Meningioma parasagital y hematoma subdural crónico, una asociación inusual / Parasagittal meningioma and chronic subdural hematoma, unusual association

RESUMEN En muchas ocasiones, los pacientes con tumores cerebrales tienen una variedad de síntomas psiquiátricos inespecíficos. Algunos de estos pueden constituir la primera o única manifestación del tumor, sin la presencia de ningún síntoma o signo neurológico. El diagnóstico ha de basarse en la anamnesis completa y en la exploración neurológica; la neuroimagen confirmará el diagnóstico clínico. Con el presente trabajo se describió la asociación inusual de hematoma subdural crónico y meningioma parasagital en un caso presentado. Se trató de un paciente de 68 años con antecedentes de esquizofrenia. Acudió a consulta con una hemiparesia izquierda. Se le realizó una tomografía axial computarizada de cráneo y arrojó un hematoma subdural crónico y un meningioma parasagital derecho. Se le aplicó tratamiento quirúrgico en dos tiempos operatorios. Su evolución posquirúrgica transcurrió sin complicaciones (AU).

ABSTRACT In many cases, patients with brain tumors have a variety of nonspecific psychiatric symptoms. Some of them can be the first or the only manifestation of the tumor, without presenting any neurological signs or symptoms. The diagnosis must be based on the complete anamnesis and on the neurological examination. The neuroimaging will confirm the clinical diagnosis. The unusual association of a chronic subdural hematoma and a parasagittal meningioma was described in a case presented in the current work. It dealt with a patient, aged 68 years with antecedents of schizophrenia. He assisted the consultation with left hemiparesis. A skull computed tomography showed a chronic subdural hematoma and a right parasagittal meningioma. He underwent a two-steps surgery. His post-surgery evolution ran without complications (AU).

Casos clínicos sobre tratamiento conservador del hematoma subdural crónico / Clinical cases on conservative treatment of chronic subdural hematoma

Introducción: El hematoma subdural crónico es una de las entidades clínicas más comunes en la práctica neuroquirúrgica diaria, cuya incidencia y prevalencia aumentan considerablemente con la edad. El tratamiento conservador puede ser muy útil en algunos casos. Objetivo: Mostrar que el manejo farmacológico exclusivo de este padecimiento, puede ser considerado en muchos pacientes. Casos clínicos: Se presentan dos pacientes adultos mayores, atendidos en el servicio de Neurocirugía, con diagnóstico de hematoma subdural crónico, tratados solo con fármacos. Conclusiones: Como resultado final, se logró la reabsorción de las colecciones subdurales, lo cual se comprobó mediante estudios imagenológicos(AU)

Introduction: Chronic subdural hematoma is one of the most common clinical entities in everyday neurosurgical practice, which incidence and prevalence increase considerably with age. Conservative treatment can be very useful in many patients. Objective: To show that the exclusive pharmacological management of this condition can be considered in many patients. Clinical cases: Two elderly patients attended at the neurosurgery service are presented with a diagnosis of chronic subdural hematoma. They were treated only with drugs. Conclusions: The final result was the reabsorption of the subdural collections, which was proven by imaging studies(AU)

Hematoma subdural crónico / Chronic subdural hematoma

El hematoma subdural crónico (HSC) es una patología neuroquirúrgica frecuente, que se reconoce como consecuencia de traumatismos craneoencefálicos de poca magnitud que habitualmente se diagnostican en pacientes seniles, aunque puede presentarse en pacientes jóvenes y sin antecedentes de traumas.El objetivo que persigue este trabajo es la presentación de una paciente con un HSC bilateral, con características poco usuales.Caso clínico: se presenta una paciente del sexo femenino, de 46 años de edad, sin antecedente de traumatismo craneal ni de otra patología concomitante, que consulta por una cefalea de 15 días de evolución. El examen físico constató midriasis, pupila de Hutchinson, papiledema bilateral y exoforia del ojo derecho, parálisis del tercer par craneal y ataxia de tronco, fue catalogada con Glasgow 13. Se realizó tratamiento anti edema cerebral temprano y las manifestaciones desaparecieron en gran medida. En la Tomografía axial computarizada se diagnosticó un hematoma subdural frontotemporal bilateral con desplazamiento de las estructuras de la línea media a la izquierda. Fue operada de urgencia y dada de alta completamente recuperada tres días después.Conclusión: el HSC puede presentarse con distintas formas clínicas, simulando procesos expansivos tumorales, ataques cerebrovasculares, demencias o entidades neurológicas de otra índole. El manejo del caso por clínicos y neurocirujanos fue rápido y efectivo, lo que explica que la paciente tuvo una recuperación temprana y total. En estos casos la actuación médica es decisiva en el éxito del tratamiento.

