Efficacy of intraoperative irrigation with artificial cerebrospinal fluid in chronic subdural hematoma surgery: study protocol for a multicenter randomized controlled trial
Yoshitaka NagashimaYoshio ArakiKazuki NishidaShunichiro KuramitsuKenichi WakabayashiShinji ShimatoTakeshi KinkoriToshihisa NishizawaT KanoToshinori HasegawaAtsushi NodaKenko MaedaYu YamamotoOsamu SuzukiNaoki KoketsuTakeshi OkadaMasashige IwasakiKiyo NakabayashiShigeru FujitaniHideki MakiYachiyo KuwatsukaMasahiro NishihoriTakafumi TaneiTomohide NishikawaYusuke NishimuraRyuta SaitoSatoshi MaesawaTakashi IzumiKazuya MotomuraEiji ItoEriko OkumuraFumiharu OhkaKazuhito TakeuchiYuichi NagataKinya YokoyamaTomotaka IshizakiFumiaki KanamoriYutaro FuseAya SatoYukio SekiTetsuya NagataniYusuke SakamotoKenji U�daT TsukadaTakayuki IshikawaHiroo SasakiIenaga JyunpeiYosuke SakaiToru WatanabeYuichiro IsozawaNobuyasu KatoYasukazu KajitaNoriyuki SuzakiKaoru EguchiMasashi ItoShunsaku GotoRyo AndoHayato YokoyamaKazuichi TeraoNaoto KawaguchiYu SugiyamaHitofumi OyamaT. KawaguchiTakafumi OtsukaTaiko OsadaTomoki MatsuyamaKengo HirayamaKouki TakedaShohei MizunoKazuhiko WatanabeShigekazu NakamuraShinji OtaNaoki KatoMasahiro UenoYusuke SatoMasato OtawaMizuki NakanoYuhei TakidoWataru OkadaTakashi SakumaShun YamamotoChihiro IinumaTakumi AsaiYoshihiro YamashitaShinsuke MuraokaS NawaHajime HamasakiTakahiko FukuiNaoki SuzukiIkuo TakahashiOta KHirotada KataokaYosuke TamariTomoya GotoToshiki SekiTomiyuki MiyakeTakenori KatoTakehiro NaitoAkihiro MizunoYuta KoketsuTakumi OtakeAkinori KageyamaHirotaka NiwaHiroyuki OishiToshio YokoeShuntaro TakasuMasaya TakemotoJungsu ChooMizuka IkezawaFumihiro SagoDaiki SomiyaM TeranoKohei DobaDaimon ShiraishiSho AkahoriMotonori IshiiNobuhisa FukayaToshiki FukuokaTakayuki AwayaShoko WakisakaMasao TambaraHiroyuki ShimizuSatoshi ShinodaYusuke MuramatsuOtone EndoKentaro FujiiYiichi KawasakiTakato OnoKento HirayamaY ItagakiShuya KuronoJyunzo IshiyamaChihiro AoshimaYuki SunoharaYuri AimiMitsuhiro YoshidaMamoru IshidaMasayuki KimataHisashi MizutaniKenichi HattoriKentaro WadaTakashi MamiyaMasahiro WakabayashiToshiaki HiroseRisa ItoYusuke OtaHiroaki KuboTomoyuki NodaTeppei KawabataT ImaiTakahiro OyamaKei HachiyaYasumasa Nishida
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Abstract:
The surgical techniques for treatment of chronic subdural hematoma (CSDH), a common neurosurgical condition, have been discussed in a lot of clinical literature. However, the recurrence proportion after CSDH surgery remains high, ranging from 10 to 20%. The standard surgical procedure for CSDH involves a craniostomy to evacuate the hematoma, but irrigating the hematoma cavity during the procedure is debatable. The authors hypothesized that the choice of irrigation fluid might be a key factor affecting the outcomes of surgery. This multicenter randomized controlled trial aims to investigate whether intraoperative irrigation using artificial cerebrospinal fluid (ACF) followed by the placement of a subdural drain would yield superior results compared to the placement of a subdural drain alone for CSDH.Keywords:
Clinical endpoint
Chronic Subdural Hematoma
Postoperative hematoma
Spontaneous resolution of the encapsulated chronic subdural hematoma has been observed not rarely in clinical practise. The authors had investigated eight such cases in detail in 1967, and the tentative criteria for the resolving hematoma had been proposed. Further eight cases were presented in this paper which accounted to seven percent of 121 cases of chronic subdural hematoma encountered between 1968 and 1978. Two cases of bilateral hematomas, two cases of apoplectic type and two cases of biconvex hematomas on CAG were included in the eight. These observations meant that the resolving subdural hematoma was not a different clinical entity from conventional chronic ones. The resolving hematoma appeared as preservation of low density area or area of decreasing density from mixed to low in successive CT scans in a course of resolution. It was proposed that in case of the resolving type increased fibrinolytic activity of the hematoma capsule and of the fluid became prematurely diminished due to unknown initiation and that spontaneous resolution took place without surgery. The previous criteria were commented based on discussion on the natural history of chronic subdural hematoma, outline of which was graphically illustrated.
