[논문]Independent Predictors for Recurrence of Chronic Subdural Hematoma

Jung, Yoon-Gyo; Jung, Na-Young; Kim, El

doi:10.3340/jkns.2015.57.4.266

[국내논문] Independent Predictors for Recurrence of Chronic Subdural Hematoma 원문보기

Journal of Korean Neurosurgical Society = 대한신경외과학회지, v.57 no.4, 2015년, pp.266 - 270

Jung, Yoon-Gyo (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) , Jung, Na-Young (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) , Kim, El (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine)

Abstract ▼ AI-Helper

Objective : Chronic subdural hematoma (CSDH) is one of the most frequent problems encountered in neurosurgery. Although burr-hole trephination is widely performed to treat CSDH, the incidence rate of recurrent CSDH is still 2-37%. The goal of this study is to determine the risk factors that affect recurrent CSDH. Methods : A total of 182 patients were included in this study who underwent burr-hole trephination. The clinical factors and radiographic features between the recurrence and the no recurrence groups were analyzed to find the parameters related to the postoperative recurrence of CSDH. Results : For the recurrence of CSDH that occurred in 25 patients (13.7%), among various risk factors, pre and postoperative midline displacements, which are more than 10 mm (p=0.000), and preoperative hemiparesis (p=0.026) had contributed to recurrent CSDH with statistical significance by univariate analysis. Unilateral CSDH were more frequently related to recurrent CSDH (16.3%), although it was not a statistical significant result (p=0.052). Furthermore, preoperative midline displacement only had statistical meaning for the recurrence of CSDH by multivariate analysis. Conclusion : This study indicates that the midline displacement on the preoperative computed tomography scan is the only independent predictor for the recurrence of CSDH.

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문제 정의

Furthermore, the crucial risk factors are still debatable despite the various elements that may be associated with the recurrence of CSDH. Thus, the goal of this study is to determine the predictors for recurrence of CSDH after burr-hole trephination.

제안 방법

The authors retrospectively reviewed the medical records as well as the pre and postoperative computed tomography (CT) scans of the 182 patients who underwent burr-hole trephination from January 2008 to December 2012. There were 131 male (71.
12 years old). The patients were divided into two groups according to the recurrence of CSDH. The clinical and radiological factors were compared between the recurrence group and the no recurrence group.
Brain atrophy was divided into three stages : none or mild atrophy, definite atrophy, such as dilated sulci, and severe atrophy, such as widely dilated sulci and subdural space^10,17). Air collection was categorized into two groups according to the subdural air found on immediate postoperative CT scan : none or mild, such as residual air bubble, and definite, such as total replacement with air¹⁷⁾. The midline displacement of the septum pellucidum and pineal body were measured at the level of foramen of Monro on the CT scans taken before and after surgery.

대상 데이터

The authors retrospectively reviewed the medical records as well as the pre and postoperative computed tomography (CT) scans of the 182 patients who underwent burr-hole trephination from January 2008 to December 2012. There were 131 male (71.9%) and 51 (28.1%) female in this study, ranging in age from 24 to 94 years old (median age : 68.12 years old). The patients were divided into two groups according to the recurrence of CSDH.
The clinical and radiological factors were compared between the recurrence group and the no recurrence group. In this study, 35 patients with bilateral CSDH were excluded in analyzing the CT density, the width of hematoma, the degree of air collection, the number of burr hole, and the drainage tube.

데이터처리

A univariate analysis was performed with Pearson’s chi-square test and Student t-test to assess the relationship between each factor and the recurrence of CSDH.
A univariate analysis was performed with Pearson’s chi-square test and Student t-test to assess the relationship between each factor and the recurrence of CSDH. A multivariate analysis was performed using a logistic regression model. The relationship between the variables and the recurrence of CSDH are presented based on the 95% confidence interval and the odd ratio (OR).

성능/효과

The reported recurrence rates of CSDH range from 2 to 37%, and this study showed a recurrence rate of 13.7%. In the previous study, a few factors for the recurrence of CSDH have been reported, such as advanced age, bleeding tendency, brain atrophy, alcohol abuse, as well as bilateral CSDH, hematoma density, diabetes mellitus, arachnoid cyst, postoperative posture, postoperative subdural air accumulation, inflammatory cytokines, and some technical aspects of surgery^3,5,13,23).

후속연구

052) because of the lack of the number of cases, unilateral CSDH tended to be associated with recurrence of CSDH. As such, further study is necessary to clarify the association between the laterality of hematoma and the recurrence of CSDH.

참고문헌 (24)

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8 Ikeda K Ito H Yamashita J Relation of regional cerebral blood flow to hemiparesis in chronic subdural hematoma Surg Neurol 1990 33 87 95 2305366

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9 Inao S Kawai T Kabeya R Sugimoto T Yamamoto M Hata N Relation between brain displacement and local cerebral blood flow in patients with chronic subdural haematoma J Neurol Neurosurg Psychiatry 2001 71 741 746 11723193

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13 Markwalder TM Chronic subdural hematomas : a review J Neurosurg 1981 54 637 645 7014792

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14 Nakaguchi H Tanishima T Yoshimasu N Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence J Neurosurg 2001 95 256 262 11780895

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15 Nakaguchi H Tanishima T Yoshimasu N Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage J Neurosurg 2000 93 791 795 11059659

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16 Ohba S Kinoshita Y Nakagawa T Murakami H The risk factors for recurrence of chronic subdural hematoma Neurosurg Rev 2013 36 145 149 discussion 149-150 22696158

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17 Oishi M Toyama M Tamatani S Kitazawa T Saito M Clinical factors of recurrent chronic subdural hematoma Neurol Med Chir(Tokyo) 2001 41 382 386 11561348

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18 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 2002 57 405 409 discussion 410 12176202

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19 Stanisic M Lund-Johansen M Mahesparan R Treatment of chronic subdural hematoma by burr-hole craniostomy in adults : influence of some factors on postoperative recurrence Acta Neurochir (Wien) 2005 147 1249 1256 discussion 1256-1257 16133770
20 Tanaka A Yoshinaga S Kimura M Xenon-enhanced computed tomographic measurement of cerebral blood flow in patients with chronic subdural hematomas Neurosurgery 1990 27 554 561 2234358

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21 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 2008 63 1125 1129 discussion 1129 19008766

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22 Wakai S Hashimoto K Watanabe N Inoh S Ochiai C Nagai M Efficacy of closed-system drainage in treating chronic subdural hematoma : a prospective comparative study Neurosurgery 1990 26 771 773 2352594

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23 Yamamoto H Hirashima Y Hamada H Hayashi N Origasa H Endo S Independent predictors of recurrence of chronic subdural hematoma : results of multivariate analysis performed using a logistic regression model J Neurosurg 2003 98 1217 1221 12816267

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24 Youmans JR Winn HR Youmans Neurological Surgery ed 6 New York W.B. Saunders 2011 532 543

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[국내논문] Independent Predictors for Recurrence of Chronic Subdural Hematoma 원문보기

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[국내논문] Independent Predictors for Recurrence of Chronic Subdural Hematoma 원문보기

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제안 방법

대상 데이터

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참고문헌 (24)

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