Chronic subdural hematoma (CSH) is a common neurosurgical pathology that is recognized as a consequence of minor head injuries that are usually diagnosed in senile patients, although it can occur in young patients without a history of trauma.The objective of this work is the presentation of a patient with a bilateral CSH, with unusual characteristics.Clinical case: a 46-year-old female patient with no history of head trauma or other concomitant pathology is presented, who consulted for a 15-day-old headache. Physical examination confirmed mydriasis, Hutchinson's pupil, bilateral papilledema and exophoria of the right eye, third cranial nerve palsy, and trunk ataxia. She was cataloged with Glasgow 13. Early anti-cerebral edema treatment was performed and the manifestations largely disappeared. A computed tomography scan diagnosed a bilateral fronto temporal subdural hematoma with displacement of the midline structures to the left. She underwent emergency surgery and was discharged completely recovered three days later. Conclusion: HSC can present with different clinical forms, simulating expansive tumor processes, cerebrovascular attacks, dementias or neurological entities of another nature. The case management by clinicians and neurosurgeons was quick and effective, which explains that the patient had an early and complete recovery. In these cases, medical action is decisive in the success of the treatment.

Abducens Nerve Palsy as Initial Manifestation of Chronic Subdural Hematoma: Case Report

Chronic subdural hematoma (CSDH) is a form of progressive intracranial hemorrhage, typically associated with cases of trauma. The manifestation of this comorbidity with abducens palsy is a rare finding. The present work aims to describe the case of an adult patient with abducens nerve palsy as a manifestation of CSDH. Chronic subdural hematoma is most commonly found in elderly patients, with systemic hypertension as amanifestation. The relation with the sixth cranial nerve is unusual and draws attention to the case reported. In addition, the prognosis is positive, since trepanation and drainage surgery was performed, as it is recommended in the literature.

Geriatric head injuries: impact and outcomes

Background: Elderly trauma patients present unique challenges and face  more  significant obstacles in  recovery  than  their younger  counterparts. They usually experience higher morbidity and mortality and slower recovery trajectories and have, on average, worse functional, cognitive, and psychosocial outcomes months or years post-injury than do younger patients.Methods: Authors conducted a study of elderly head injury patients to understand the epidemiology of geriatric TBI, the impact of comorbidities and management issues and  outcomes in such patients. Authors had a total of 110 patients who presented with traumatic brain injury and were admitted in this hospital over 2 years. Authors also reviewed the literatures to study the factors affecting outcome after geriatric TBI and studied the role of aggressive neurosurgical management in geriatric TBI.Results: Among 68%(n=75) of the patients were male and 32% females. Age group of 60-65 years was the highest with 60.9% patients. Patients with GCS of 8 and below had the highest mortality rates of 68 %. Overall  mortality  rate  was  32.72%  and  9.09 %  of  the patients survived in a vegetative condition. The proportion of injury secondary to fall was the largest single group in 50.9% patients, and Chronic SDH was the most common pathology seen in 36.45 % patients. Highest mortality was seen in patients with Diffuse Axonal Injury (69.23 %). Out of the 110 patients , 57 patients underwent surgery for various pathologies. Chronic SDH were the most common operated pathology followed by acute SDH. Glassgow outcome scale was used as the measure of outcome in these series of patients.  32.72 % patients had a GOS score of 1 and 9.09 % had a score of 2. 18.18 % patients remained severely disabled with a score of 3 and nine patients (8.18 %) had a score of 4 and thirty five patients had good recovery (GOS-5).Conclusions: Due to the better treatment options there is an increase in the number of elderly around the world. Thus, the number of eldery individuals presenting with TBI to the emergency department is also on the rise more commonly due to falls than road traffic accidents. There is a need for specific prognostic and management guidelines for the elderly which can lead to better diagnosis, care and recovery and eventual short- and long-term outcomes in the elderly.

