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Multimodality management for chronic subdural hematoma in China: protocol and characteristics of an ambidirectional, nationwide, multicenter registry study

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中华神经外科杂志(英文) 2024年第02期10卷 124-133页

作者： Liu Tao Zhao Zhihao Huang Jinhao Zhu Xide Chen Weiliang Lin Kun Yu Yunhu Li Zhanying Fan Yibing Liu Mingqi Nie Meng Liu Xuanhui Gao Chuang Quan Wei Qian Yu Wu Chenrui Yuan Jiangyuan Wu Di Lv Chuanxiang Dong Shiying Mi Liang Tian Yu Tian Ye Zhang Jianning Jiang Rongcai Department of Neurosurgery Tianjin Medical University General Hospital Tianjin China Ministry of Education Tianjin Neurological Institute Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System Tianjin Medical University General Hospital Tianjin China Department of Neurosurgery Linyi People’s Hospital Shandong China Department of Neurosurgery Haining People’s Hospital Zhejiang China Department of Neurosurgery Fujian Provincial Hospital Fujian China Department of Clinical Research Center for Neurological Disease the People’s Hospital of HongHuaGang District of ZunYi Guizhou China Department of Neurosurgery Kailuan General Hospital Hebei China Department of Neurosurgery Tianjin First Central Hospital Tianjin China Department of Neurosurgery The First Hospital of Jilin University Changchun China

Background Despite its prevalence, there is ongoing debate regarding the optimal management strategy for chronic subdural hematoma (CSDH), reflecting the variability in clinical presentation and treatment outcomes. This ambidirectional, nationwide, multicenter registry study aims to assess the efficacy and safety of multimodality treatment approaches for CSDH in the Chinese ***/design A multicenter cohort of CSDH patients from 59 participating hospitals in mainland China was enrolled in this study. The treatment modalities encompassed a range of options and baseline demographics, clinical characteristics, radiographic findings, and surgical techniques were documented. Clinical outcomes, including hematoma resolution, recurrence rates, neurological status, and complications, were assessed at regular intervals during treatment, 3 months, 6 months, 1 year, and 2 years *** Between March 2022 and August 2023, a comprehensive cohort comprising 2173 individuals who met the criterion was assembled across 59 participating clinical sites. Of those patients, 81.1% were male, exhibiting an average age of 70.12 ± 14.53 years. A historical record of trauma was documented in 48.0% of cases, while headache constituted the predominant clinical presentation in 58.1% of patients. The foremost surgical modality employed was the burr hole (61.3%), with conservative management accounting for 25.6% of cases. Notably, a favorable clinical prognosis was observed in 88.9% of CSDH patients at 3 months, and the recurrence rate was found to be 2.4%.Conclusion This registry study provides critical insights into the multimodality treatment of CSDH in China, offering a foundation for advancing clinical practices, optimizing patient management, and ultimately, improving the quality of life for individuals suffering from this challenging neurosurgical *** registration ChiCTR2200057179

关键词： chronic subdural hematoma Multimodality therapy Outcome Recurrence

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chronic subdural hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

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Open Journal of Modern Neurosurgery 2024年第1期14卷 57-63页

作者： Komi Egu Agbéko Komlan Doléagbénou Messan Hobli Ahanogbé Abdel Kader Moumouni Essossinam Kpélao Katanga Anthony Békéti Department of Neurosurgery Sylvanus Olympio Teaching Hospital Lomé Togo Department of Neurosurgery Kara Teaching Hospital Kara Togo

Intracranial arachnoid cysts (AC) are believed to be congenital and chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury. The association between these two entities sporadically occur in relatively young patients but rare in elderly patients. We report a 65-year-old man who presented with headache and dizziness of 2 months’ duration with a history of head injury. Brain computed tomography (CT) a CSDH in right side and a hygroma in left side. After first operation with burr holes in both sides, the patient underwent an early recurrence of acute subdural hematoma in the right side. The evacuation of this hematoma by a craniotomy allowed seeing an AC that we resected partially with complete recovery of the patient. The association CSDH/AC is rare and possible in elderly patients and there is no consensus on treatment.

