Journal List > Korean J Neurotrauma > v.9(2) > 1058935

TOOLS
Kim, Yang, Kim, and Park: Factors that Influence to Chronic Subdural Hematoma Recurrence
Clinical Article

Korean J Nutr 2013;9(2):81-86.

Published online: 20 October 2013

DOI: https://doi.org/10.13004/kjnt.2013.9.2.81

Factors that Influence to Chronic Subdural Hematoma Recurrence

Sung Gon Kim, MD, Joo Chul Yang, MD, Tae Wan Kim, MD, Kwan Ho Park, MD

Department of Neurosurgery, VHS Medical Center, Seoul, Korea

Address for correspondence: Tae Wan Kim, MD Department of Neurosurgery, VHS Medical Center, 53 Jinhwang-do-ro 61-gil, Gangdong-gu, Seoul 134-791, Korea Tel: +82-2-2225-1363, Fax: +82-2-2225-4152 E-mail: euro3399@naver.com

Received 15 July 2013       Revised 4 September 2013       Accepted 4 September 2013

Copyright © 2013 The Korean Nutrition Society

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

The purpose of this study was to evaluate the factors that influence to chronic subdural hematoma recurrence.

Methods

We retrospectively evaluated 55 patients who underwent an operation for a chronic subdural hematoma using burr hole trephination and hematoma drainage from January 2010 to December 2011. We analyzed their demographics, trauma history, medication history, initial symptoms, bilaterality, postoperative pneumocephalus, and hematoma recurrence.

Results

Medication history (anticoagulant and/or antiplatelet agents) was not influenced the hematoma recurrence rate statistically (p=0.622). Prolongation of International Normalized Ratio and decrease of platelet count increased recurrence rate, but not significantly. An absence of trauma history was a factor that significantly influenced hematoma recurrence (p= 0.037).

Conclusion

Medication history did not significantly influence the recurrence rate, if the medication will stopped more than 3 days prior to hematoma evacuation. Chronic subdural hematomas that occurred without definite trauma history were more prevalent with recurrence.

Keywords: Chronic subdural hematoma, Trauma, Recurrence

References

1. Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK. Chronic subdural haematoma in the elderly. Postgrad Med J. 78:71–75. 2002.
2. Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien). 154:1541–1548. 2012.
crossref
3. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol. 48:220–225. 1997.
crossref
4. Erol FS, Topsakal C, Faik Ozveren M, Kaplan M, Tiftikci MT. Irrigation vs. closed drainage in the treatment of chronic subdural hematoma. J Clin Neurosci. 12:261–263. 2005.
crossref
5. Forster MT, Mathé AK, Senft C, Scharrer I, Seifert V, Gerlach R. The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic subdural hematoma. J Clin Neurosci. 17:975–979. 2010.
crossref
6. Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 107:223–229. 2005.
crossref
7. Kim HS, Heo W, Cha JH, Song JS, Rhee DY. Factor affecting recurrence of chronic subdural hematoma after burrhole drainage. Korean J Neurotrauma. 8:73–78. 2012.
crossref
8. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc. 43:11–15. 2008.
crossref
9. Kong WK, Kim BC, Cho KT, Hong SK. Factors affecting postoperative recurrence of chronic subdural hematoma. Korean J Neurotrauma. 8:122–127. 2012.
crossref
10. Kurabe S, Ozawa T, Watanabe T, Aiba T. Efficacy and safety of postoperative early mobilization for chronic subdural hematoma in elderly patients. Acta Neurochir (Wien). 152:1171–1174. 2010.
crossref
11. Lee CH, Lee YS, Lee JH, Lee HG, Ryu KY, Kang DG. The technical factors that influence recurrence of chronic subdural hematoma: a review of 140 consecutive surgical cases. J Korean Neurotraumatol Soc. 5:79–82. 2009.
crossref
12. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burrhole craniostomy and closed-system drainage. J Neurosurg. 55:390–396. 1981.
crossref
13. Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg. 114:72–76. 2011.
crossref
14. Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma–craniotomy versus burr hole trepanation. Br J Neurosurg. 23:612–616. 2009.
crossref
15. Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 41:371–381. 2001.
crossref
16. Ohba S, Kinoshita Y, Nakagawa T, Murakami H. The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev. 36:145–149. ; discussion 149–150,. 2013.
crossref
17. Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H. A comparative study of the treatment of chronic subdural hematoma–burr hole drainage versus burr hole irrigation. Surg Neurol. 57:405–409. ; discussion 410,. 2002.
crossref
18. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burrhole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 374:1067–1073. 2009.
crossref
19. Sim YW, Min KS, Lee MS, Kim YG, Kim DH. Recent changes in risk factors of chronic subdural hematoma. J Korean Neurosurg Soc. 52:234–239. 2012.
crossref
20. Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burrhole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien). 147:1249–1256. ;discussion 1256–1257,. 2005.
crossref
21. Suzuki K, Sugita K, Akai T, Takahata T, Sonobe M, Takahashi S. Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surg Neurol. 50:231–234. 1998.
crossref
22. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery. 63:1125–1129. ;discussion 1129,. 2008.
23. Tsai TH, Lieu AS, Hwang SL, Huang TY, Hwang YF. A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitating factors and postoperative outcomes. J Trauma. 68:571–575. 2010.
crossref
24. Won YD, Yi HJ, Lee YJ, Chun HJ, Cho H, Bak KH. Chronic subdural hematoma in young adult: an age comparison study. Korean J Neurotrauma. 9:6–11. 2013.
crossref
25. Yu GJ, Han CZ, Zhang M, Zhuang HT, Jiang YG. Prolonged drainage reduces the recurrence of chronic subdural hematoma. Br J Neurosurg. 23:606–611. 2009.
crossref