Epidemiology and Estimated Cost of Surgery for Chronic Subdural Hematoma Conducted by the Unified Health System in Brazil (2008­2016)

Introduction Chronic subdural hematoma (CSH) is one of the most frequent forms of intracranial hemorrhage. It is a collection of encapsulated, well-delimited fluid and/or coagulated blood in several clotting stages located between the dura mater and the arachnoid mater. Objective To describe the epidemiological aspects of CSH described in the database of the Brazilian Unified Health System (SUS, in the Portuguese acronym) regarding admission numbers, hospitalization expenses, health care professional expenses, mortality rate, and death numbers by region from 2008 to the first half of 2016. Methods The present work was performed between August and September 2016 with a review about the epidemiological aspects of CSH in Brazil according to the Informatics Department of the Unified Health System (DATASUS) database, encompassing the period from January 2008 to June 2016, and to scientific papers from the past 10 years which were electronically published at the PubMed, Scielo, and LILACS databases. Results From 2008 to the first half of 2016, the total values were the following: hospital admission authorizations (HAAs). 33,878; hospital expenses, BRL 65,909,429.22; health care professional expenses, BRL 25,158,683.21; deaths, 2,758; and mortality rates ranging from 6.47 to 12.63%. Conclusion In spite of the high clinical relevance of CSH, epidemiological studies about this condition are limited. As such, the present paper is an updated approach on CSH, focusing on its epidemiological aspects according to the DATASUS database.

The role of subgaleal suction drain in chronic subdural hematoma evacuation – Retrospective study in a tertiary care centre

Background: Chronic subdural hematoma (CSDH) is one of the common problems seen in neurosurgical practice, especially in the elderly. Chronic subdural hematoma is a pseudo-encapsulated collection of old blood between the duramater and subarachnoid caused by tear of bridging veins. Materials and methods: Total of 186 patients have underwent burr hole evacuation for subdural hematoma in the study period according to the medical records. Of which 93 had a subgleal drain and rest 93without the drain. Results: The mean GCS at admission was 14 (+/- 1). Out of total 186 patients, 164 (88%) patients had unilateral CSDH and 22(12%) had bilateral CSDH. Among 164 patients with unilateral CSDH 82 (50%) and out of 22 with bilateral CSDH 11 (50%), subgaleal vacuum drain was placed. In rest of 82 (50%) patients with unilateral and 11 (50%) bilateral CSDH, drain was not used. Conclusions: Chronic sub dural hematoma is a common presentation to the neurosurgeon. The present retrospective, comparative study of evacuation of chronic SDH with subgaleal suction drain, and without drain were compared and found to be an effective and safe method in reducing recurrence.

A Case Report of Recurrent Chronic Subdural Hematoma Successfully Treated with Jidabokuippo / 日本東洋医学雑誌

We report a case of recurrent chronic subdural hematoma (CSDH) successfully treated with jidabokuippo. The patient was an 81 year-old woman who was performed burr hole surgery for left CSDH. Residual hematoma was gradually increased in postoperative serial brain CT. Although goreisan and saireito were administrated to prevent recurrence, the treatment was not effective. Thereafter, reoperation was performed because of the appearance of aphasia and right hemiparesis. Intraoperative findings revealed that the hematoma was viscous and was not enough drained. Since there was little improvement in clinical and CT findings, a phenomenon of the hematoma was considered as oketsu and jidabokuippo was administrated. Three weeks after the medication, right hemiparesis was improved. Seven weeks after the medication, the hematoma was markedly reduced. Taken together, these results strongly suggest that jidabokuippo is effective for postoperative recurrent CSDH which is difficult for drainage and has no response to the administration of goreisan and saireito.

