Abstract:Objective To investigate the influencing factors of postoperative recurrence of chronic subdural hematoma in the elderly patients.Methods The clinical data of 148 elderly patients with chronic subdural hematoma who underwent surgical treatment in the Department of Neurosurgery of Miyun Teaching Hospital of Capital Medical University from January 2015 to December 2020 were retrospectively analyzed,and the related risk factors were statistically analyzed by univariate factor analysis (χ2 test) and logistic regression analysis.Results Of the 148 elderly patients with chronic subhematoma,12 cases (8.11%) had recurrence.Univariate analysis showed that there were significant differences in postoperative widening of subarachnoid space ≥10 mm on one side of the surgical area and postoperative tension pneumocephalus (P<0.05).While the general factors of patients included age,gender,body mass index,hypertension,diabetes,hyperlipidemia and history of cerebral infarction,perioperative drug-related factors included preoperative antiplatelet therapy,anticoagulant therapy and postoperative statin administration,and surgery-related factors included age,operation time,postoperative drainage volume,postoperative drainage time,and the maximum thickness of preoperative hematoma were not significantly correlated with postoperative hematoma recurrence (P>0.05).Logistic regression analysis showed that postoperative widening of the submandibular space ≥10 mm on one side of the surgical area and postoperative tension pneumocephalus were closely related to postoperative hematoma recurrence,which were independent risk factors for postoperative hematoma recurrence (P<0.05).Conclusion Postoperative recurrence in elderly patients with chronic subdural hematoma is associated with postoperative widening of subarachnoid space ≥10 mm on one side of the surgical area and postoperative tension pneumocephalus,both of which are independent risk factors.
Santarius T,Hutchinson PJ.Chronic subdural haematoma:time to rationalize treatment?[J].Br J Neurosurg,2004,18(4):328-332.
[2]
Yang W,Huang J.Chronic subdural hematoma:epidemiology and natural history[J].Neurosurg Clin N Am,2017,28(2):205-210.
[3]
Kudo H,Kuwamura K,Izawa I,et al.Chronic subdural hematoma in elderly people:present status on Awaji Island and epidemiological prospect[J].Neurol Med Chir (Tokyo),1992,32(4):207-209.
Miah IP,Holl DC,Peul WC,et al.Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial):study protocol for a randomised controlled trial[J].Trials,2018,19(1):575.
[9]
Bartek J Jr,Sjavik K,Kristiansson H,et al.Predictors of recurrence and complications after chronic subdural hematoma surgery:a population-based study[J].World Neurosurg,2017,106:609-614.
[10]
Holl DC,Volovici V,Dirven CMF,et al.Corticosteroid treatment compared with surgery in chronic subdural hematoma:a systematic review and meta-analysis[J].Acta Neurochir (Wien),2019,161(6):1231-1242.
[11]
Qian Z,Yang D,Sun F,et al.Risk factors for recurrence of chronic subdural hematoma after burr hole surgery:potential protective role of dexamethasone[J].Br J Neurosurg,2017,31(1):84-88.
[12]
Ryu SM,Yeon JY,Kong DS,et al.Risk of recurrent chronic subdural hematoma associated with early warfarin resumption:a matched cohort study[J].World Neurosurg,2018,120:e855-e862.
[13]
Fornebo I,Sjavik K,Alibeck M,et al.Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chronic subdural hematoma evacuation:a population-based consecutive cohort study[J].Acta Neurochir (Wien),2017,159(11):2045-2052.
[15]
Wang Y,Wang C,Liu Y.Chronic subdural haematoma evolving from traumatic subdural hydroma[J].Brain Inj,2015,29(4):462-465.
Kravtchouk AD,Likhterman LB,Potapov AA,et al.Postoperative complications of chronic subdural hematomas:prevention and treatment[J].Neurosurg Clin N Am,2000,11(3):547-52.
[19]
You CG,Zheng XS.Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma[J].Clin Neurol Neurosurg,2018,166:56-60.