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Gender-Specific Differences in Chronic Subdural Hematoma. J Craniofac Surg 2023; 34:e124-e128. [PMID: 36857560 DOI: 10.1097/scs.0000000000008855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE Few studies concerning aspects of gender-specific differences in chronic subdural hematoma (CSDH). This study aimed to determine whether gender-specific differences exist in CSDH regarding clinical, radiological characteristics, and prognosis. METHODS A total of 585 patients with CSDH were retrospectively identified. Patients were divided into 2 groups based on gender. Clinical, radiological characteristics, and prognosis were compared using Fisher's exact test or Student t test when applicable. The logistic regression model was used to identify independent risk factors associated with death in CSDH patients. The receiver operating characteristic curve was used to detect the sensitivity and specificity of independent risk factors. RESULTS The average age of women was 71.50±0.92 years, significantly older than 67.30±0.60 years in men. Hypertension, diabetes mellitus, and uremia were significantly more common in women than in men. Alcohol intake was more in males than in females. CSDH patients in males manifested homogeneous iso-dense and homogeneous hyper-dense was obviously more than that in the females. Although homogeneous hypo-dense and mixed density were significantly more common in the females. The average preoperative hematoma volume of the unilateral CSDH in males was 160.85±3.06 cm3, significantly more than 139.60±5.70 cm3 in females. The mortality of females was 7.4%, higher than 1.7% in males (P=0.004). Female, age, uremia, and recurrence were independent risk factors for death in CSDH patients. CONCLUSIONS Gender-specific differences do exist in CSDH. Female, age, uremia, and recurrence were independent risk factors for death in CSDH patients.
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Sharma R, Rocha E, Pasi M, Lee H, Patel A, Singhal AB. Subdural Hematoma: Predictors of Outcome and a Score to Guide Surgical Decision-Making. J Stroke Cerebrovasc Dis 2020; 29:105180. [PMID: 33066943 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE There is little evidence to guide patient selection for subdural hemorrhage (SDH) evacuation. This study was designed to assess the benefit of surgical evacuation of SDH, identify predictors of functional outcome, and create a bedside score to guide the clinical management of SDH. METHODS A cohort of 331 patients presenting to a single center from 2010 to 2014 with a principal diagnosis of subdural hemorrhage was identified. Clinical and radiographic information were extracted from the medical record. Outcomes of interest were (1) the occurrence of surgical evacuation of SDH, and (2) an unfavorable 90-day functional status represented by a modified Rankin score (mRS) ≥ 3. Propensity score matching and adjustment techniques were employed to assess the benefit of surgery accounting for confounding by indication. Multivariable logistic regression models predicting follow-up functional outcome were generated and bootstrapped separately among those with acute SDH and those with either subacute or chronic SDH. Clinical scores were created using model coefficients. RESULTS In this cohort [65% male, mean age 67 years], 47% underwent surgery. Age, focal neurologic deficit, SDH thickness > 10 mm, midline shift > 5mm, and SDH acuity predicted undergoing surgery. Propensity score matching analysis demonstrated that operated patients overall were less likely to have unfavorable 90-day mRS outcome (OR 0.35, 95% C.I. 0.15-0.82). Among patients with acute SDH, age, female sex, pre-admission mRS, focal neurologic deficit, and neuropsychiatric symptoms predicted 90-day functional outcome (c-statistic 0.89, optimism-corrected c-statistic 0.87) and were incorporated into an acute SDH score (range 1-10). Patients with SDH score > 4 were significantly more likely to have an unfavorable outcome if treated medically versus surgically; there was no difference in 90-day functional status by treatment strategy among patients with SDH score ≤ 4. No difference in outcome was seen by surgical status across the spectrum of chronic SDH scores. CONCLUSIONS Surgical evacuation of subdural hematomas overall is associated with favorable outcome. Patient selection for evacuation is enhanced by the application of the acute SDH score. Future studies are necessary to validate the SDH score in an external cohort.
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Affiliation(s)
- Richa Sharma
- Department of Neurology, Yale School of Medicine, CT, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Eva Rocha
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marco Pasi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Aman Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Rajah GB, Waqas M, Dossani RH, Vakharia K, Gong AD, Rho K, Housley SB, Rai HH, Chin F, Tso MK, Snyder KV, Levy EI, Siddiqui AH, Davies JM. Transradial middle meningeal artery embolization for chronic subdural hematoma using Onyx: case series. J Neurointerv Surg 2020; 12:1214-1218. [DOI: 10.1136/neurintsurg-2020-016185] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023]
Abstract
BackgroundMiddle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation.MethodsData for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018–2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed.ResultsForty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index (>5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009).ConclusionTransradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities.