Delayed Operation of Acute Subdural Hematoma in Subacute Stage by Trephine Drainage using Urokinase / 대한신경손상학회지

OBJECTIVE: The principle operation of acute subdural hematoma (ASDH) is a craniotomy with hematoma removal, but a trephination with hematoma evacuation may be another method in selected cases. Trephine drainage was performed for ASDH patients in subacute stage using urokinase (UK) instillation, and its results were evaluated. METHODS: Between January 2016 and December 2018, the trephine evacuation using UK was performed in 9 patients. The interval between injury and operation was from 1 to 2 weeks. We underwent a burr hole trephination with drainage initially, and waited until the flow of liquefied hematoma stopped, then instilled UK for the purpose of clot liquefaction. RESULTS: The mean age of patients was 71.6 years (range, 38–90 years). The cause of ASDH was trauma in 8 cases, and supposed a complication of anticoagulant medication in 1 case. Four out of 8 patients took antiplatelet medications and one of them was a chronic alcoholism. The range of the Glasgow Coma Scale score before surgery was from 13 to 15. Most of patients, main symptom was headache at admission. The Glasgow Outcome Scale score was 5 in 8 cases and 3 in 1 case. CONCLUSION: It is thought to be a useful operation method in selected patients with ASDH that the subdural drainage in subacute stage with UK instillation. This method might be another useful option for the patients with good mental state regardless of age and the patients with a risk of bleeding due to antithrombotic medications.

Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas / 대한신경손상학회지

OBJECTIVE: Chronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas. METHODS: From January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images. RESULTS: 60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group. CONCLUSION: Burr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.

Spontaneous Disappearance of an Arachnoid Cyst after Burr Hole Drainage of Chronic Subdural Hematoma / 대한신경손상학회지

It is well known that the presence of arachnoid cysts (ACs) in young patients is a risk factor for developing a chronic subdural hematoma (CSDH) after a minor head injury. Although there have been controversies with the treatment, most authors recommend only draining the CSDH if the AC is asymptomatic. This judgement is based on the facts that this surgical approach has shown good clinical outcomes, and the AC usually remains unchanged after the surgery. Our case demonstrates that the AC of a young patient who developed a CSDH after a minor head injury completely disappeared after a burr hole drainage of the CSDH. Although the chances of an AC disappearing are low, this case shows that an AC might disappear after only draining a CSDH when a rupture of the AC membrane is identified. In such cases, we recommend first draining only the CSDH for the treatment of AC-associated CSDHs.

Disappearance of Arachnoid Cyst after Burrhole Trephination: Case Series / 대한신경손상학회지

We report 3 cases of arachnoid cysts (ACs) that completely disappeared after burr hole drainage, without cyst fenestration into the subarachnoid space or cystoperitoneal shunt. The first patient was a 21-year-old female with an AC of the right cerebral convexity, found incidentally. After endoscopic AC fenestration was performed, the patient complained of persistent headache. Two-month postoperative brain imaging revealed reaccumulated AC and associated multi-stage subdural hematoma. Burr hole drainage was performed to resolve the chronic subdural hematoma (CSDH). Three months later, brain computed tomography showed that the CSDH and the AC had disappeared. The second patient was an 11-year-old male who had a history of trauma 1 month prior to presentation at the clinic. Brain magnetic resonance imaging revealed an AC in the left sylvian fissure with CSDH. We performed burr hole drainage to treat the CSDH first. Subsequently, the AC as well as the CSDH disappeared. The third case was an AC of the right parietal convexity, found incidentally. Only burr hole drainage was performed, following which, the AC disappeared. This case series shows that an AC can disappear naturally after rupture into the subdural space by trauma or the burr hole procedure.

