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Keywords = chronic subdural hematoma

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7 pages, 4665 KiB  
Case Report
Endless-Loop Craniotomy for Revision Surgery After the Burr-Hole Evacuation of Chronic Subdural Hematoma—A Technical Note
by Artem Rafaelian, Sae-Yeon Won, Thomas M. Freiman, Florian Gessler and Daniel Dubinski
Surg. Tech. Dev. 2025, 14(3), 19; https://doi.org/10.3390/std14030019 - 21 Jun 2025
Viewed by 218
Abstract
Background and Importance: Chronic subdural hematoma (cSDH) is a common and complex neurosurgical problem, particularly in elderly patients. Revision surgery for chronic subdural hematoma can be challenging, particularly in cases with inhomogeneous, firm consistency and extensive adhesions. Clinical Presentation: In this article, we [...] Read more.
Background and Importance: Chronic subdural hematoma (cSDH) is a common and complex neurosurgical problem, particularly in elderly patients. Revision surgery for chronic subdural hematoma can be challenging, particularly in cases with inhomogeneous, firm consistency and extensive adhesions. Clinical Presentation: In this article, we present our endless-loop craniotomy technique, which offers a novel approach to address these challenges by performing the wide, curved exposure of the subdural space utilizing the already-present burr hole. This technique allows for a wide, unobstructed view of the subdural space, enabling the access and evacuation of this chronic and often adhesive subdural hematoma. Conclusion: We believe that endless-loop craniotomy is a valuable addition to the neurosurgeon’s armamentarium for managing complex cases of revision surgery in chronic subdural hematomas. Full article
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10 pages, 416 KiB  
Article
Imaging and Clinical Outcomes Six Months After Middle Meningeal Artery Embolization with Squid for Chronic Subdural Hematoma: A Prospective Study
by Ángela H. Schmolling, Carlos Pérez-García, Isabel Bérmudez, Alfonso López-Frías, Eduardo Fandiño, Carmen Trejo, Santiago Rosati, Daniel Padrón, Lara Guardado, José Carlos Méndez, Juan Arrazola and Manuel Moreu
Diagnostics 2025, 15(11), 1424; https://doi.org/10.3390/diagnostics15111424 - 3 Jun 2025
Viewed by 634
Abstract
Background: Chronic subdural hematoma (CSDH) is a common condition in older adults with rising rates of incidence. While burr hole drainage remains the standard treatment, it is associated with significant recurrence and complications. This study assesses MMA embolization with Squid, both as a [...] Read more.
Background: Chronic subdural hematoma (CSDH) is a common condition in older adults with rising rates of incidence. While burr hole drainage remains the standard treatment, it is associated with significant recurrence and complications. This study assesses MMA embolization with Squid, both as a standalone procedure and as an adjunct to surgery. Methods: Our prospective registry included 101 patients with 134 CSDH cases treated at two tertiary care centers from December 2020 to January 2024. Patients were divided into two groups: embolization alone and embolization combined with surgery. Demographic, clinical, radiological, and procedural data were collected. Follow-up imaging was conducted at 1, 3, and 6 months. Treatment failure was defined as rescue surgery, hematoma thickness ≥ 10 mm, midline shift > 3 mm at 6 months, or procedure-related death. Results: Fifty-two patients (51.5%) underwent combined treatment, and forty-nine (48.5%) received embolization alone. Most were men (68.3%) and the median age was 82 years. Combined-treatment patients had larger hematomas and more symptoms. Procedures were performed under general anesthesia in 72.3% of patients, with radial and femoral access used equally frequently, and 32.7% underwent bilateral embolization. Patients’ hematoma thickness in follow-up imaging showed a significant decrease (p = 0.000), reaching a median of 0 mm at six months, with no significant difference between groups. Complications occurred in 5.9%, and treatment failure in 4%. Mortality was higher in the embolization-only group, likely reflecting greater rates of comorbidities. Conclusions: This study supports the use of MMA embolization with Squid as a safe and effective treatment for CSDH. Comparable procedural and radiological outcomes in both groups suggest embolization alone may suffice in select patients, offering a less invasive alternative. Full article
(This article belongs to the Special Issue Chronic Subdural Hematoma: Diagnosis and Management, 2nd Edition)
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11 pages, 1430 KiB  
Article
Impact of Frailty on Surgical Outcomes in Nonacute Subdural Hematomas: A Nationwide Analysis of 251,597 Patients over 20 Years
by Avi A. Gajjar, Nathan Ramachandran, Tarun Prabhala, John Y. Chen, Amanda Custozzo and Alexandra R. Paul
J. Clin. Med. 2025, 14(9), 3176; https://doi.org/10.3390/jcm14093176 - 4 May 2025
Cited by 1 | Viewed by 497
Abstract
Background/Objectives: Nonacute subdural hematomas (naSDHs) are a prevalent intracranial pathology, particularly in older people, due to increased brain atrophy, fall risk, and anticoagulant use. This study examines the impact of frailty on the surgical outcomes of craniotomy for naSDH over 20 years. [...] Read more.