关键词： Arachnoid Cyst chronic subdural hematoma Elderly Patient

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Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma:An observational study

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World Journal of Clinical Cases 2022年第35期10卷 12920-12927页

作者： Xue-Jian Wang Yu-Hua Yin Zhi-Feng Wang Yi Zhang Cheng Sun Zhi-Ming Cui Department of Neurosurgery Affiliated Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Neurosurgery Renji HospitalShanghai Jiao Tong UniversityShanghai 200000China Jiangsu Provincial Key Laboratory of Nerve Regeneration Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Orthopedic Affiliated Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina

BACKGROUND chronic subdural hematoma(CSDH)is a common disease in *** traditional treatment methods include burr hole drainage,bone flap craniectomy and other surgical methods,and there are certain complications such as recurrence,pneumocephalus,infection and so *** the promotion of neuroendoscopic technology,its treatment effect and advantages need to be further *** To study the clinical effect of endoscopic small-bone approach in *** A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method:the neuroendoscopy group(n=61 cases)and the burr hole drainage group(n=61 cases).The clinical treatment effect of the two groups of patients with CSDH was *** At the early postoperative stage(1 d and 3 d),the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete reexpansion was higher in the neuroendoscopy group than in the burr hole drainage group,and the difference between the two groups was statistically significant(Phematoma in the neuroendoscopy group was lower than that in the burr hole drainage group,and the difference between the two groups was statistically significant(Phematoma,low cranial pressure,tension pneumocephalus or other complications occurred in the neuroendoscopy *** The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal *** surgical effect is apparent with few complications and definite curative effect,which is worthy of clinical promotion and application.

关键词： Neuroendoscopy Small bone window approach chronic subdural hematoma Curative effect Burr hole drainage

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Positioning and design by computed tomography imaging in neuroendoscopic surgery of patients with chronic subdural hematoma

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World Journal of Clinical Cases 2023年第14期11卷 3204-3210页

作者： Xue-Jian Wang Yu-Hua Yin Long-Yao Zhang Zhi-Feng Wang Cheng Sun Zhi-Ming Cui Department of Neurosurgery Affiliated Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Neurosurgery Renji HospitalShanghai Jiao Tong UniversityShanghai 200000China Jiangsu Provincial Key Laboratory of Nerve Regeneration Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Orthopedic Affiliate Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina

BACKGROUND Neuroendoscopy is a very useful technique to chronic subdural hematoma(CSH).But how to achieve the goal of treatment more minimally invasive?AIM To develop a simple,fast and accurate preoperative planning method in our way for endoscopic surgery of patients with *** From June 2018 to May 2020,forty-two patients with CSH,admitted to our hospital,were performed endoscopic minimally invasive surgery;computed tomography(CT)imaging was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic *** clinical data and treatment efficacy were *** According to the learning of CT scanning images,the surgeon can accurately design the best minimally invasive neuroendoscopic surgical approach and realize the precise positioning and design of the drilling site of the skull and the size of the bone window,so as to provide the most effective operation space with the smallest bone *** this group,the average operation time was only about 1 h,and the clearance rate of hematoma was about 95%.CONCLUSION Patients with CSH can achieve good therapeutic effect by using our way to positioning and design to assist the operation of CSH according to CT scan and image,and our way is very useful and necessary.

关键词： chronic subdural hematoma Neurosurgery neuroendoscopy Positioning and design Bone window design

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Steroid for chronic subdural hematoma? A prospective phase IIB pilot randomized controlled trial on the use of dexamethasone with surgical drainage for the reduction of recurrence with reoperation

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Chinese Neurosurgical Journal 2015年第1期1卷 -页

作者： David Yuen Chung Chan Tin Fung David Sun Wai Sang Poon Division of Neurosurgery Department of Surgery Prince of Wales HospitalThe Chinese University of Hong Kong 30-32 Ngan Shing Street Shatin NTHong Kong

