Factor Affecting Recurrence of Chronic Subdural Hematoma after Burr-Hole Drainage

Hwan Soo Kim; Weon Heo; Jae Hun Cha; Joon Suk Song; Dong Youl Rhee

doi:10.13004/kjnt.2012.08.0.73

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Factor Affecting Recurrence of Chronic Subdural Hematoma after Burr-Hole Drainage

Original Article

Korean J Nutr 2012;8(2):73-78.

Published online: 19 January 2012

DOI: https://doi.org/10.13004/kjnt.2012.08.0.73

Factor Affecting Recurrence of Chronic Subdural Hematoma after Burr-Hole Drainage

Hwan Soo Kim, MD, Weon Heo, MD, Jae Hun Cha, MD, Joon Suk Song, MD, Dong Youl Rhee, MD

Department of Neurosurgery, Wallace Memorial Baptist Hospital, Busan, Korea

Address for correspondence: Weon Heo, MD Department of Neurosurgery, Wallace Memorial Baptist Hospital 200 Geumdan-ro, Geumjeong-gu, Busan 609-728, Korea Tel: +82-51-580-1282, Fax: +82-51-582-6682 E-mail: hw610202@hanmail.net

Received 21 May 2012 Revised 13 August 2012 Accepted 15 August 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

A variety of factors are known to have an influence on the recurrence of chronic subdural hematoma (CSDH). In this study, the authors investigated the influential factors for recurrence of CSDH after burr hole drainage.

Methods:

45 patients with unilateral CSDH were treated with one-burr hole trephination and closed drainage in our hospital during last 6 years, whom the drainage catheter tip was randomly located and checked on postoperative computed tomography (CT). The clinical status of patients, thickness of hematoma, midline displacement of before and after surgery, amount of subdural air collection, drainage catheter tip location were estimated and the relationship of those factors with the recurrence was analyzed.

Results:

Patients with located catheter tip in frontal had a better clinical and radiological result. And the recurrence of CSDH was lower who has lesser amount of subdural air collection in postoperative CT.

Conclusion:

The recurrence rate of unilateral CSDH is influenced by the location of drainage catheter tip and the amount of subdural air collection.

Keywords: Chronic subdural hematoma, Recurrence, Catheter tip location, Air collection

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TABLE 1.

Relationship between age and CSDH preoperative thickness, recurrence

Age	CSDH thickness of pre-op CT (%)		p-value	Recurrence of CSDH (%)	p-value
Age	10-20 mm	＞20 mm	p-value	Recurrence of CSDH (%)
＜60	07 (16)	06 (13)		2 (5)
＞60	24 (53)	08 (18)	0.151	10 (22)	0.241
Total	31 (69)	14 (31)		12 (27)

CSDH: chronic subdural hematoma, CT: computed tomography

TABLE 2.

DM, hypertension and recurrence of CSDH

	Recurrence of CSDH		p-value
	Total (%)	Recurred (%)	p-value
Hypertension	15 (34)	5 (11)	0.379
DM	10 (23)	5 (11)	0.079

CSDH: chronic subdural hematoma, DM: diabetes mellitus

TABLE 3.

Relationship between CSDH thickness, midline shifting of preoperative CT and recurrence of CSDH

	CSDH thickness of preoperative CT (%)		p-value	Midline shifting of preoperative CT (%)		p-value
	10-20 mm	＞20 mm	p-value	＜10 mm	＞10 mm	p-value
Resolved	11 (24)	22 (49)	0.442	13 (29)	20 (44)	0.577
Recurred	3 (7)	09 (20)		05 (11)	07 (16)
Total	14 (31)	31 (69)		18 (40)	27 (60)

CSDH: chronic subdural hematoma, CT: computed tomography

TABLE 4.

Relationship between CSDH density, air collection, catheter tip location in subdural space and recurrence of CSDH

		Recurrence of CSDH (%)		p-value
		Resolved	Recurred	p-value
Density of preoperative CT	High∗	2 (4)	1 (2)	0.847
	Iso^†	2 (4)	0 (0)
	Low^‡	21 (47)	08 (18)
	Mix	08 (18)	3 (7)
Air collection in subdural space	＜10%	29 (64)	07 (16)	0.025
	10-50%	4 (9)	3 (7)
	＞50%	0	2 (4)
Catheter tip location	Frontal	23 (51)	3 (7)	0.010
	Temporal	0	3 (7)
	Parietal	06 (13)	06 (13)
	Occipital	4 (9)	0
Total		33 (73)	12 (27)

∗high density: ＞24 Hounsfield Unit (H.U.),

^† iso density: 14-24 H.U.,

^‡ low density: 4-14 H.U. CSDH: chronic subdural hematoma

TABLE 5.

Relationship between catheter tip location and subdural air collection

		Air collection in subdural space			Total	Mann-Whitney p-value
		＜10%	10-50%	＞50%	Total	Mann-Whitney p-value
Catheter tip location	Frontal	23	3	0	26	0.004
	Temporal	03	0	0	03
	Parietal	6	4	2	12
	Occipital	4	0	0	4
Total		36	7	4	45

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