Background/Objectives: Nonacute subdural hematomas (naSDHs) are a prevalent intracranial pathology, particularly in older people, due to increased brain atrophy, fall risk, and anticoagulant use. This study examines the impact of frailty on the surgical outcomes of craniotomy for naSDH over 20 years. Methods: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2021 were analyzed, including 251,597 patients who underwent cranial decompression for naSDH. Patients were selected using specific ICD codes. Frailty was calculated using the modified frailty index (mFI-5 and mFI-11) and the Charlson Comorbidity Index (CCI). Outcomes were compared using descriptive statistics and multivariable regression models. Results: 251,597 patients underwent craniotomy, with a mean age of 69.2 years. The cohort exhibited significant comorbid conditions, reflected in a mean Charlson Comorbidity Index (CCI) of 3.8, and a high frailty prevalence, with 23.49% of patients classified as frail and 20.14% as severely frail. The CCI demonstrated the highest predictive value for adverse outcomes, with an area under the curve (AUC) of 0.6346 for mortality and 0.6804 for complications. Frailty indices (mFI-5 and mFI-11) were also strongly associated with increased mortality (p < 0.001), complications (p < 0.001), and extended length of stay (p < 0.001). Age was not a significant predictor of outcomes. Conclusions: This study highlights the moderate impact of frailty on surgical outcomes for naSDH. Full article
(This article belongs to the Section Brain Injury)
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15 pages, 2781 KiB  
Systematic Review
Embolization of Middle Meningeal Artery in Patients with Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis of Randomized-Controlled Clinical Trials
by Nikolaos M. Papageorgiou, Lina Palaiodimou, Konstantinos Melanis, Aikaterini Theodorou, Maria-Ioanna Stefanou, Panagiota-Eleni Tsalouchidou, Pinelopi Vlotinou, Lampis C. Stavrinou, Efstathios Boviatsis, Georgios Magoufis, Marios Themistocleous, Amrou Sarraj, Vijay K. Sharma, Nitin Goyal and Georgios Tsivgoulis
J. Clin. Med. 2025, 14(9), 2862; https://doi.org/10.3390/jcm14092862 - 22 Apr 2025
Viewed by 1528
Abstract
Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly among elderly patients. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive adjunctive treatment aimed at reducing recurrence. However, its comparative efficacy and safety remain under investigation. Methods: In this [...] Read more.
Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly among elderly patients. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive adjunctive treatment aimed at reducing recurrence. However, its comparative efficacy and safety remain under investigation. Methods: In this systematic review and meta-analysis, randomized-controlled clinical trial (RCT) data evaluating MMA embolization combined with best medical therapy (BMT) versus BMT alone in adult patients with symptomatic cSDH were pooled. The primary efficacy outcome was recurrence or progression of hematoma at follow-up. Secondary efficacy outcomes included good functional outcome [modified Rankin Scale (mRS) score ≤ 2], independent ambulation (mRS score ≤ 3), and hematoma thickness at follow-up. The primary safety outcome was all-cause mortality. Procedure-related complications were assessed as a secondary safety outcome. Results: Six RCTs were included, comprising 760 patients treated with MMA embolization and 788 patients treated with BMT alone. MMA embolization significantly reduced recurrence compared to BMT alone (RR: 0.50; 95% CI: 0.37–0.69; six studies; I2 = 0%; number-needed-to-treat = 13). No significant differences were observed in good functional outcome (RR: 1.01; 95% CI: 0.97–1.05; three studies; I2 = 0%), independent ambulation (RR: 1.01; 95% CI: 0.99–1.04; three studies; I2 = 0%), or hematoma thickness at follow-up (SMD: −0.1; 95% CI: −0.3 to 0; four studies; I2 = 42%). All-cause mortality was similar between the two groups (RR: 1.01; 95% CI: 0.42–2.40; five studies; I2 = 44%). The pooled rate of procedure-related adverse events in the MMA embolization-group was 1% (95% CI: 0–3%; two studies; I2 = 35%). Conclusions: MMA embolization significantly reduced cSDH recurrence when used as an adjunct to BMT. However, it did not demonstrate a significant impact on functional outcomes or mortality in this meta-analysis. Further research is needed to identify patient subgroups that benefit most from MMA embolization and to evaluate its impact on cognitive function and quality of life using longer follow-up periods. Full article
(This article belongs to the Section Clinical Neurology)
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10 pages, 207 KiB  
Article
Risk Factors for Recurrence in Patients Surgically Treated for Chronic Subdural Hematomas: A Single Institutional Experience
by Marios Lampros, Ilektra-Theodora Katsiou, Georgios Kafritsas, Dimitrios Metaxas, Panagiota Zagorianakou, Andreas Zigouris, Dionysoula Skiada, Euaggelos Michos, Dimitrios Pachatouridis, George A. Alexiou and Spyridon Voulgaris
Surgeries 2025, 6(1), 19; https://doi.org/10.3390/surgeries6010019 - 28 Feb 2025
Cited by 1 | Viewed by 829
Abstract
Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that usually occurs in the elderly. Surgical evacuation of the hematoma with burr holes is considered the standard of care for the treatment of patients with CSDH. However, a high risk of recurrence, [...] Read more.
Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that usually occurs in the elderly. Surgical evacuation of the hematoma with burr holes is considered the standard of care for the treatment of patients with CSDH. However, a high risk of recurrence, up to 34%, after hematoma evacuation has been reported, while the risk factors linked with recurrence have not been studied in depth. In the present study, we set out to identify risk factors of recurrence in patients surgically treated for CSDH. Methods: We retrospectively studied patients with symptomatic CSDH who were treated surgically in our institute during a five-year period. All the patients were treated by single or double burr hole drainage. The data for this study were extracted by the pre-operative and post-operative CT scan of each patient. These data include the sex, the midline shift, the width, and the presence of acute clots and subdural air collection post-operatively. A univariate analysis was performed. A receiver operating characteristic (ROC) analysis was utilized to detect the hematoma’s width more efficiently, differentiating patients that developed recurrence. Results: A total of 222 patients were included in this study. Recurrence occurred in 20 (9.0%) patients. The univariate analysis showed that the presence of acute clots post-operatively are significant factors related with recurrence (OR = 4.01, CI 95% 1.55–10.33, and p = 0.002). There was no significant relationship between the recurrence rate and the hematoma’s width, sex, the midline shifts pre-operatively or post-operatively, the subdural space, and air collection post-operatively. Conclusions: The presence of acute clots in the post-operative CT scan is a potential, previously unexplored, risk factor associated with the recurrence of CSDH. Full article
10 pages, 5058 KiB  
Case Report
Spontaneous Intracranial Hypotension and Dural Ectasia in Marfan Syndrome: An Illustrative Case Successfully Treated with Steroid Therapy and Literature Review
by Francesco Signorelli, Omar Ktari, Ludovico Agostini, Giorgio Ducoli, Fabio Zeoli and Massimiliano Visocchi
Brain Sci. 2024, 14(11), 1143; https://doi.org/10.3390/brainsci14111143 - 15 Nov 2024
Viewed by 2181
Abstract
Background: Spontaneous intracranial hypotension (SIH) is a rare and frequently misdiagnosed disorder characterized by a low volume of cerebrospinal fluid (CSF) caused by the leakage of CSF through the spinal dural membrane. Patients with Marfan Syndrome (MS) and other connective tissue disorders are [...] Read more.
