Risk factors for need of reoperation in bilateral chronic subdural haematomas
Zolfaghari, Shaian LU
; Bartek, Jiri
LU
; Djärf, Felix
; Wong, San-San
; Strom, Isabelle
; Ståhl, Nils
LU
; Jakola, Asgeir S.
and Nittby, Henrietta
LU
(2021)
In Acta Neurochirurgica
163(7).
p.1849-1856
- Abstract
Background: Chronic subdural haematoma (CSDH) is one of the most common neurosurgical diseases. A subtype of CSDH is bilateral chronic subdural haematoma (bCSDH) which represents 20-25% of patients with CSDH and has a higher recurrence rate. There is no clear consensus on how bCSDH should be treated regarding upfront unilateral- or bilateral evacuation of both haematomas. The purpose of this study was to identify risk factors associated with reoperation of bCSDH.
Methods: A total of 326 patients with radiological evidence of bCSDH were included in this retrospective cohort study where 133 (40.8%) patients underwent primary bilateral evacuation and 193 (59.2%) primary unilateral evacuation. The two centres operated using... (More)
Background: Chronic subdural haematoma (CSDH) is one of the most common neurosurgical diseases. A subtype of CSDH is bilateral chronic subdural haematoma (bCSDH) which represents 20-25% of patients with CSDH and has a higher recurrence rate. There is no clear consensus on how bCSDH should be treated regarding upfront unilateral- or bilateral evacuation of both haematomas. The purpose of this study was to identify risk factors associated with reoperation of bCSDH.
Methods: A total of 326 patients with radiological evidence of bCSDH were included in this retrospective cohort study where 133 (40.8%) patients underwent primary bilateral evacuation and 193 (59.2%) primary unilateral evacuation. The two centres operated using different surgical approaches. Analyses were performed to identify risk factors associated with reoperation of bCSDH. Reoperation rate was defined as reoperation of CSDH on either side of the hemisphere within 3 months after primary evacuation.
Results: The cohort had a total reoperation rate of 26.4%. Patients which underwent unilateral evacuation had a reoperation rate of 32.1%, and the bilateral group had a reoperation rate of 18.0% (p=0.005). Multivariable logistic regression identified unilateral evacuation (OR 1.91, p=0.022) and complications according to Ibanez (OR 2.20, p=0.032) to be associated with the need of reoperation of bCSDH. One-burr hole craniostomy with active subgaleal drain was primarily performed in bilateral approach (69.4%) whereas patients operated with minicraniotomy with passive subdural drain were primarily operated by unilateral evacuation of the larger symptomatic side (92.8%).
Conclusions: Unilateral evacuation of bCSDH was associated with a higher risk for reoperation than upfront bilateral evacuations in this study. There is a need to further discuss the criteria for uni- or bilateral evacuation since patients are treated differently at different centres. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/e4cb628b-57a0-4bdd-b44e-03b9457c2934
- author
- Zolfaghari, Shaian
LU
; Bartek, Jiri
LU
; Djärf, Felix
; Wong, San-San
; Strom, Isabelle
; Ståhl, Nils
LU
; Jakola, Asgeir S.
and Nittby, Henrietta
LU
- organization
- publishing date
- 2021-07-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Neurochirurgica
- volume
- 163
- issue
- 7
- pages
- 8 pages
- publisher
- Springer
- external identifiers
-
- scopus:85103411905
- pmid:33796888
- ISSN
- 0001-6268
- DOI
- 10.1007/s00701-021-04811-5
- language
- English
- LU publication?
- yes
- id
- e4cb628b-57a0-4bdd-b44e-03b9457c2934
- date added to LUP
- 2021-04-02 10:11:05
- date last changed
- 2024-02-20 01:57:47
@article{e4cb628b-57a0-4bdd-b44e-03b9457c2934,
abstract = {{<br/><br/>Background: Chronic subdural haematoma (CSDH) is one of the most common neurosurgical diseases. A subtype of CSDH is bilateral chronic subdural haematoma (bCSDH) which represents 20-25% of patients with CSDH and has a higher recurrence rate. There is no clear consensus on how bCSDH should be treated regarding upfront unilateral- or bilateral evacuation of both haematomas. The purpose of this study was to identify risk factors associated with reoperation of bCSDH.<br/><br/>Methods: A total of 326 patients with radiological evidence of bCSDH were included in this retrospective cohort study where 133 (40.8%) patients underwent primary bilateral evacuation and 193 (59.2%) primary unilateral evacuation. The two centres operated using different surgical approaches. Analyses were performed to identify risk factors associated with reoperation of bCSDH. Reoperation rate was defined as reoperation of CSDH on either side of the hemisphere within 3 months after primary evacuation.<br/><br/>Results: The cohort had a total reoperation rate of 26.4%. Patients which underwent unilateral evacuation had a reoperation rate of 32.1%, and the bilateral group had a reoperation rate of 18.0% (p=0.005). Multivariable logistic regression identified unilateral evacuation (OR 1.91, p=0.022) and complications according to Ibanez (OR 2.20, p=0.032) to be associated with the need of reoperation of bCSDH. One-burr hole craniostomy with active subgaleal drain was primarily performed in bilateral approach (69.4%) whereas patients operated with minicraniotomy with passive subdural drain were primarily operated by unilateral evacuation of the larger symptomatic side (92.8%).<br/><br/>Conclusions: Unilateral evacuation of bCSDH was associated with a higher risk for reoperation than upfront bilateral evacuations in this study. There is a need to further discuss the criteria for uni- or bilateral evacuation since patients are treated differently at different centres.}},
author = {{Zolfaghari, Shaian and Bartek, Jiri and Djärf, Felix and Wong, San-San and Strom, Isabelle and Ståhl, Nils and Jakola, Asgeir S. and Nittby, Henrietta}},
issn = {{0001-6268}},
language = {{eng}},
month = {{07}},
number = {{7}},
pages = {{1849--1856}},
publisher = {{Springer}},
series = {{Acta Neurochirurgica}},
title = {{Risk factors for need of reoperation in bilateral chronic subdural haematomas}},
url = {{http://dx.doi.org/10.1007/s00701-021-04811-5}},
doi = {{10.1007/s00701-021-04811-5}},
volume = {{163}},
year = {{2021}},
}