scholarly journals Evaluation of Chronic Subdural Hematoma Volume Calculated via Cavalieri’s Principle

2019 ◽  
pp. 260-268
Author(s):  
Zeynep Karakaya ◽  
Ayhan Saritas ◽  
Pınar Yeşim Akyol ◽  
Fatih Esad Topal ◽  
Umut Payza ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Hematoma Volume ◽  
Cavalieri’S Principle

scholarly journals Relationship between Symptoms of Chronic Subdural Hematoma and Hematoma Volume or Regional Cerebral Blood Flow

1984 ◽  
Vol 24 (11) ◽  
pp. 869-875 ◽  
Author(s):  
Kiyonobu IKEDA ◽  
Akihiko KANO ◽  
Hideo HAYASE ◽  
Tetsumori YAMASHIMA ◽  
Haruhide ITO ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subdural Hematoma ◽  
Regional Cerebral Blood Flow ◽  
Chronic Subdural Hematoma ◽  
Regional Cerebral Blood ◽  
Hematoma Volume

scholarly journals Intraoperative hematoma volume can predict chronic subdural hematoma recurrence

2021 ◽  
Vol 12 ◽  
pp. 232
Author(s):  
Masaru Honda ◽  
Hajime Maeda
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Risk Factor ◽  
Sensitivity And Specificity ◽  
Subdural Hematoma ◽  
Independent Risk Factor ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Hematoma Volume ◽  
Cutoff Value

Background: We routinely measured the exact chronic subdural hematoma (CSDH) volume during single burr hole surgery. To date, several risk factors have been reported for CSDH recurrence, including sex, hematoma volume and degree of midline shift calculated from computed tomography, use of anticoagulants or antiplatelet medications, and alcohol consumption habits. The aim of this study was to clarify whether hematoma volume, in conjunction with other factors, can predict recurrence. Methods: We retrospectively reviewed the clinical data of 194 consecutive patients with CSDH who underwent single burr hole surgery. The risk factors for recurrence were analyzed based on patients’ sex, age, bilaterality, existence of apparent trauma history, exact intraoperative hematoma volume, and various clinical factors, including preoperative anticoagulant/antiplatelet intake. Results: Recurrence occurred in 22 patients (11.3%). Multivariate logistic regression analysis revealed that intraoperative hematoma volume was an independent risk factor for CSDH recurrence (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.01–1.02, P < 0.001), in addition to sex (male) (OR 9.25; 95% CI, 1.00–84.8; P = 0.049) and diabetes mellitus (DM) (OR: 3.97, 95% CI, 1.34–11.7, P = 0.013). Based on receiver operating characteristics analysis, the cutoff value of the hematoma volume predicting CSDH recurrence was 150 ml (sensitivity and specificity of 72.7% and 72.1%, respectively; area under the curve: 0.7664, 95% CI: 0.654–0.879, P < 0.001). Of these, a hematoma volume ≥150 mL was the strongest independent risk factor for recurrence according to multiple regression (OR: 8.98, 95% CI: 2.73–29.6, P < 0.001) and Cox regression analysis (hazard ratio: 3.05, 95% CI: 1.18–7.87, log-rank P = 0.0046, P = 0.021). Follow-up periods after surgery were significantly longer for cases with recurrence than for non-recurrence cases (24.8 ± 11.5 vs. 15.9 ± 9.7 days), and the recurrence prediction cutoff value was 17 days, with a sensitivity and specificity of 83.1% and 68.2%, respectively (AUC: 0.7707, 95% CI: 0.6695–0.8720, P < 0.001). Conclusion: Intraoperative hematoma volume could be a predictive value for CSDH recurrence.