Background: Spontaneous intracranial hypotension (SIH) is a rare and frequently misdiagnosed disorder characterized by a low volume of cerebrospinal fluid (CSF) caused by the leakage of CSF through the spinal dural membrane. Patients with Marfan Syndrome (MS) and other connective tissue disorders are at an increased risk for dural ectasia, which may predispose them to spontaneous CSF leaks due to the structural weakness of their dural membranes. The management of SIH in MS patients is debated. Conservative measures, an epidural blood patch (EBP), and surgical treatments are the options generally provided. Methods: Herein, we report on the case of a 52-year-old female affected by MS, genetically confirmed, with a two-month history of sudden-onset, “thunderclap” headache, worsened in an upright position and horizontal diplopia. A Computed Tomography (CT) scan of the brain showed a bilateral chronic subdural hematoma, slit ventricles, and a caudal descent of the brainstem without overt tonsillar herniation. The Magnetic Resonance Imaging (MRI) scan of the whole spine revealed dural ectasia in the lumbosacral area and presacral perineural cyst without extradural CSF collection. The case was successfully managed with bed rest and high-dose corticosteroid therapy. Then, we discuss the pertinent literature, consisting of 25 papers dealing with the treatment of SIH in patients affected by MS. Results: The literature review yielded 25 papers dealing with SIH management in patients with MS, including 28 patients overall; 21 patients underwent EBP, of whom 7 patients had multiple procedures. Overall, in 23 cases (82%), the symptoms improved. In three cases, the patients were managed conservatively with bed rest. In three of these cases, there was an improvement. In one case, the surgical fenestration of two lumbar intradural spinal meningeal cysts was performed and the patient improved after the procedure. Our patient underwent 15 days of steroid therapy (dexamethasone iv 12 mg/day for 7 days, then reduced to 4 mg/day) and intravenous hydration (Ringer lactate 1500 mL/day). In ten days, the symptoms disappeared. At the 6-month follow-up, the patient was in good clinical condition, and a CT scan showed an almost complete regression of the bilateral subdural hematoma. Conclusions: The management of SIH in MS patients is still challenging. Patients with connective tissue disorders such as MS are at an increased risk for SIH. Few studies have assessed the management of these patients and different strategies. Our case and the available literature provide further data for this type of case. Full article
(This article belongs to the Special Issue New Trends and Technologies in Modern Neurosurgery)
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10 pages, 249 KiB  
Article
Chronic Subdural Hematomas—A Retrospective Analysis of the Internal Architecture and Evaluation of Risk Factors for Recurrences After Surgical Therapy
by Nadja Grübel, Christine Klemptner, Benjamin Mayer, Frank Runck, Gregor Durner, Christian Rainer Wirtz and Andrej Pala
Diagnostics 2024, 14(22), 2494; https://doi.org/10.3390/diagnostics14222494 - 7 Nov 2024
Cited by 1 | Viewed by 1528
Abstract
Background: Chronic subdural hematoma (CSDH) is increasingly common due to the aging population and widespread use of anticoagulant and antiplatelet medications. The objective of this study is to examine the internal composition of CSDH and explore potential risk factors associated with its recurrence. [...] Read more.
Background: Chronic subdural hematoma (CSDH) is increasingly common due to the aging population and widespread use of anticoagulant and antiplatelet medications. The objective of this study is to examine the internal composition of CSDH and explore potential risk factors associated with its recurrence. Methods: This retrospective study analyzed data from 189 patients who underwent surgery in our department between 2014 and 2018. Recorded data included demographics, clinical information, details of surgical interventions, computer tomography (CT) scans, neurological assessments, and follow-up data. The outcome was evaluated clinically and through CT follow-up conducted 4–12 weeks post-surgery. CT scans measured various parameters, including hematoma thickness, hyperdense regions, chronic components, and membrane presence. Results: Patients after the evacuation of CSDH were significantly more common males (66.1%, p > 0.001) had a significantly higher BMI (p < 0.001, 61.6%), arterial hypertension (p < 0.001, 68.3%), and the intake of anticoagulant therapy (p < 0.001, 58%). The recurrence rate was 18.6% after 4 weeks and 2.1% after 8–12 weeks. After uni- and multivariable analysis, the initial hemispheric type (p = 0.019, HR: 3.191; p = 0.012, HR: 3.810) and the increasing preoperative midline shift in CT (p = 0.028, HR: 1.114; p = 0.041, HR: 1.107) were found as independent predictors for recurrence. Overall, outcomes were favorable with a modified Rankin scale (mRS) of 0–2 at discharge (72%), after 4 (89.7%) and 12 (87%) weeks. Conclusion: According to our data, increasing midline shift before surgery and initial hemispheric type of hematoma were independent predictors of recurrence. Most patients achieved an excellent outcome with a low-risk profile. Full article
(This article belongs to the Special Issue Chronic Subdural Hematoma)
9 pages, 1624 KiB  
Article
Radiological Outcome of Middle Meningeal Artery Embolization in Relation to Chronic Subdural Hematoma Cause and Architecture
by Ahmed Abdelghafar, Andrew Falzon, Eef J. Hendriks, Ivan Radovanovic, Hugo Andrade, Joanna D. Schaafsma and Pascal J. Mosimann
Brain Sci. 2024, 14(11), 1097; https://doi.org/10.3390/brainsci14111097 - 30 Oct 2024
Cited by 2 | Viewed by 1409
Abstract
Background/Objectives: MMAE (middle meningeal artery embolization) has emerged as a potential effective treatment for cSDH (chronic subdural hematoma). In this study, MMAE efficiency with regards to cSDH cause and architecture was explored. The comparability of cSDH thickness and volume as parameters for [...] Read more.
