Original ArticleGrowth Potential of Subdural Hematomas Under Clinical Observation: Which Subdural Hematomas Tend to Grow and Why They Do
Introduction
Subdural hematomas (SDHs) are among the most common intracranial hemorrhages. Symptomatic or enlarged SDHs are treated surgically. Trauma plays the most common role in the etiology of acute SDHs, whereas in other forms, anticoagulant and antiaggregant drug use, cerebral atrophy, and advanced age are the most frequently identified etiologic factors.1, 2, 3, 4, 5 These etiologic factors are also the factors that play a role in SDH recurrence in patients undergoing surgical intervention.1, 2, 3 It is argued that the surgical techniques applied also play a role in recurrence. Along with the modified surgical techniques, it is still under debate which technique is more efficient and leads to fewer complications.6, 7
Clinical and radiologic processes in SDHs other than ASDHs are generally followed up by a similar approach because they show a more prolonged course than ASDH. Moreover, similar surgical techniques are applied to the treatment of these patients. Although the symptoms and neurologic findings of the patients are similar, there is no consensus on how and how often the patients will be checked on clinically and radiologically during follow-up. It may not be possible to foresee which patients will show what kind of prognosis in what amount of time. Although numerous studies have described the risk factors for recurrence and the surgical treatment of these patients, there are not many studies on the follow-up period and the prognosis prediction for patients not operated on other than ASDH patients.
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Materials and Methods
The records of the patients who were being followed up after they had received diagnoses of SDH were retrospectively reviewed. The computed tomographic and magnetic resonance imaging examinations of all patients were obtained by scanning the picture archiving communication systems, and their radiologic findings were recorded. According to their radiologic findings, they were classified as having acute SDH (ASDH), subacute SDH (SSDH), chronic SDH (CSDH), acute component with chronic SDH
Results
Of a total of 291 patients with diagnoses of SDH, 80, 163, 29, and 35 patients had diagnoses of ASDH, CSDH, SSDH, and double component SDH, respectively. Surgical intervention was performed in 82 patients under follow-up because of SDH. Sixteen patients underwent repeated operated because of recurrence.
Surgically, all patients were operated on by applying the methods of a craniotomy or 2 twisted burr-hole drainage. Surgical techniques and their results were not discussed. The growth potential
Discussion
The risk factors for SDHs with the tendency to grow were described as a result of the assessment of 291 different patients who were being followed up and did not undergo surgical intervention during diagnosis. It was brought into view that the most prominent differences in patients other than those with ASDH depended on age and anticoagulant/antiaggregant drug use.
In the literature, fibrinolytic activity has also been defined as a risk factor for CSDH patients who were being followed up and
Conclusion
In the follow-up of SDHs other than ASDHs, bicomponent hematomas tend to grow at higher rates. Age and associated cerebral atrophy, the use of antiaggregant/anticoagulants, large hematoma width, and the presence of septation in the hematoma were defined as the etiologic factors for an increase in hematoma volume. The presence of 1 or more of these risk factors may change the risk coefficient depending on the patient. The simultaneous presence of several identified risk factors should suggest
References (14)
- et al.
Risk factor analysis for the recurrence of chronic subdural hematoma: a review of 368 consecutive surgical cases
Korean J Neurotrauma
(2015) - et al.
Dexamethasone treatment in chronic subdural haematoma
Neurocirugia (Astur)
(2009) - et al.
Nonsurgical treatment of chronic subdural hematoma with steroids
World Neurosurg
(2015) - et al.
Independent predictors for recurrence of chronic subdural hematoma
Acta Neurochir (Wien)
(2012) - et al.
Comparison of the outcomes and recurrence with three surgical techniques for chronic subdural hematoma: single, double burr hole, and double burr hole drainage with irrigation
Korean J Neurotrauma
(2015) - et al.
Clinical analysis of risk factors related to recurrent chronic subdural hematoma
J Korean Neurosurg Soc
(2008) - et al.
Chronic subdural hematoma-craniotomy versus burr hole trepanation
Br J Neurosurg
(2009)
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Factors that negatively influence the Glasgow Outcome Scale in patients with chronic subdural hematomas. An analytical and retrospective study in a tertiary center
2020, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :At the moment of the diagnosis, we found that 28.5% and 26.3% of the patients were taking antiplatelet and anticoagulant drugs respectively, 45.2% of the patients were not taking any of these drugs. We reviewed each case with a neuroradiologist to identify 3 types of hematoma, which according to their radiological characteristics, we classified them into CSH that represents 17.1% of the subjects, SCSH with 50.5% and CWAB with 34.4% of the sample [14,15]. In our series, 24.9% of the patients presented hematoma septation.
Success of conservative therapy for chronic subdural hematoma patients: a systematic review
2023, Frontiers in Neurology
Conflict of interest statement: The author declares (or authors declare) that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (see p. 19 for variations)