====== Chronic subdural hematoma recurrence ====== ===== Latest in real time ===== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1bGVAOyPwMuVIJRjL7VcZJ1znRrRvW2t_XZI65eDeH25eEd98N/?limit=15&utm_campaign=pubmed-2&fc=20221211151331}} {{ ::chronic_subdural_hematoma_recurrence.jpg?300|}} ---- The most frequent [[chronic subdural hematoma surgery complication]] is [[chronic subdural hematoma]] [[recurrence]] requiring [[reoperation]]. Although several definitions of [[recurrence]] have been proposed ((A. Chiari, K. Hocking, E. Broughton, C. Turner, T. Santarius, P. Hutchinson, A. Kolias, Core outcomes and common data elements in chronic subdural hematoma: a systematic review of the literature focused on reported outcomes, J.Neurotrauma 33 (2016) 1212–1219, https://doi.org/10.1089/neu.2015.3983.)) one of the most consensual definitions of [[recurrence]] is the association between new clinical symptoms and hematoma revealed by CT scans. Thus, one can wonder whether a systematic CT scan is necessary after CSDH [[evacuation]] for a patient without symptoms. ---- Dspite patients experiencing high [[chronic subdural hematoma recurrence]] and [[readmission]] rates after surgical management of [[nontraumatic subdural hematoma]]s (SDHs), few studies have examined the causes and predictors of unplanned readmissions in this population on a national scale. Shaftel et al. analyzed independent factors predicting 30-day hospital readmissions after surgical treatment of nontraumatic SDH in patients who survived their index surgery and evaluate hospital readmission rates and charges. Using the Nationwide Readmissions Database, they identified patients who underwent craniotomy for nontraumatic SDH evacuation (2010-2015) using a retrospective cohort observational study design. National estimates and variances within the cohort were calculated after stratifying, hospital clustering, and weighting variables. Among 49 013 patients, 10 643 (21.7%) had at least 1 readmission within 30 days of their index treatment and 38 370 (78.3%) were not readmitted. Annual readmission rates did not change during the study period ( P = .74). The most common primary causes of 30-day readmissions were [[chronic subdural hematoma recurrence]] (n = 3949, 37.1%), [[venous thromboembolism]] (n = 1373, 12.9%), and delayed [[hyponatremia]] and [[syndrome of inappropriate antidiuretic hormone secretion]] (n = 1363, 12.8%). Comorbidities that independently predicted readmission included [[congestive heart failure]], [[chronic obstructive pulmonary disease]], [[coagulopathy]], [[diabetes mellitus]], [[liver disease]], [[lymphoma]], fluid and electrolyte disorders, metastatic cancer, [[peripheral vascular disease]], [[psychosis]], and [[renal failure]] ( P ≤ .03). Household income in the 51st to 75th percentile was associated with a decreased risk of readmission. National [[trend]]s in 30-day [[readmission]] rates after nontraumatic SDH treatment by [[craniotomy]] provide quality benchmarks that can be used to drive quality improvement efforts on a national level ((Shaftel KA, Cole TS, Jubran JH, Schriber TD, Little AS. Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1-Craniotomy. Neurosurgery. 2022 Aug 1;91(2):247-255. doi: 10.1227/neu.0000000000002001. Epub 2022 May 16. PMID: 35551171.)) ===== Prognostic models ===== [[Prognostic models for chronic subdural hematoma recurrence]]. ===== Epidemiology ===== [[Chronic subdural hematoma recurrence]] after [[evacuation]] occurs in approximately 10% of [[chronic subdural hematoma]]s, and the various [[Chronic subdural hematoma surgery]] [[intervention]]s are approximately equivalent. [[Corticosteroid]]s are associated with reduced recurrence but also increased [[morbidity]]. [[Drain]]s reduce the risk of recurrence, but the position of drain (subdural vs subgaleal) did not influence [[recurrence]]. [[Middle meningeal artery embolization]] is a promising treatment warranting further evaluation in [[randomized trial]]s ((Henry J, Amoo M, Kissner M, Deane T, Zilani G, Crockett MT, Javadpour M. [[Management]] of [[Chronic Subdural Hematoma]]: A [[Systematic Review]] and [[Component Network Meta-analysis]] of 455 Studies With 103 645 Cases. Neurosurgery. 