Predicting recurrence after chronic subdural haematoma drainage

Andrew Jack, Cian O'Kelly, Cameron M McDougall, J. Max Findlay

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Recurrence of chronic subdural haematomas (CSDHs) after surgical drainage is a significant problem with rates up to 20%. This study focuses on determining factors predictive of haematoma recurrence and presents a scoring system stratifying recurrence risk for individual patients. Methods : Between the years 2005 and 2009, 331 consecutive patients with CSDHs treated with surgery were included in this study. Univariate and multivariate analyses were performed searching for risk factors of increased post-operative haematoma volume and haematoma recurrence requiring repeat drainage. Results: We found a 12% reoperation rate. CSDH septation (seen on computed tomogram scan) was found to be an independent risk factor for recurrence requiring reoperation (p=0.04). Larger post-operative subdural haematoma volume was also significantly associated with requiring a second drainage procedure (p<0.001). Independent risk factors of larger post-operative haematoma volume included septations within a CSDH (p<0.01), increased pre-operative haematoma volume (p<0.01), and a greater amount of parenchymal atrophy (p=0.04). A simple scoring system for quantifying recurrence risk was created and validated based on patient age (< or ≥80 years), haematoma volume (< or ≥160cc), and presence of septations within the subdural collection (yes or no). Conclusion: Septations within CSDHs are associated with larger post-operative residual haematoma collections requiring repeat drainage. When septations are clearly visible within a CSDH, craniotomy might be more suitable as a primary procedure as it allows greater access to a septated subdural collection. Our proposed scoring system combining haematoma volume, age, and presence of septations might be useful in identifying patients at higher risk for recurrence.

Original languageEnglish (US)
Pages (from-to)34-39
Number of pages6
JournalCanadian Journal of Neurological Sciences
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Hematoma, Subdural, Chronic
Hematoma
Drainage
Recurrence
Reoperation
Subdural Hematoma
Craniotomy
Atrophy
Multivariate Analysis

Keywords

  • Chronic subdural hematoma
  • intracranial hemorrhage
  • multivariate analysis
  • recurrence
  • risk factor
  • scoring scale

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Predicting recurrence after chronic subdural haematoma drainage. / Jack, Andrew; O'Kelly, Cian; McDougall, Cameron M; Max Findlay, J.

In: Canadian Journal of Neurological Sciences, Vol. 42, No. 1, 01.01.2015, p. 34-39.

Research output: Contribution to journalArticle

Jack, Andrew ; O'Kelly, Cian ; McDougall, Cameron M ; Max Findlay, J. / Predicting recurrence after chronic subdural haematoma drainage. In: Canadian Journal of Neurological Sciences. 2015 ; Vol. 42, No. 1. pp. 34-39.
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