J Korean Neurosurg Soc.  2022 Mar;65(2):255-268. 10.3340/jkns.2021.0138.

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

• Oh HJ
• Seo Y
• Choo YH
• Kim YI
• Kim KH
• Kwon SM
• Lee MH
• Chong K

• KMID: 2527182
• DOI: http://doi.org/10.3340/jkns.2021.0138

Abstract

Objective
: Chronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence.
Methods
: We enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women.
Results
: The median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017).
Conclusion
: This is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.

Keyword

Hematoma, Subdural, Chronic; Epidemiology; Patient outcome assessment

Figure

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  Fig. 1. Computed tomography demonstrating four types of chronic subdural hematoma. A : Homogeneous type. B : Laminar type. The arrowheads indicate the high-density laminar structure running along the inner membrane. C : Separated type. The arrow indicates a thick component of the liquefied hematoma. D : Trabecular type. The arrow indicates multiple septations created by fibrosis.

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  Fig. 2. A-D : Comparison of recurrence rate according to age group, history of traumatic brain injury (TBI), alcohol consumption and antithrombotics.

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  Fig. 3. Comparison of the differences in surgery related methods in chronic subdural hematoma patients.

Reference

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