Pseudo-Subarachnoid Hemorrhage; Chronic Subdural Hematoma with an Unruptured Aneurysm Mistaken for Subarachnoid Hemorrhage / 대한신경손상학회지

Subarachnoid hemorrhage (SAH) usually occurs due to aneurysmal rupture of intracranial arteries and its typical computed tomography (CT) findings are increased attenuation of cisterns and subarachnoid spaces. However, several CT findings mimicking SAH are feasible in diverse conditions. They are so-called as pseudo-SAH, and this report is a case of pseudo-SAH which is misdiagnosed as aneurysm rupture accompanied by bilateral chronic subdural hematoma (cSDH). A 42-year-old male with severe headache visited our institute. Non-contrast brain CT images showed increased attenuation on basal cistern, and cSDH on both fronto-temporo-parietal convexity with midline shifting. Trans-femoral cerebral angiography was done and we confirmed small aneurysm at right M1 portion of middle cerebral artery. Under diagnosis of SAH, we planned an operation in order to clip aneurysmal neck and remove cSDH. cSDH was removed as planned, however, there was no SAH and we also couldn't find the rupture point of aneurysm. Serial follow-up CT showed mild cumulative cSDH recurrence, but the patient was tolerant and had no neurologic deficit during hospitalization. We have checked the patient via out-patient department for 6 months, there are no significant changes in volume and density of cSDH and the patient also have no neurologic complications.

Craniotomy and Membranectomy for Treatment of Organized Chronic Subdural Hematoma / 대한신경손상학회지

We report the case of a patient with organized chronic subdural hematoma (OCSH) that was treated with craniotomy. A 72-year-old man was admitted with a complaint of a drowsy mental status after a generalized tonic-clonic seizure. A brain computed tomography scan acquired at a local hospital revealed a large chronic subdural hematoma (CSDH) in the left frontoparietal lobe. The patient had not experienced head trauma and had been taking clopidogrel due to angina. A neurosurgeon at the local hospital performed single burr hole trephination in the left frontal bone and drained some of the hematoma. Brain magnetic resonance imaging performed upon transfer to our hospital showed a large OCSH with a midline shift to the right side, revealing a low, heterogeneous signal on T2-weighted images (WI) and an isodense signal on T1-WI. We performed craniotomy and membranectomy to achieve adequate decompression and expansion of the brain. Following this, the patient recovered completely. Our findings support that neurosurgeons should consider the possibility of organization of a CSDH when selecting a diagnosis and treatment plan.

Prognostic analysis and bilateral bleeding risk factor analysis of chronic subdural hematoma / 上海交通大学学报（医学版）

Objective: To analyse the relating factors that influence the prognosis of chronic subdural hematoma(CSDH) after drilling drainage and to explore the bilateral bleeding risk factors of CSDH. Methods: Four hundred and forty patients with CSDH who underwent drilling drainage were retrospectively analysed. Clinical data, including medical history, signs, blood coagulation function and imaging examination were collected. Spearman correlation analysis and ordinal Logistic regression analysis were performed to assess the relationships between various variables and the prognosis, and univariate analysis and multivariate Logistic regression analysis were performed to explore the risk factors that lead to the occurrence of bilateral bleeding. Results: Spearman correlation analysis indicated that age, medication history of anticoagulant drugs, bilateral hematoma or not, the thickness of the hematoma and volume of intracranial gas on the first post-surgery day and preoperative Markwalder grade were associated with postoperative Markwalder grade (P<0.05). Ordinal Logistic regression analysis showed that medication history of anticoagulant drugs and preoperative Markwalder grade were the independent risk factors (P=0.028, P=0.000). Univariate analysis of the bilateral bleeding indicated that age, medication history of anticoagulant drugs and thrombin time were statistically different between unilateral and bilateral CSDH (P<0.05). Multivariate Logistic regression analysis revealed that thrombin time was the independent risk factor (OR=1.147, 95%CI 1.005-1.309, P=0.042). Conclusion: Age and medication history of anticoagulant drugs were closely related to the bilateral chronic subdural hematoma. The higher the preoperative Markwalder grade is, the higher the postoperative Markwalder grade is. The prognosis of patients without anticoagulant drugs is better than those users.

