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Neurosurg Clin N Am. 2017 Apr;28(2):279-286. doi: 10.1016/j.nec.2016.11.010. Epub 2017 Jan 4.

Management of Recurrent Subdural Hematomas.

Author information

1
Department of Neurosurgery, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA. Electronic address: vrdesai@houstonmethodist.org.
2
Department of Neurosurgery, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA.

Abstract

Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage. Most recurrent hematomas are managed successfully with burr hole craniostomies with postoperative closed-system drainage. Refractory hematomas may be managed with a variety of techniques, including craniotomy or subdural-peritoneal shunt placement.

KEYWORDS:

Chronic subdural hematoma; Recurrent hematoma; Recurrent subdural hematoma; Subdural hematoma

PMID:
28325462
DOI:
10.1016/j.nec.2016.11.010
[Indexed for MEDLINE]

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