, this is the first report of a prostate neoplasm mimicking chronic subdural hematoma in Brazil.

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