Modified Arachnoid Plasty Reduces Chronic Subdural Hematoma after Unruptured Aneurysm Clipping : Technical Note

OBJECTIVE: Chronic subdural hematoma (CSDH) is a rare complication of unruptured intracranial aneurysm (UIA) clipping surgery. To prevent postoperative CSDH by reducing subdural fluid collection, we applied the modified arachnoid plasty (MAP) during the UIA clipping surgery to seal the dissected arachnoid plane.METHODS: This retrospective study included 286 patients enrolled from July 2012 to May 2015. We performed arachnoid plasty in all patients, with MAP used after June 17, 2014. Patients were divided into two groups (non-MAP vs. MAP), and by using uni- and multivariate analyses, baseline characteristics, and relationships with postoperative CSDH between the two groups were analyzed. The degree of preoperative brain atrophy was estimated using the bicaudate ratio (BCR) index.RESULTS: Ten patients (3.5%) among 286 patients had postoperative CSDH after clipping. Nine (3.1%) were in the non-MAP group, and one (0.9%) was in the MAP group. The higher BCR index showed statistical significance with occurrence of postoperative CSDH in both uni- (p=0.018) and multivariate (p=0.012; odds ratio [OR], 8.547; 95% confidence interval [CI], 1.616–45.455) analyses. MAP was associated with a lower risk of postoperative CSDH (p=0.022; OR, 0.068; 95% CI, 0.007–0.683).CONCLUSION: This study shows that the degree of preoperative brain atrophy is associated with an increased occurrence of CSDH after clipping and that MAP could help reduce the risk of postoperative CSDH after unruptured aneurysm clipping via a lateral supraorbital approach.

Risk assessment of chronic subdural hematoma after surgical clipping of intracranial aneurysms / 中国脑血管病杂志

Objective To compare the incidence of chronic subdural hematoma(CSDH) and its risk factors after surgical clipping unruptured intracranial aneurysms(UIA) and ruptured intracranial aneurysms (RIA). Methods From January 2006 to December 2015,410 consecutive patients with UIA and 464 patients with RIA treated with aneurysm clipping at the Department of Neurosurgery,Hanzhong Central Hospital were enrolled retrospectively. According to whether having postoperative CSDH or not(evaluating subdural effusion and its degree with head CT scan),the difference of the incidence of CSDH after aneurysm clipping in patients with UIA and RIA were compared,and logistic regression analysis was used to evaluate the risk factors for the occurrence of postoperative CSDH. Results (1) The incidence of CSDH after UIA clipping was higher than that of RIA(11.0% [45/410] vs. 3.0% [14/464]). There was significant difference (P<0.01). The rate of surgical treatment for CSDH because of the symptoms of nervous system injury in patients with UIA was higher than that in patients with RIA(35.6% [16/45] vs. 28.6% [4/14], P<0.05). (2) Multivariate logistic regression analysis showed that unruptured aneurysms (OR,2.59, 95% CI 2.19-3.06,P<0.01),subdural effusion ≥5 mm (OR,1.98,95% CI 1.94-2.03,P<0.01), and CT value≥40 HU (OR,2.87,95% CI 2.65-3.01,P<0.01) were the independent risk factors for postoperative CSDH in patients with intracranial aneurysm. Conclusions The incidence of CSDH was significantly higher than that of RIA after UIA clipping. UIA,subdural effusion ≥5 mm,and CT value ≥40 HU were the independent risk factors for CSDH of intracranial aneurysms.

Prognostic analysis and bilateral bleeding risk factor analysis of chronic subdural hematoma / 上海交通大学学报（医学版）

