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World Neurosurg. 2017 Mar;99:465-470. doi: 10.1016/j.wneu.2016.12.058. Epub 2016 Dec 23.

Risk Factors for Chronic Subdural Hematoma Recurrence Identified Using Quantitative Computed Tomography Analysis of Hematoma Volume and Density.

Author information

1
Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany. Electronic address: pantelis.stavrinou@uk-koeln.de.
2
Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
3
Department of Radiology, University Hospital of Cologne, Cologne, Germany.

Abstract

OBJECTIVE:

Chronic subdural hematoma (CSDH), a common condition in elderly patients, presents a therapeutic challenge with recurrence rates of 33%. We aimed to identify specific prognostic factors for recurrence using quantitative analysis of hematoma volume and density.

METHODS:

We retrospectively reviewed radiographic and clinical data of 227 CSDHs in 195 consecutive patients who underwent evacuation of the hematoma through a single burr hole, 2 burr holes, or a mini-craniotomy. To examine the relationship between hematoma recurrence and various clinical, radiologic, and surgical factors, we used quantitative image-based analysis to measure the hematoma and trapped air volumes and the hematoma densities.

RESULTS:

Recurrence of CSDH occurred in 35 patients (17.9%). Multivariate logistic regression analysis revealed that the percentage of hematoma drained and postoperative CSDH density were independent risk factors for recurrence. All 3 evacuation methods were equally effective in draining the hematoma (71.7% vs. 73.7% vs. 71.9%) without observable differences in postoperative air volume captured in the subdural space.

CONCLUSIONS:

Quantitative image analysis provided evidence that percentage of hematoma drained and postoperative CSDH density are independent prognostic factors for subdural hematoma recurrence.

KEYWORDS:

Chronic subdural hematoma; Computed tomography; Density; Multiple regression; Recurrence; Volume

PMID:
28017760
DOI:
10.1016/j.wneu.2016.12.058
[Indexed for MEDLINE]

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