Outcome and survival of surgically treated acute subdural hematomas and postcraniotomy hematomas - A retrospective cohort study

Quantitative evaluation of early antifibrinolytic therapy on 90-day mortality in elderly patients with acute traumatic subdural hematoma: insights from a prospective cohort study

BACKGROUND AND OBJECTIVES

Acute traumatic subdural hematomas (aTSDH) represent a frequent and critical neurosurgical emergency, associated with a significant risk of mortality. Elderly patients with symptomatic aTSDH may benefit from early antifibrinolytic therapy (EAFT). We aim to investigate whether EAFT can improve clinical outcomes in aTSDH patients and to explore the factors influencing mortality, using data from a nationwide, multicenter, prospective cohort study.

METHODS

Multicenter, prospective cohort study at 30 trauma centers from 2023 to 2024 enrolled 963 patients diagnosed aTSDH. After screening, 297 patients aged 60 years or older met inclusion criteria. The primary outcome was 90-day mortality. Secondary outcomes included vascular occlusion, brain rebleeding, sepsis, gastrointestinal bleeding, and renal failure.

RESULTS

A total of 297 aTSDH patients were identified, of whom 195 received EAFT, and 102 were in the control group. After propensity score matching (PSM), 80 patients in each group were compared. There were no significant differences in 90-day mortality (before PSM, P = 0.439; after PSM, P = 0.828). The difference between the two group in the incidence of brain rebleeding, sepsis, gastrointestinal bleeding, and renal failure were similar before and after PSM. The EAFT group had a significantly higher incidence of vascular occlusion compared to the control group (before PSM, P = 0.014; after PSM, P = 0.027). In multivariate logistic regression (odds ratio [95% confidence interval]), increased 90-day mortality was predicted by larger hematoma volume (2.329 [1.123-4.830], P = 0.023) and greater midline shift (2.251 [1.065-4.755], P = 0.034). Sensitivity analysis indicated that there was heterogeneity in the treatment effects between the two groups across different midline shift categories (before PSM, P = 0.012; after PSM, P = 0.043).

CONCLUSION

EAFT may not significantly reduce mortality in elderly aTSDH patients and could potentially increase the risk of vascular occlusion. Therefore, its use in this population should be approached with caution, carefully assessing the potential risks.

RADAR - Radiomics on aSDH: predicting outcome with surface area

BACKGROUND

Acute subdural hematoma is a critical condition, leading to significant morbidity and mortality. Despite advancements in surgical techniques, a portion of patients only show limited clinical improvement post-evacuation. Surgical intervention decisions are critically important, as they can either improve or worsen a patient's condition. Radiomics offers significant potential by extracting complex patterns from digital medical images and transforming them into high-dimensional data that reflect the underlying pathophysiology. By integrating Radiomics with individual patient characteristics, we can develop decision support models. This study aims to analyze radiomic parameters of aSDH to determine whether they support the decision to proceed with urgent surgery or opt for a conservative approach. We hypothesized that surface area could be a significant predictor of neurological outcome such as maintaining independent mobility (mRS ≥ 3) and survival rates.

METHODS

This retrospective study involved radiomic analysis according to neurological outcome and survival. Radiomic parameters were measured using 3D Slicer software. Statistical analyses explored correlations, employing AUC-analysis and Kaplan-Meier survival.

RESULTS

Our findings revealed significant correlations between hematoma and surface area with poorer neurological prognosis. Further subgroup analysis showed surface area as a significant predictor for poorer outcomes in patients undergoing craniotomy (p = 0.006 in univariant- and p = 0.020 in multivariant analysis). In the total cohort, among conservatively managed and craniotomy subgroups, survival analysis highlighted an advantageous survival for patients exhibiting smaller surface areas (< 339.50 cm2).

CONCLUSIONS

Especially in craniotomy patients, surface area emerged as a possible predictor for neurological outcome and survival.

Hydrogel in the Treatment of Traumatic Brain Injury

The high prevalence of traumatic brain injury (TBI) poses an important global public health challenge. Current treatment modalities for TBI primarily involve pharmaceutical interventions and surgical procedures; however, the efficacy of these approaches remains limited. In the field of regenerative medicine, hydrogels have garnered significant attention and research efforts. This review provides an overview of the existing landscape and pathological manifestations of TBI, with a specific emphasis on delineating the therapeutic potential of hydrogels incorporated with various bioactive agents for TBI management. Particularly, the review delves into the utilization and efficacy of hydrogels based on extracellular matrix (ECM), stem cell-loaded, drug-loaded, self-assembled peptide structures or conductive in the context of TBI treatment. These applications are shown to yield favorable outcomes such as tissue damage mitigation, anti-inflammatory effects, attenuation of oxidative stress, anti-apoptotic properties, promotion of neurogenesis, and facilitation of angiogenesis. Lastly, a comprehensive analysis of the merits and constraints associated with hydrogel utilization in TBI treatment is presented, aiming to steer and advance future research endeavors in this domain.