Chronic Subdural Hematoma
Acute subdural hematoma
Subdural Hematomas
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✓The relationship of age to clinical and pathological findings was analyzed in 109 adult patients operated on because of chronic subdural hematoma. A well-formed membrane on the inner and outer surface of the hematoma was used as the criterion for chronicity of the hematoma. Younger patients had more evidence of increased intracranial pressure; older patients had more evidence of mental deterioration and pyramidal tract lesions. The interval from trauma to operation was shorter in the young patients. The thickness of the hematoma as measured from angiograms increased with the age of the patient. The cause of this difference is discussed.
Chronic Subdural Hematoma
Acute subdural hematoma
Midline shift
Altered Mental Status
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Objective To investigate the clinical epidemiologic characteristics of chronic subdural hematoma and risk factors for its recurrence so as to offer scientific basis for treatment and prognostic evaluation. Methods A retrospective study was done on clinical data of 150 adults with chronic subdural hematoma from the Traumatic Brain Injury Database of Neurosurgery Department of General Hospital of Tianjin Medical University to analyze the clinical characteristics and the postoperative recurrence factors of the chronic subdural hematoma. Results Hematoma volume of the patients in the recurrence group was more than that in the non-recurrence group.Age ＞ 80 years and brain atrophy were two independent risk factors for postoperative recurrence of the chronic subdural hematoma.The recurrence rate was declined with the decrease of hematoma density on CT.The recurrence rate of the chronic subdural hematoma in the high-density group was significantly higher than that in the low-and iso-density groups. Conclusions Preoperative hematoma volume,onset age,brain atrophy and hematoma density on CT are significantly correlated with the postoperative recurrence of the chronic subdural hematoma.A detailed clinical and radiological evaluation is of great importance for the treatment and prognostic evaluation of the chronic subdural hematoma.
Key words:
Hematoma,subdural,chronic; Risk factors; Recurrence
Chronic Subdural Hematoma
Midline shift
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Chronic Subdural Hematoma
Subdural Hematomas
Acute subdural hematoma
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Objective To evaluate effect of surgical treatment on chronic subdural hematoma.Methods 112 cases of chronic subdural hematoma were analyzed.Results Of 112 patients,there were 95 cases treated with drilling drainage and 17 cases with open-flap hematoma.Postoperative symptoms were significantly improved,CT review showed hematoma decreased or disappeared.Conclusion The current combination therapy to BHID is to open the main flap hematoma.
Chronic Subdural Hematoma
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The possibility exists that residual air after surgery is one cause of recurrence of chronic subdural hematoma. We have devised a new simple method which decreases postoperative residual air, using external drainage and an endoscope. First, we make endoscopic observations of the inner aspect of the hematoma cavity. Then, we insert external drainage apparatus into the most frontal area of the hematoma cavity, we regard this location as the most appropriate place to ensure most effective drainage. The present study included 37 chronic subdural hematomas in 32 patients who had been treated between January and December, 1999. Their ages ranged from 48 to 86 years old, with an average of 72 years. Insertion of external drainage in the most frontal area of the hematoma cavity was successfully achieved in 27 (73%, Group I) out of 37 cases and resulted in no recurrence. In the remaining 10 hematomas (27%, Group II), external drainage was not able to be inserted in the most frontal area, and four hematomas (40%) had recurrence (p < 0.01 vs Group I). Insertion in the most frontal area of the hematoma cavity decreases residual air after surgery, and may be effective for the prevention of recurrence of chronic subdural hematoma.