Objective·To analyse the relating factors that influence the prognosis of chronic subdural hematoma(CSDH) after drilling drainage and to explore the bilateral bleeding risk factors of CSDH.Methods·Four hundred and forty patients with CSDH who underwent drilling drainage were retrospectively analysed.Clinical data,including medical history,signs,blood coagulation function and imaging examination were collected.Spearman correlation analysis and ordinal Logistic regression analysis were performed to assess the relationships between various variables and the prognosis,and univariate analysis and multivariate Logistic regression analysis were performed to explore the risk factors that lead to the occurrence of bilateral bleeding.Results·Spearman correlation analysis indicated that age,medication history of anticoagulant drugs,bilateral hematoma or not,the thickness of the hematoma and volume of intracranial gas on the first post-surgery day and preoperative Markwalder grade were associated with postoperative Markwalder grade (P＜0.05).Ordinal Logistic regression analysis showed that medication history of anticoagulant drugs and preoperative Markwalder grade were the independent risk factors (P=0.028,P=0.000).Univariate analysis of the bilateral bleeding indicated that age,medication history of anticoagulant drugs and thrombin time were statistically different between unilateral and bilateral CSDH (P＜0.05).Multivariate Logistic regression analysis revealed that thrombin time was the independent risk factor (OR=1.147,95％CI1.005-1.309,P=0.042).Conclusion·Age and medication history of anticoagulant drugs were closely related to the bilateral chronic subdural hematoma.The higher the preoperative Markwalder grade is,the higher the postoperative Markwalder grade is.The prognosis of patients without anticoagulant drugs is better than those users.

Treatment of blood disease with chronic subdural hematoma / 基础医学与临床

Objective To understand the characteristics of patients with hematological illness and chronic subdural hematoma.,and the effect of blood disease on the treatment of chronic subdural hematoma. To guide the treatment of patients who both with hematological illness and chronic subdural hematoma. Methods Through a retrospective study of the cases of chronic subdural hematoma from January 1, 2000 to June 1, 2017 in Peking Union Medical College Hospital, the following items were investigated. 1).According to whether or not they were associated with blood disorders, the collected cases were divided into the blood disorders group and the non-blood disorders group. And the clinic data of the sex composition, average ages, treatment effect and mortality were compared. 2). Ac-cording to the treatment, the cases with blood disease were divided into the surgical group and the conservative group. And the treatment effect and mortality were compared. Results A total of 433 patients with chronic subdural hematoma were included in this study, including 35 patients associated with hematological illness. 1) Compared to the controls group, the patients group was younger( P＜0.01) ;the male ratio was lower ( P＜0.01) ; the treatment effect was lower( P＜0.001) and the mortality was higher( P＜0.001) . 2) Within the patients with hematological illness, the surgical group had the better treatment effect(78.9% vs 31.3%,P＜0.01) and the lower mortality (15.8% vs 50.0%,P＜0.05). Conclusions 1)The hematological illness group is younger and the male ratio is lower than the non-hematological illness group; 2) The hematological illness is a risk factor for the treatment of chronic subdural hematoma; 3) The patients who both with the hematological illness and the chronic subdural he-matoma should be treated by surgery.

Modified Arachnoid Plasty Reduces Chronic Subdural Hematoma after Unruptured Aneurysm Clipping : Technical Note

OBJECTIVE: Chronic subdural hematoma (CSDH) is a rare complication of unruptured intracranial aneurysm (UIA) clipping surgery. To prevent postoperative CSDH by reducing subdural fluid collection, we applied the modified arachnoid plasty (MAP) during the UIA clipping surgery to seal the dissected arachnoid plane. METHODS: This retrospective study included 286 patients enrolled from July 2012 to May 2015. We performed arachnoid plasty in all patients, with MAP used after June 17, 2014. Patients were divided into two groups (non-MAP vs. MAP), and by using uni- and multivariate analyses, baseline characteristics, and relationships with postoperative CSDH between the two groups were analyzed. The degree of preoperative brain atrophy was estimated using the bicaudate ratio (BCR) index. RESULTS: Ten patients (3.5%) among 286 patients had postoperative CSDH after clipping. Nine (3.1%) were in the non-MAP group, and one (0.9%) was in the MAP group. The higher BCR index showed statistical significance with occurrence of postoperative CSDH in both uni- (p=0.018) and multivariate (p=0.012; odds ratio [OR], 8.547; 95% confidence interval [CI], 1.616–45.455) analyses. MAP was associated with a lower risk of postoperative CSDH (p=0.022; OR, 0.068; 95% CI, 0.007–0.683). CONCLUSION: This study shows that the degree of preoperative brain atrophy is associated with an increased occurrence of CSDH after clipping and that MAP could help reduce the risk of postoperative CSDH after unruptured aneurysm clipping via a lateral supraorbital approach.