Nonsurgical treatment of chronic subdural hematoma with tranexamic acid

2013 ◽  
Vol 119 (2) ◽  
pp. 332-337 ◽  
Author(s):  
Hiroshi Kageyama ◽  
Terushige Toyooka ◽  
Nobusuke Tsuzuki ◽  
Kazunari Oka
Keyword(s):  
Tranexamic Acid ◽  
Head Trauma ◽  
Medical Therapy ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Hematoma Volume ◽  
Acid Therapy ◽  
Early Stages ◽  
Concomitant Surgery

Object Chronic subdural hematoma (CSDH) is a common condition after head trauma. It can often be successfully treated surgically by inserting a bur hole and draining the liquefied hematoma. However, to the best of the authors' knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach for preventing hematoma enlargement or resolving it completely. The authors hypothesized that hyperfibrinolysis plays a major role in liquefaction of the hematoma. Therefore, they evaluated the ability of an antifibrinolytic drug, tranexamic acid, to completely resolve CSDH compared with bur hole surgery alone. Methods From 2007 to 2011, a total of 21 patients with CSDH seen consecutively at Kuki General Hospital, Japan, were given 750 mg of tranexamic acid orally every day. Patients were identified by a retrospective records review, which collected data on the volume of the hematoma (based on radiographic measurements) and any complications. Follow-up for each patient consisted of CT or MRI every 21 days from diagnosis to resolution of the CSDH. Results Of the 21 patients, 3 with early stages of CSDH were treated by bur hole surgery before receiving medical therapy. The median duration of clinical and radiographic follow-up was 58 days (range 28–137 days). Before tranexamic acid therapy was initiated, the median hematoma volume for the 21 patients was 58.5 ml (range 7.5–223.2 ml); for the 18 patients who had not undergone surgery, the median hematoma volume was 55.6 ml (range 7.5–140.5 ml). After therapy, the median volume for all 21 patients was 3.7 ml (range 0–22.1 ml). No hematomas recurred or progressed. Conclusions Chronic subdural hematoma can be treated with tranexamic acid without concomitant surgery. Tranexamic acid might simultaneously inhibit the fibrinolytic and inflammatory (kinin-kallikrein) systems, which might consequently resolve CSDH. This medical therapy could prevent the early stages of CSDH that can occur after head trauma and the recurrence of CSDH after surgery.

Double-crescent sign as a predictor of chronic subdural hematoma recurrence following burr-hole surgery

2019 ◽  
Vol 131 (6) ◽  
pp. 1905-1911 ◽  
Author(s):  
Koichi Miki ◽  
Hiroshi Abe ◽  
Takashi Morishita ◽  
Shuji Hayashi ◽  
Kenji Yagi ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Imaging Finding ◽  
Past History ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Hematoma Volume ◽  
Independent Predictive Factor ◽  
Space Correlation ◽  
Crescent Sign ◽  
Postoperative Residual

OBJECTIVESubdural hygroma has been reported as a causative factor in the development of a chronic subdural hematoma (CSDH) following a head trauma and/or neurosurgical procedure. In some CSDH cases, the presence of a 2-layered space delineated by the same or similar density of CSF surrounded by a superficial, residual hematoma is seen on CT imaging after evacuation of the hematoma. The aims of the present study were to test the hypothesis that the double-crescent sign (DCS), a unique imaging finding described here, is associated with the postoperative recurrence of CSDH, and to investigate other factors that are related to CSDH recurrence.METHODSThe authors retrospectively analyzed data from 278 consecutive patients who underwent single burr-hole surgery for CSDH between April 2012 and March 2017. The DCS was defined as a postoperative CT finding, characterized by the following 2 layers: a superficial layer demonstrating residual hematoma after evacuation of the CSDH, and a deep layer between the brain’s surface and the residual hematoma, depicted as a low-density space. Correlation of the recurrence of CSDH with the DCS was evaluated by multivariate logistic regression modeling. The authors also investigated other classic predictive factors including age, sex, past history of head injury, hematoma laterality, anticoagulant and antiplatelet therapy administration, preoperative hematoma volume, postoperative residual hematoma volume, and postoperative brain reexpansion rate.RESULTSA total of 277 patients (320 hemispheres) were reviewed. Fifty (18.1%) of the 277 patients experienced recurrence of CSDH within 3 months of surgery. CSDH recurred within 3 months of surgery in 32 of the 104 hemispheres with a positive DCS. Multivariate logistic analyses revealed that the presence of the DCS (OR 3.36, 95% CI 1.72–6.57, p < 0.001), large postoperative residual hematoma volume (OR 2.88, 95% CI 1.24–6.71, p = 0.014), anticoagulant therapy (OR 3.03, 95% CI 1.02–9.01, p = 0.046), and bilateral hematoma (OR 3.57, 95% CI 1.79–7.13, p < 0.001) were significant, independent predictors of CSDH recurrence.CONCLUSIONSIn this study, the authors report that detection of the DCS within 7 days of surgery is an independent predictive factor for CSDH recurrence. They therefore advocate that clinicians should carefully monitor patients for postoperative DCS and subsequent CSDH recurrence.