Background: chronic subdural hematoma is a common neurosurgical condition especially in the aging *** hole for drainage is an effective treatment, yet recurrence is reported at 8 to 22 ％ worldwide, and 1-year mortality rates could be as high as 32 ％.Our previous study on the use of dexamethasone as a primary nonsurgical treatment showed good response in selected group of *** study aims to assess the efficacy of dexamethasone with surgical drainage in the reduction of recurrence requiring ***: From October 2000 to September 2006, patients with chronic subdural hematoma admitted to the Prince of Wales Hospital, The Chinese University of Hong Kong, were randomized to surgical drainage with steroid versus surgical drainage *** primary endpoint was symptomatic recurrence requiring ***: Two hundred forty-eight patients were recruited and consented for the randomization during the study *** hundred twenty-two received both surgery and steroid (the intervention arm) while 126 received surgery only (the control arm).The recurrence rate requiring reoperation was 6.6 ％ (8/122) and 13.5 ％ (17/126),respectively (p =0.109).There was no significant difference in complications such as chest infection (p =0.201) or wound infection (p =0.987).Favorable outcome (Glasgow Outcome Score 4-5) was 104/122 (85.2 ％) in the intervention group versus 105/126 (83.3 ％) in the control group, respectively (p =0.811).Based on the recurrence rate in our study, we generate a potential sample size of at least 594 patients (type Ⅰ error =5 ％, power =80 ％,two-sided test) to detect a significant ***, brief summary, and potential implications: In this prospective pilot phase IIB randomized controlled study, steroid with surgical drainage had a lower recurrence with reoperation though statistically *** was safe with no significant difference in complication *** pilot study generates a potential sample s

关键词： chronic subdural hematoma Steroid Burr hole for drainage

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Risk Factors of Reoperation and Outcome of Patients Operated for chronic subdural hematoma in a Teaching Hospital in Rabat

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Open Journal of Modern Neurosurgery 2023年第2期13卷 60-68页

作者： Yolande Michèle Moune Jose Dimbi Makosso Mustapha Hemama Alngar Djimrabeye Dognon Kossi François de Paul Adjiou Saad Elmi Moussa Nourou Dine Adeniran Bankole Nizar El Fatemi Rachid El Maaqili Neurosurgery Department Ibn Sina Hospital Rabat Morocco

Background: chronic subdural hematoma is a common pathology, especially in the elderly. Although it has a good prognosis, it poses the problem of recurrence after surgical evacuation. Objective: To analyze the risk factors of reoperation in patients surgically treated for chronic subdural hematoma (cSDH) and evaluate the outcome of patients who benefited from a reoperation. Materials and Methods: A retrospective review was conducted in a single University Hospital Center in Rabat (Morocco) on 49 patients operated on from January 2020 to June 2021 for cSDH. Possible risk factors described in the literature were analyzed and the outcome of post-operative course was evaluated. Statistical significance was defined by p-value Results: 49 patients underwent surgical evacuation of cSDH. The sex ratio of male/female was 3.08. The mean age was 70.6 years. Concerning the medical history, 8.2% were diabetics, 10.2% had heart disease, 18.4% had hypertension, 16.3% associated of comorbidities, 2% had pulmonary embolism, and 2% had neoplasm. 18.4% were on anticoagulation therapy, no patients were on new oral anticoagulants. The clinical findings upon admission were motor deficit at 57.1%, signs of intracranial hypertension at 20.4%, altered consciousness at 16.9% and impaired behavior at 6.1%. 28.6% of patients had a past history of head trauma. The pre-operative CT scan showed unilateral cSDH at 81.6%, midline shifts at 77.6%, and false membranes at 34.7%. Blood appeared chronic at 40.8%, subacute at 24.5%, and mixed densities at 34.7%. The post-operative course was uneventful in 73.5%. According to Ibanez grading 8 patients had mild complications (grade I) and 5 moderate complications (grade II) after the first surgery. We recorded 10.2% of patients who needed a second surgery because of the deterioration of neurologic status or motor deficit associated with an abnormal CT scan. According to the GOS, 85.7% of patients had a good recovery while 10.2% died. None of the factors as

关键词： chronic subdural hematoma Risk Factors of Reoperation Outcome

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Estimation of chronic subdural hematoma Size Using CT Imaging;a Comparison of In-Plane Thickness to 3D Volumetry

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Open Journal of Modern Neurosurgery 2014年第1期4卷 1-6页

作者： Milo Stanisic Department of Neurosurgery Oslo University HospitalOsloNorway Department of Psychology Oslo UniversityOsloNorway Department of Radiology Oslo University HospitalOsloNorway Unit of Biostatistics and Epidemiology Oslo University HospitalOsloNorway

