J Korean Neurosurg Soc.  2016 Sep;59(5):458-465. 10.3340/jkns.2016.59.5.458.

Predicting Factors of Chronic Subdural Hematoma Following Surgical Clipping in Unruptured and Ruptured Intracranial Aneurysm

• Kwon MY
• Kim CH
• Lee CY

• KMID: 2351713
• DOI: http://doi.org/10.3340/jkns.2016.59.5.458

Abstract

OBJECTIVE
The aim of this study is to analyze the differences in the incidence, predicting factors, and clinical course of chronic subdural hematoma (CSDH) following surgical clipping between unruptured (UIA) and ruptured intracranial aneurysm (RIA).
METHODS
We conducted a retrospective analysis of 752 patients (UIA : 368 and RIA : 384) who underwent surgical clipping during 8 years. The incidence and predicting factors of CSDH development in the UIA and RIA were compared according to medical records and radiological data.
RESULTS
The incidence of postoperative CSDH was higher in the UIA (10.9%) than in the RIA (3.1%) (p=0.000). In multivariate analysis, a high Hounsfield (HF) unit (blood clots) for subdural fluid collection (SFC), persistence of SFC ≥5 mm and male sex in the UIA and A high HF unit for SFC and SFC ≥5 mm without progression to hydrocephalus in the RIA were identified as the independent predicting factors for CSDH development (p<0.05).
CONCLUSION
There were differences in the incidence and predicting factors for CSDH following surgical clipping between UIA and RIA. Blood clots in the subdural space and persistence of SFC ≥5 mm were predicting factors in both UIA and RIA. However, progression to hydrocephalus may have in part contributed to low CSDH development in the RIA. We suggest that cleaning of blood clots in the subdural space and efforts to minimize SFC ≥5 mm at the end of surgery is helpful to prevent CSDH following aneurysmal clipping.

Keyword

Chronic subdural hematoma; Surgical clipping; Intracranial aneurysm

MeSH Terms

Aneurysm
Hematoma, Subdural, Chronic*
Humans
Hydrocephalus
Incidence
Intracranial Aneurysm*
Male
Medical Records
Multivariate Analysis
Retrospective Studies
Subdural Space
Surgical Instruments*

Figure

• 

  Fig. 1 The degree of brain atrophy. A : Grade 1 is no atrophy with thickness of sulci of cerebral cortex below 1 mm. B : Grade 2 is mild atrophy with thickness above 1 mm and below 3 mm. C : Grade 3 is definite atrophy with dilated sulci thicker than 3 mm and a widened Sylvian fissure. D : Grade 4 is severe atrophy with the features of grade 3 plus an enlarged subdural space.

• 

  Fig. 2 As the degree of brain atrophy increases, percentages of male sex, age ≥60 years, subdural fluid collection (SFC) ≥5 mm, SFC IB, chronic subdural hematoma (CSDH) development, and CSDH requiring surgery show a tendency to increase.

• 

  Fig. 3 A : The patient was a 66-year-old man admitted to hospital for ruptured intracranial aneurysm of the left middle cerebral artery bifurcation. Hunt and Hess grade is 3 and Fisher scale is 2. B: The attenuation in Hounsfield units of subdural fluid collection from the CT after the clipping surgery is 40. SFC thickness is 8 mm. C : CT taken on the 8th day after the operation. SFC thickness is 10 mm and classification of SFC is IIC. Hydrocephalus not occurred. The patient was discharged on the 37th day. D : CT taken on the 81st day after the operation when the patient presented with dysarthria. Left chronic subdural hematoma is observed. E : Burr-hole and irrigation surgery was immediately conducted successfully. F : CT taken on the 325th day after the operation. No complication or recurrence of CSDH was observed, and the patient's symptoms were completely resolved.

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