Effect of atorvastatin on resolution of chronic subdural hematoma: a prospective observational study [RETRACTED]

2016 ◽  
pp. 1-10 ◽  
Author(s):  
Hua Liu ◽  
Zhongkun Liu ◽  
Yong Liu ◽  
Shifeng Kan ◽  
Jian Yang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Observational Study ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Control Group ◽  
Hematoma Volume ◽  
Atorvastatin Treatment ◽  
Atorvastatin Group ◽  
Significant Difference

OBJECTIVE Chronic subdural hematoma (CSDH) is prevalent in the aged population and is commonly treated with bur hole drainage. This treatment, however, can lead to various surgical complications. Atorvastatin may cure CSDH via its antiinflammatory and proangiogenesis effects, but not all patients treated with this medication can avoid surgery. The authors' aim was to investigate the effect of atorvastatin and identify characteristics of patients with CSDH sensitive to atorvastatin therapy. METHODS A prospective, placebo-controlled observational study was conducted in 80 patients with evidence of CSDH. The patients were enrolled between February 2012 and August 2014 and were randomly assigned to either atorvastatin treatment (atorvastatin group) or placebo (control group). Patients were followed up for 12 months after initiation of treatment. Clinically relevant data were collected and compared between the 2 groups. The atorvastatin group was subdivided into patients who required surgery and those who did not, and characteristics of these subgroups were also compared. The relationship between atorvastatin treatment and need for surgery was investigated by means of multiple regression analysis using the following variables as predictors: age, sex, admission Markwalder grade, level of dependency in activities of daily living (ADL) as assessed with the modified Barthel Index, presence of hemiparesis, and hematoma volume. RESULTS The proportion of patients who required surgical intervention during the follow-up period was significantly lower in the atorvastatin group than in the control group (p = 0.001), and the mean time to surgery was longer in the atorvastatin group (p = 0.018). Within the atorvastatin group, there was a significant difference with respect to Markwalder grades, degree of dependency in ADL, percentage of patients with hemiparesis, and mean hematoma volume between the patients who required surgery during the follow-up period and those who did not (p = 0.002, p = 0.001, p = 0.001, and p = 0.012, respectively). The results of the logistic regression analysis showed that atorvastatin significantly reduced the probability of surgery and that female sex and favorable admission Markwalder grades and favorable dependency status with respect to ADL (independent, slightly dependent, or moderately dependent) were independent predictors of not requiring surgery. CONCLUSIONS Atorvastatin administration can promote the resolution of CSDH, especially for women with favorable Markwalder grades and favorable ADL dependency status at admission.

The Validity of the Simple Methods of Estimating Chronic Subdural Hematoma Volume

2021 ◽  
Author(s):  
Eitaro Ishisaka ◽  
Akio Morita ◽  
Yasuo Murai ◽  
Atsushi Tsukiyama
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Hematoma Volume

scholarly journals Chronic subdural hematoma pressure measurement and its correlation with clinical characteristics and postoperative neurological outcome

2021 ◽  
Vol 9 (1) ◽  
pp. 44
Author(s):  
Tinu Ravi Abraham ◽  
Shaju Mathew ◽  
P. K. Balakrishnan ◽  
Ajax John ◽  
Haris Thottathil Pareed ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Prognostic Value ◽  
Clinical Characteristics ◽  
Chronic Subdural Hematoma ◽  
Pressure Group ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Ranking Score ◽  
The Mean ◽  
Gcs Score