Chronic Subdural Hematoma
Endoscope
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Calcified chronic subdural hematoma is a rare condition, representing 0.4-2.6% of all chronic subdural hematomas. It is often difficult to remove the hematoma without damaging the brain, owing to the adhesion between hematoma capsule and brain. Therefore, surgical intervention in managing calcified chronic subdural hematoma cases is still considered controversial. We report a case of calcified chronic subdural hematoma, which was successfully performed under microscopic guidance. A 72-year-old man complained of progressive left hemiparesis of 6-month duration. A CT scan revealed a calcified chronic subdural hematoma, 10 cm long and 4.5 cm thick, in the right convexity. On MRI, T2-weighted images showed a thin layer of cerebrospinal fluid intensity between the hematoma capsule and brain. There was no brain edema adjacent to the chronic subdural hematoma. Based on these MRI observations, we believed that adhesion between the hematoma capsule and brain would be mild. We then planned and succeeded in total removal of the calcified chronic subdural hematoma mass under microscopic guidance. The left hemiparesis disappeared after surgery. The patient was discharged without any neurological deficit. While considering surgical management in calcified chronic subdural hematoma cases, it should be important to evaluate adhesion between the hematoma capsule and brain with MRI.
Chronic Subdural Hematoma
Midline shift
Hemiparesis
Capsule
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Contralateral acute complications such as acute epi/subdural hematomas can be encountered after evacuation of a chronic subdural hematoma, though they are rare. We found only one case of chronic subdural hematoma following the surgery for contralateral chronic subdural hematoma, have been published in English language literature. A 73-year-old male admitted to our hospital with a right-sided subdural hematoma. The subdural hematoma was evacuated through a burr-hole. A left-sided subdural higroma appeared after operation and turned into classical subdural hematoma in the course of time. After evacuation of contralateral chronic subdural hematoma, the patient recovered completely. All stages of the development of contralateral chronic subdural hematomas were shown by serial computed tomograms. It was suggested that traumatic chronic subdural hematomas develop from mostly subdural higromas. If contralateral subdural higroma is seen after surgical evacuation of a chronic subdural hematoma, the possibility of development of contralateral chronic subdural hematoma must be kept on mind.
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Acute subdural hematoma
Subdural Hematomas
Subdural hemorrhage
Subdural space
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Chronic subdural hematoma is one of the most common clinical entities encountered in daily neurosurgical practice. Considerable recurrence rates have been reported for chronic subdural hematoma following surgical evacuation. Many studies have suggested various radiological factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. This study focuses on determining the radiological factors predictive of chronic subdural hematoma recurrence.A retrospective analysis of 113 patients diagnosed with chronic subdural hematoma who were surgically treated between August 2013 and December 2014 was performed. The radiological features were analyzed to clarify the correlation between these radiological factors and postoperative recurrence of chronic subdural hematoma.Twenty patients (17.7%) experienced recurrence. Chronic subdural hematoma recurrence was found to be significantly associated (p<0.05) with preoperative hematoma thickness ≥ 20 mm. Midline shift, hematoma density and bilaterality were not significantly associated with recurrence. Post operative drainage also significantly (p<0.05) reduced chronic subdural hematoma recurrence.Preoperative hematoma thickness ≥ 20 mm is an independent predictor of recurrence of chronic subdural hematoma. Postoperative drainage also significantly reduces chronic subdural hematoma recurrence.
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Midline shift
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Objective:To explore the related factors of recurrence of chronic subdural hematoma after burr hole drainage.Methods:The related aspects that affected the recurrence in 165 cases with chronic subdural hematomas after burr hole drainage were reviewed,and patient's age,drainage volume,thickness of hematoma,septal hematoma cavity and direction of drain pipe were evaluated.Results:Clinical outcomes were satisfactory.151 patients completely recovered after burr hole drainage,there were 14 patients with hematoma recurrence.Conclusion:Age,drainage volume, thickness of hematoma,septal hematoma cavity and direction of drain pipe would affect the prognosis.
Chronic Subdural Hematoma
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