Backgrounds: Pre- and postoperative chronic subdural hematoma (CSDH) sizes have been used in clinical trials to predict the risk of postoperative recurrence. Commonly, dimensions of the pre- and postoperative lesions have been assessed by computerized tomography (CT) scans using maximum thickness as a linear measurement. Our goal was to characterize this common method for quantification of pre- and postoperative lesion sizes and to assess its estimation validity compared to estimation by hematoma volumetry. Methods: We prospectively investigated pre- and 1st postoperative day CT scans of 107 adult surgical patients with uni- or bilateral CSDH. Pre- and postoperative thickness of CSDH was determined and then compared to pre- and postoperative lesion volume measured with 3D hematoma volumetry. Results: Pearson correlation coefficients between mean pre- and postoperative lesion thickness and mean pre- and postoperative lesion volume in the unilateral subgroup were 0.491 and 0.498, respectively;in the bilateral subgroup 0.505 and 0.579, respectively;and in the whole series 0.653 and 0.472, respectively. Conclusions: Pre- and postoperative thickness of CSDH does not offer reasonable approximations of the pre- and postoperative lesion size when compared with results from 3D volumetry in the unilateral subgroup, bilateral subgroup or overall.

关键词： chronic subdural hematoma Computerized Tomography Thickness Volume

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Calcified chronic subdural hematoma: A case report and literature review

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Translational Neuroscience and Clinics 2017年第4期3卷 220-223页

作者： Zongyu Xiao Xiaojuan Chen Kunzheng Li Zhengping Zhang Department of Neurosurgery Affiliated Hospital of Qinghai University Department of Neurology Qinghai People’s Provincial Hospital

Calcified chronic subdural hematoma(CCSDH) is a rare disease that accounts for approximately 0.3%–2.7% of all chronic subdural hematomas(CSDHs). The clinical features of CCSDH are very similar to those of noncalcified CSDH and include headache,decreased alertness,weakness,numbness,gait disturbance,seizures,memory impairment,confusion,and unconsciousness. All symptomatic CCSDH should be treated surgically. Majority of these patients recover well following surgery. In this report,we present the case of a patient with CCSDH who developed severe cerebral edema following its removal,necessitating decompressive craniectomy. Although there were no abnormal findings in laboratory blood tests,and no signs of brain herniation or epilepsy was found the following day after surgery,the patient's family refused all treatment and a post-operative brain computed tomography(CT) scan. The patient was discharged and died at home. Cerebral hematoma and normal perfusion pressure breakthrough(NPPB) may cause severe cerebral edema following the total removal of a CCSDH.

关键词： calcified chronic subdural hematoma chronic subdural hematoma surgical treatment normal perfusion pressure breakthrough

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Epidural blood patch for spontaneous intracranial hypotension with subdural hematoma: A case report and review of literature

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World Journal of Clinical Cases 2022年第1期10卷 388-396页

作者： Se Hee Choi Youn Young Lee Won-Joong Kim Anesthesiology and Pain Medicine Ewha Womans University Mokdong HospitalSeoul 07985South Korea Anesthesiology and Pain Medicine School of MedicineEwha Womans UniversitySeoul 07985South Korea

BACKGROUND Cerebrospinal fluid(CSF)leakage at C1/2 in spontaneous intracranial hypotension(SIH)is *** hematoma(SDH),a serious complication of SIH,may lead to neurological *** report presents a case of SDH after spontaneous C1/2 CSF leakage,which was treated with a targeted epidural blood patch(EBP).CASE SUMMARY A 60-year-old man with no history of trauma was admitted to our hospital with orthostatic headache,nausea,and *** computed tomography imaging revealed bilateral,subacute to chronic *** magnetic resonance imaging(MRI)findings were SDH with dural enhancement in the bilateral cerebral convexity and posterior fossa and mild sagging,suggesting *** the patient underwent burr hole trephination,the patient’s orthostatic headache was *** myelography led to a suspicion of CSF leakage at C1/***,we performed a targeted cervical EBP using an epidural catheter under fluoroscopic *** 5 d after EBP,a follow-up MR myelography revealed a decrease in the interval size of the CSF *** his symptoms improved,the patient still complained of headaches;therefore,we repeated the targeted cervical EBP 6 d after the initial ***,his headache had almost disappeared on the 8th day after the repeated *** Targeted EBP is an effective treatment for SDH in patients with SIH due to CSF leakage at C1/2.

关键词： Cerebrospinal fluid chronic subdural hematoma Epidural blood patch Myelography Spontaneous intracranial hypotension Case report

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