Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

OBJECTIVE: Burr hole drainage has been widely used to treat chronic subdural hematoma (CSDH). However, the incidence of recurrent CSDH varies from 3.7 to 30% after surgery. The authors attempted to elucidate the risk factors associated with the recurrence of CSDH in one burr hole drainage technique. METHODS: A total of 255 consecutive cases who underwent one burr hole drainage for CSDH were included in this study. Twenty-four patients (9.4%) underwent a repeated operation because of the recurrence of CSDH. We analyzed retrospectively the demographic, clinical and radiologic factors associated with the recurrence of CSDH. RESULTS: In this study, two risk factors were found to be independently associated with the recurrence of CSDH. The incidence of CSDH recurrence in the high- and mixed-density groups was significantly higher than those in the low- and iso-density groups (p<0.001). Bleeding tendency such as in leukemia, liver disease and chronic renal failure was also significantly associated with recurrence of CSDH (p=0.037). CONCLUSION: These results suggest that high- and mixed-density shown on computed tomographic scan was closely relates with a high incidence of recurrence. Therefore, the operation could be delayed in those cases unless severe symptoms or signs are present. Reoperation using the previous burr hole site is a preferred modality to treat the recurrent CSDH.

Origin of Chronic Subdural Haematoma / 医学研究杂志

Objective To explore the origin of chronic subdural heamatoma.Methods Follow-up 92 patients of acute subdural haematoma(ASDH)and 207 patients of traumatic subdural effusion(TSE)S by CT or MRI.Results None of ASDHs developed into CSDHs directly,but ASDHs could become to CSDHs via TSEs;67 cases of TSE was proved becoming to CSDHs by CT scanning or operation.Conclusions Origin of CSDH is TSE.

The Active Mechanism of Dural Border Layer Cells in the Process of Subdural Fluid Collection Developing into Hematoma / 医学研究杂志

Objective Discuss the active mechanism of dural border layer cells in the process of subdural fluid collection developing into chronic subdural hematoma.Methods Review and analyse literature combined with one special return case whom with subdural fluid collection.Results At the same case,subdural fluid collection at left side did no change during 49 months,and that at right side developed into chronic subdural hematoma in 23rd week,and the latter was absorbed at 62rd week.Conclusion In the process of subdural fluid collection developing into chronic subdural hematoma,dural border layer cells roll on important functions.

Analysis of Management According to CT Findings in Chronic Subdural Hematoma

OBJECTIVE: The brain computed tomography(CT) is an important tool throughout the clinical course of chronic subdural hematoma(CSDH). In CT findings, the density of CSDH is different in each case. We analyze management options and results according to the density of CSDH. METHODS: Seventy one patients with CSDH, who had been managed in our institute from August 2001 to December 2003, were reviewed retrospectively. The authors divided the patients into six groups according to the density of hematoma; Group A-hypodense rather than the brain parenchyma, group B-isodense, group C-hyperdense, group D-mixed with hypodense and hyperdense, group E-mixed with isodense and hypodense and group F-mixed with isodense and hypersdense. In each group, the operation method, the duration of the indwelling catheter and prognosis were analyzed. RESULTS: The patients who showed mixed density were 39 and, those who showed single density were 32. All the patients underwent burr hole drainage for the primary choice. There was only two cases that needed additional craniotomy. The average duration of indwelling catheter was 5.40+/-1.91days. Statistically the duration was not different in each group(p-value<0.05, Chi-square test). Three cases recurred, one in group C, another in group D, and the last in group E. It had no statistical significance due to low incidence of recurrence. CONCLUSION: We conclude that burr hole drainage is an acceptable primary treatment option for CSDH even though the density of hematoma is different in every single case.