2022 Dec 1;91(6):842-855. doi: 10.1227/neu.0000000000002144. Epub 2022 Sep 28. PMID: 36170165.)). ---- In 2 large cohorts of US patients, approximately 5% to 10% of patients who underwent surgery for nontraumatic SDH were required to undergo repeated operation within 30 to 90 days. These results may inform the design of future prospective studies and trials and help practitioners calibrate their index of suspicion to ensure that patients are referred for timely surgical care ((Knopman J, Link TW, Navi BB, Murthy SB, Merkler AE, Kamel H. Rates of Repeated Operation for Isolated Subdural Hematoma Among Older Adults. JAMA Netw Open. 2018 Oct 5;1(6):e183737. doi: 10.1001/jamanetworkopen.2018.3737. PubMed PMID: 30646255. )). [[Recurrence]] rates after [[chronic subdural hematoma]] (CSDH) evacuation with any of actual techniques [[twist drill]] craniostomy (TDC), [[burr hole]] craniostomy, craniotomy range from 5% to 30%. ((Escosa Baé M, Wessling H, Salca HC, de Las Heras Echeverría P. Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence. Acta Neurochir (Wien). 2011 May;153(5):1097-103. doi: 10.1007/s00701-010-0903-3. Epub 2010 Dec 31. PubMed PMID: 21193935. )). ===== Grading ===== [[Oslo grading system]]. ===== Risk factors ===== [[Chronic subdural hematoma recurrence risk factors]] ===== Prevention ===== [[Chronic subdural hematoma recurrence prevention]] ===== Treatment ===== [[Chronic subdural hematoma recurrence treatment]]. ===== Systematic Review and Meta-Analysis ===== [[Chronic subdural hematoma recurrence Systematic Review and Meta-Analysis]] ---- ===== Systematic reviews ===== [[Chronic subdural hematoma recurrence]] after [[evacuation]] occurs in approximately 10% of [[chronic subdural hematoma]]s, and the various [[Chronic subdural hematoma surgery]] [[intervention]]s are approximately equivalent. [[Corticosteroid]]s are associated with reduced recurrence but also increased [[morbidity]]. [[Drain]]s reduce the risk of recurrence, but the position of drain (subdural vs subgaleal) did not influence [[recurrence]]. [[Middle meningeal artery embolization]] is a promising treatment warranting further evaluation in [[randomized trial]]s ((Henry J, Amoo M, Kissner M, Deane T, Zilani G, Crockett MT, Javadpour M. [[Management]] of [[Chronic Subdural Hematoma]]: A [[Systematic Review]] and [[Component Network Meta-analysis]] of 455 Studies With 103 645 Cases. Neurosurgery. 2022 Dec 1;91(6):842-855. doi: 10.1227/neu.0000000000002144. Epub 2022 Sep 28. PMID: 36170165.)). ===== Case series ===== see [[Chronic subdural hematoma recurrence case series]]. ===== Case reports ===== [[Chronic subdural hematoma recurrence case reports]]. ===== Chronic Subdural Hematoma Recurrence Cases from the General University Hospital of Alicante ===== A 73-year-old man [[Active smoker]] Undifferentiated [[non-small cell lung cancer]] [[Chronic obstructive pulmonary disease]] [[Type 2 diabetes mellitus]] [[Cirrhosis]] [[Dupuytren contracture]] Prophylactic holocranial RT 25 Gy {{::hsdc1.jpg?200|}} CT Post-surgical changes after drainage of the subdural hematoma through a right frontal [[trephine]], with reduction of the subdural hematoma in the right convexity that now presents a maximum diameter measured in coronal of 10 mm (previously 28 mm) and some pneumocephalus bubbles. It presents hyperdense content in sloped areas and in the anterobasal region. The mass effect has also been reduced with a reduction in the collapse of adjacent sulci as well as the collapse of the right lateral ventricle, with less midline displacement and [[subfalcine herniation]] (4 mm, previously 8 mm). {{::hsdc2.jpg?200|}} Later {{::hsdc3.jpg?200|}} ---- A 79-year-old man, anticoagulated with [[Acenocoumarol]], referred from primary care due to [[disorientation]], unsteady [[gait]], frequent [[memory loss]], [[psychomotor retardation]], a tendency to [[sleep]], and nocturnal [[aggression]] of 1 week's evolution. Associated intense [[headache]] of new appearance in recent days. {{::chronic_subdural_hematoma_recurrence_cases_from_the_general_university_hospital_of_alicante1.jpg?200|}} Left hemispheric extraaxial collection that occupies the surface of the left frontal-parietotemporal lobes, 2.3 cm maximum thickness, semilunar morphology with hypodense areas, and more hyperdense peripheral areas, related to chronic subdural hematoma, with areas of rebleeding . It produces a considerable mass effect with collapse of the left lateral ventricle, deviation from the midline of 1.4 cm, and moderate dilatation of the contralateral ventricle. Erasing of the furrows of the left convexity, secondary to [[cerebral edema]]. There is no uncal displacement or [[effacement]] of [[cistern]]s that suggest [[transtentorial herniation]]. {{::chronicsubduralhematomarebleedingct.jpg?266|}}{{::uncal_herniationct.jpg?300|}} Marked worsening of the neurological condition, and [[drowsiness]] 3 days after the operation. A greater deformation of the [[midbrain]] and collapse of the right [[perimesencephalic cistern]] are observed, these findings being compatible with left [[uncal herniation]] ===== References =====