Background: The pressure of the chronic SDH (subdural haemotoma), the age of the patient, preoperative GCS score and midline shift were considered prognostic dependent factors. The study aimed at the significance of the pressure of chronic SDH in the outcome of patients.Methods: A correlation between subdural hematoma pressure and preoperative and postoperative clinical variables such as hematoma volume, midline shift, age, GCS score and postoperative modified ranking scale score as well as complications were assessed and analyzed.Results: According to the pressure of chronic SDH, 56 patients were grouped into 4 groups. In the pressure group <15 cm/h20 group the mean age was 85 and postoperative ranking score was 3 and the recurrence was 21 % while in high pressure group (>25 cm/h20) the mortality was 14% and no recurrence.Conclusions: The pressure of the chronic SDH has significant prognostic value in chronic SDH surgeries.

scholarly journals Atorvastatin Plus Low-Dose Dexamethasone May Be Effective for Leukemia-Related Chronic Subdural Hematoma but Not for Leukemia Encephalopathy: A Report of Three Cases

2021 ◽  
Vol 11 ◽  
Author(s):  
Jiangyuan Yuan ◽  
Ying Li ◽  
Xuanhui Liu ◽  
Meng Nie ◽  
Weiwei Jiang ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Subdural Hematoma ◽  
Medical Records ◽  
Low Dose ◽  
Chronic Subdural Hematoma ◽  
Resonance Imaging ◽  
Hematoma Volume ◽  
The Third ◽  
Leukocyte Counts ◽  
Dural Metastasis

We are not aware of any reports regarding conservative treatment for leukemia-related chronic subdural hematoma (CSDH). We report our experience with 3 men who were admitted with subdural masses and abnormal leukocyte counts. In two patients, leukemia and CSDH were confirmed on the basis of medical records, mild head trauma, and neuroimaging features. Both patients experienced reduced CSDH and neurological symptoms after receiving atorvastatin (20 mg/day) plus low-dose dexamethasone. However, this combined conservative treatment was ineffective in the third patient, who was diagnosed as having leukemia and showed an increased hematoma volume after two weeks of therapy. Magnetic resonance imaging findings suggested dural metastasis, which prompted a switch from statin-based conservative treatment to chemotherapy. Complete remission of the leukemia and resolution of the subdural mass were observed after chemotherapy, which supported a diagnosis of leukemia encephalopathy. The 5-month follow-ups did not reveal CSDH relapse in all 3 cases. Thus, atorvastatin-based conservative treatment may be effective for leukemia-related CSDH but not for leukemia encephalopathy.

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

2019 ◽  
Vol 12 (7) ◽  
pp. 695-699 ◽  
Author(s):  
Sam Ng ◽  
Imad Derraz ◽  
Julien Boetto ◽  
Cyril Dargazanli ◽  
Gaëtan Poulen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pilot Study ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Hematoma Volume ◽  
Clinical Recurrence ◽  
Promising Treatment ◽  
Meningeal Artery

BackgroundChronic subdural hematoma (CSDH) is a common condition requiring surgical treatment; however, recurrence occurs in 15% of cases at 1 year. Middle meningeal artery (MMA) embolization has recently emerged as a promising treatment to prevent CSDH recurrence.ObjectiveTo investigate the effect of MMA embolization on hematoma volume resorption (HVR) after surgery in symptomatic patients.MethodsFrom April 2018 to October 2018, participants with CSDH requiring surgery were prospectively randomized in a pilot study, and received either surgical treatment alone (ST group) or surgery and adjuvant MMA embolization (ST+MMAE group). The primary outcome was HVR measured on the 3 month CT scan compared with the immediate pre-embolization CT scan. Secondary outcomes were clinical recurrence of CSDH and safety measures.Results46 patients were randomized and 41 of these achieved a 3 month follow-up . Twenty-one patients received MMA embolization. At 3 months, the HVR from postsurgical level was higher in the ST+MMAE group (mean difference 17.5 mL, 95% CI 3.87 to 31.16 mL; p=0.015). Two participants presented a CSDH recurrence (one in each group). One patient died (ST group). No MMA embolization-related adverse events were reported.ConclusionThe addition of MMA embolization to surgery led to an increase in CSDH resorption at 3 months. One recurrence of CSDH was reported in each group, and there were no treatment-related complications.

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