J Korean Neurosurg Soc.  2016 Nov;59(6):622-627. 10.3340/jkns.2016.59.6.622.

Analysis of Risk Factor for the Development of Chronic Subdural Hematoma in Patients with Traumatic Subdural Hygroma

• Ahn JH
• Jun HS
• Kim JH
• Oh JK
• Song JH
• Chang IB

• KMID: 2417346
• DOI: http://doi.org/10.3340/jkns.2016.59.6.622

Abstract

OBJECTIVE
Although a high incidence of chronic subdural hematoma (CSDH) following traumatic subdural hygroma (SDG) has been reported, no study has evaluated risk factors for the development of CSDH. Therefore, we analyzed the risk factors contributing to formation of CSDH in patients with traumatic SDG.
METHODS
We retrospectively reviewed patients admitted to Hallym University Hospital with traumatic head injury from January 2004 through December 2013. A total of 45 patients with these injuries in which traumatic SDG developed during the follow-up period were analyzed. All patients were divided into two groups based on the development of CSDH, and the associations between the development of CSDH and independent variables were investigated.
RESULTS
Thirty-one patients suffered from bilateral SDG, whereas 14 had unilateral SDG. Follow-up computed tomography scans revealed regression of SDG in 25 of 45 patients (55.6%), but the remaining 20 patients (44.4%) suffered from transition to CSDH. Eight patients developed bilateral CSDH, and 12 patients developed unilateral CSDH. Hemorrhage-free survival rates were significantly lower in the male and bilateral SDG group (log-rank test; p=0.043 and p=0.013, respectively). Binary logistic regression analysis revealed male (OR, 7.68; 95% CI 1.18-49.78; p=0.033) and bilateral SDG (OR, 8.04; 95% CI 1.41-45.7; p=0.019) were significant risk factors for development of CSDH.
CONCLUSION
The potential to evolve into CSDH should be considered in patients with traumatic SDG, particularly male patients with bilateral SDG.

Keyword

Chronic subdural hematoma; Subdural hygroma

MeSH Terms

Craniocerebral Trauma
Follow-Up Studies
Hematoma, Subdural, Chronic*
Humans
Incidence
Logistic Models
Male
Retrospective Studies
Risk Factors*
Subdural Effusion*
Survival Rate

Figure

• 

  Fig. 1 Initial CT scan of 63 years old male shows hemorrhagic contusion at the left frontal and temporal lobe (arrow) (A). Follow-up contrast-enhanced T1-weighted MRI reveals newly developed subdural hygroma (arrow) at the right frontal lobe with minimal enhancement of pachymeninx (B) after 4 days from trauma. Follow-up MRI after 10 days from trauma showed regression of subdural hygroma (C). CT : computed tomography, MRI : magnetic resonance imaging.

• 

  Fig. 2 Initial CT scan of 70 years old male shows traumatic subarachnoid hemorrhage at the right frontal lobe (A). Follow-up T2-weighted MRI demonstrated newly developed subdural hygroma (arrow) at the both frontal lobe (B), and strong enhancement of pachymeninx (arrow) (C) on contrast-enhanced fluid-attenuated inversion recovery imaging after 2 days from trauma. Subdural hygroma developed into chronic subdural hematoma (arrow) at the right hemisphere after 3 month (D). The amount of subdural hematoma decheased after surgical drainage (E). CT : computed tomography, MRI : magnetic resonance imaging.

• 

  Fig. 3 Kaplan Meier survival analysis according to gender (A) and bilaterality (B) of subdural hygroma.

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