TABLE 1.
Summary of clinical findings of 55 patients
No. Sex/ age DM/ HTN Smoking/ alcohol PLT (×103/mm3) INR Initial symptom Med Trauma history Site Recurrence
1 M/81 –/- +/- 223 1.04 Decreased mental status – – Lt  
2 M/78 –/+ –/- 130 1.15 Headache + + Rt  
3 M/77 –/- +/+ 245 0.95 Hemiparesis – + Rt  
4 M/67 –/+ –/+ 203 1.00 Hemiparesis + – Lt  
5 F/67 –/+ –/- 218 1.00 Headache – + Rt  
6 M/82 –/- +/- 260 0.98 Hemiparesis + – Both  
7 M/80 –/+ +/- 40 1.05 Headache – – Both (+)
8 M/68 +/+ –/- 245 0.96 Headache – – Rt  
9 M/67 –/- –/- 267 1.18 Dizziness – + Rt  
10 F/69 –/+ –/- 248 0.91 Hemiparesis – + Lt  
11 M/81 +/+ –/+ 161 1.07 Decreased mental status + – Rt  
12 M/63 –/+ –/+ 204 0.98 Hemiparesis + – Rt  
13 F/74 –/+ –/- 239 0.98 Headache – + Rt  
14 M/80 –/- –/- 131 1.15 General weakness – + Rt  
15 M/60 +/- –/- 162 1.01 Hemiparesis – + Rt  
16 M/79 –/- –/- 225 2.32 Hemiparesis + + Lt  
17 M/83 –/+ –/+ 241 1.06 Hemiparesis – – Lt  
18 M/87 –/+ –/- 267 1.06 Hemiparesis + + Lt  
19 M/63 –/- –/- 86 1.23 Headache – + Lt  
20 F/77 –/+ +/- 239 0.96 Hemiparesis + – Rt  
21 M/82 +/+ +/- 188 1.09 Dizziness + + Both  
22 M/81 –/+ –/- 155 1.07 Headache + + Rt  
23 M/80 –/- +/+ 199 1.10 Headache – – Both  
24 M/78 +/+ –/- 203 1.10 Hemiparesis + + Both  
25 M/65 +/+ –/- 183 1.05 Hemiparesis – + Rt  
26 M/79 –/+ +/+ 240 0.99 Dizziness + + Lt  
27 M/80 –/- –/- 395 1.29 Decreased mental status + – Rt  
28 M/82 –/+ +/+ 216 0.98 Hemiparesis + – Lt  
29 M/65 –/+ +/+ 248 1.07 Hemiparesis + – Rt (+)
30 M/81 +/- +/- 47 1.29 Headache – – Lt  
31 M/63 +/+ –/- 87 1.58 Headache + – Rt  
32 M/62 +/- –/- 67 1.28 Dysarthria – – Lt  
33 M/84 –/- –/- 206 0.99 Dizziness – – Lt  
34 M/78 –/- –/- 256 0.97 Decreased mental status – + Both  
35 M/82 –/- +/+ 207 1.00 Hemiparesis – + Lt  
36 M/69 +/- +/+ 163 1.04 Hemiparesis + + Lt  
37 M/82 +/+ –/+ 213 0.98 Hemiparesis + + Lt  
38 M/79 +/+ +/+ 223 0.98 Hemiparesis + + Rt  
39 M/78 +/+ –/+ 151 1.16 Headache + – Lt (+)
40 M/83 –/+ +/- 280 1.11 Decreased mental status + – Lt  
41 M/79 –/+ +/- 144 1.13 Hemiparesis + + Rt  
42 M/66 –/+ –/- 275 1.04 Hemiparesis – + Rt  
43 M/76 –/- +/- 192 0.93 Headache – + Lt  
44 F/81 –/- –/- 298 1.13 Hemiparesis – – Rt (+)
45 M/84 –/- –/+ 146 0.95 Hemiparesis – + Rt  
46 M/79 +/+ +/+ 195 1.05 Headache + + Rt  
47 M/79 –/+ –/- 258 1.04 Hemiparesis – – Lt  
48 M/79 +/+ –/- 137 1.22 Hemiparesis + + Rt  
49 M/66 –/+ –/+ 88 1.05 Headache – + Rt  
50 M/86 +/+ –/- 107 1.37 Hemiparesis + – Rt  
51 M/67 –/- –/- 178 0.97 Hemiparesis – – Both  
52 M/67 –/- –/- 310 0.96 Headache – – Both  
53 M/81 –/- +/+ 244 1.12 Hemiparesis – – Lt  
54 M/66 +/- –/- 246 1.20 Headache – + Lt  
55 M/83 –/+ –/- 170 1.09 Hemiparesis – + Both  

DM: diabetes mellitus, HTN: hypertension, PLT: platelet, INR: international normalized ratio, Med: medication history, Lt: left, Rt: right

TABLE 2.
Influencing factors to hematoma recurrence
    Recurrence (n=4) Non-recurrence (n=51) p-value
Age More than 70 3 34 0.604
Less than 70 1 17  
Hypertension + 3 29 0.632
– 1 22  
Diabetes + 1 16 0.637
– 3 35  
Smoking + 2 17 0.602
– 2 34  
PLT (×103/mm3) More than 140 1 09 0.563
Less than 140 3 42  
Prolongation of INR More than 1.11 2 14 0.571
Less than 1.11 2 37  
Medication history + 2 23 0.622
– 2 28  
Trauma history + 0 30 0.037
– 4 21  
Postoperative pneumocephalus + 1 21 0.642
– 3 30  
TOOLS
Similar articles