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Neifert SN, Chaman EK, Hardigan T, Ladner TR, Feng R, Caridi JM, Kellner CP, Oermann EK. Increases in Subdural Hematoma with an Aging Population-the Future of American Cerebrovascular Disease. World Neurosurg 2020; 141:e166-e174. [PMID: 32416236 DOI: 10.1016/j.wneu.2020.05.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Subdural hematomas (SDHs) are a common and dangerous condition, with potential for a rapid rise in incidence given the aging U.S. population, but the magnitude of this increase is unknown. Our objective was to characterize the number of SDHs and practicing neurosurgeons from 2003-2016 and project these numbers to 2040. METHODS Using the National Inpatient Sample years 2003-2016 (nearly 500 million hospitalizations), all hospitalizations with a diagnosis of SDH were identified and grouped by age. Numerical estimates of SDHs were projected to 2040 in 10-year increments for each age group using Poisson modeling with population estimates from the U.S. Census Bureau. The number of neurosurgeons who billed the Centers for Medicare and Medicaid Services from 2012 to 2017 was noted and linearly projected to 2040. RESULTS From 2020-2040, SDH volume is expected to increase by 78.3%, from 135,859 to 208,212. Most of this increase will be seen in the elderly, as patients 75-84 years old will experience an increase from 37,941 to 69,914 and patients older than 85 years old will experience an increase from 31,200 to 67,181. The number of neurosurgeons is projected to increase from 4675 in 2020 to 6252 in 2040. CONCLUSIONS SDH is expected to increase significantly from 2020-2040, with the majority of this increase being concentrated in elderly patients. While the number of neurosurgeons will also increase, the ability of current neurosurgical resources to properly handle this expected increase in SDH will need to be addressed on a national scale.
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Affiliation(s)
- Sean N Neifert
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Emily K Chaman
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Trevor Hardigan
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Travis R Ladner
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Rui Feng
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - John M Caridi
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | | | - Eric Karl Oermann
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
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Venturini S, Fountain DM, Glancz LJ, Livermore LJ, Coulter IC, Bond S, Matta B, Santarius T, Hutchinson PJ, Brennan PM, Kolias AG. Time to surgery following chronic subdural hematoma: post hoc analysis of a prospective cohort study. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2019; 1:e000012. [PMID: 35047776 PMCID: PMC8749282 DOI: 10.1136/bmjsit-2019-000012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/26/2019] [Accepted: 10/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background Chronic subdural hematoma (CSDH) is a common neurological condition; surgical evacuation is the mainstay of treatment for symptomatic patients. No clear evidence exists regarding the impact of timing of surgery on outcomes. We investigated factors influencing time to surgery and its impact on outcomes of interest. Methods Patients with CSDH who underwent burr-hole craniostomy were included. This is a subset of data from a prospective observational study conducted in the UK. Logistic mixed modelling was performed to examine the factors influencing time to surgery. The impact of time to surgery on discharge modified Rankin Scale (mRS), complications, recurrence, length of stay and survival was investigated with multivariable logistic regression analysis. Results 656 patients were included. Time to surgery ranged from 0 to 44 days (median 1, IQR 1–3). Older age, more favorable mRS on admission, high preoperative Glasgow Coma Scale score, use of antiplatelet medications, comorbidities and bilateral hematomas were associated with increased time to surgery. Time to surgery showed a significant positive association with length of stay; it was not associated with outcome, complication rate, reoperation rate, or survival on multivariable analysis. There was a trend for patients with time to surgery of ≥7 days to have lower odds of favorable outcome at discharge (p=0.061). Conclusions This study provides evidence that time to surgery does not substantially impact on outcomes following CSDH. However, increasing time to surgery is associated with increasing length of stay. These results should not encourage delaying operations for patients when they are clinically indicated.
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Affiliation(s)
- Sara Venturini
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Daniel M Fountain
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Ian C Coulter
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Basil Matta
- Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Tomita Y, Yamada SM, Yamada S, Matsuno A. Subdural Tension on the Brain in Patients with Chronic Subdural Hematoma Is Related to Hemiparesis but Not to Headache or Recurrence. World Neurosurg 2018; 119:e518-e526. [PMID: 30075268 DOI: 10.1016/j.wneu.2018.07.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemiparesis is a major symptom of chronic subdural hematoma (CSDH). Its severity does not always correlate with hematoma size. The authors analyzed hematoma thickness, pressure, and tension to clarify the mechanism of hemiparesis in CSDH patients. METHODS A burr-hole surgery was performed on 124 CSDHs in 102 patients. Hematoma thickness and midline shift were measured by computed tomography, and hematoma pressure was measured in surgery. According to Laplace law, tension was calculated as follows: (half the hematoma thickness × hematoma pressure)/2. Student t test and Pearson correlation coefficient (r) were applied in statistical analysis of findings. RESULTS Motor weakness was identified in 76.5% of our cases. Tension was strongly related to hemiparesis (r = -0.747, P < 0.01), whereas hematoma thickness (r = -0.458, P < 0.01) and pressure (r = -0.596, P < 0.01) were moderately correlated. Mean age of 14 patients (13.7%) with headache was much younger than those without headache (P < 0.01). Stronger midline shift (P < 0.01) and greater ratio of midline shift to hematoma thickness (P < 0.01) were statistically correlated with headache. Recurrence was recognized in 8 patients (7.8%), and stronger midline shift (P < 0.05) and greater ratio of midline shift to hematoma thickness (P < 0.05) were statistically associated with recurrence. CONCLUSIONS Tension is the most influencing factor to hemiparesis in CSDH patients. This study also elucidates the mechanism for quick recovery from hemiparesis after surgery in that tension on the motor cortex is decreased immediately by drainage.
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Affiliation(s)
- Yusuke Tomita
- Department of Neurosurgery, Teikyo University Hospital Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, Japan
| | - Shoko Merrit Yamada
- Department of Neurosurgery, Teikyo University Hospital Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, Japan.
| | - Shokei Yamada
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Akira Matsuno
- Department of Neurosurgery, Teikyo University Medical School, Itabashi-ku, Tokyo, Japan
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