Background/Objectives: MMAE (middle meningeal artery embolization) has emerged as a potential effective treatment for cSDH (chronic subdural hematoma). In this study, MMAE efficiency with regards to cSDH cause and architecture was explored. The comparability of cSDH thickness and volume as parameters for cSDH pre- and post-MMAE assessment was also analyzed. Methods: In this retrospective cohort study, 52 consecutive cSDH patients treated with MMAE in a single tertiary center were included. The cohort was divided into two group pairs pertaining to cSDH cause (spontaneous or traumatic) and cSDH architecture (non-mature or mature). The radiological outcome was compared in each group before and after MMAE and between each group pair using CT imaging. A correlation analysis between cSDH thickness and volume before and after MMAE was also performed. Results: A statistically significant positive linear association between cSDH thickness and volume at admission and at each follow-up interval (1–3, 3–6, 6–12 months) was noticed. cSDH thickness and volume reduction in each group was statistically significant, except for a traumatic cSDH volume reduction at 6–12 months. There was no statistically significant difference between each group pair in the cSDH thickness and volume reduction difference at all the follow-up intervals. Conclusions: A comparable efficiency of MMAE may be achieved in non-mature and mature as well as in spontaneous and traumatic cSDH, with an advantage for spontaneous cSDH at 6–12 months follow-up compared to traumatic cSDH. Traumatic cSDH may require a relatively long-term follow-up post-MMAE. cSDH thickness and volume, as parameters for pre- and post-MMAE cSDH evaluation, appear similar. Full article
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20 pages, 6360 KiB  
Article
Penetration of Non-Adhesive Gel-like Embolic Materials During Dural Vessels Embolization According to Characteristics of Tantalum Powder
by Andrey Petrov, Arkady Ivanov, Sergei Ermakov, Egor Kolomin, Anna Petrova, Oleg Belokon, Konstantin Samochernykh and Larisa Rozhchenko
J. Funct. Biomater. 2024, 15(11), 319; https://doi.org/10.3390/jfb15110319 - 27 Oct 2024
Cited by 1 | Viewed by 1861
Abstract
Tantalum powder is included in the composition of Non-Adhesive Gel-like Embolic Materials (NAGLEMs) for X-ray opacity. The duration of X-ray opacity during embolization is primarily associated with the particle size, which differs in the most used NAGLEMs—ONYX (Medtronic) and SQUID (Balt). NAGLEMs are [...] Read more.
Tantalum powder is included in the composition of Non-Adhesive Gel-like Embolic Materials (NAGLEMs) for X-ray opacity. The duration of X-ray opacity during embolization is primarily associated with the particle size, which differs in the most used NAGLEMs—ONYX (Medtronic) and SQUID (Balt). NAGLEMs are widely used for the embolization of branches of the middle meningeal artery (MMA) in patients with chronic subdural hematomas (CSDHs). Considering the size (5–15 microns) of the target dural vessels, we assumed that not only the viscosity of NAGLEMs, but also the size and shape of tantalum granules may be important for the penetration of these gel-like embolic agents and determine their behavior. A notable discrepancy in size was observed. The medium-sized granules in the SQUID 18 sample (0.443 ± 0.086 microns, M ± SD) were found to be approximately ten times smaller than the tantalum granules in the ONYX 18 sample (5.2 ± 0.33 microns, M ± SD).Tantalum granules in SQUID 18 have a regular spherical shape; in ONYX 18 they have an irregular angular shape. When comparing the behavior of gel-like embolic agents of the same viscosity during MMA embolization in patients with CSDHs (an average age of 62.2 ± 14.3 years) in the group where SQUID 18 (n = 8) was used, the gel-like embolic agent in dural vessels demonstrated significantly greater penetration ability compared with the group where ONYX 18 (n = 8) was used. Accordingly, not only the viscosity of NAGLEMs, but also the size and shape of tantalum granules can have a significant effect on the penetration ability of gel compositions. Full article
(This article belongs to the Section Biomaterials and Devices for Healthcare Applications)
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10 pages, 1011 KiB  
Article
An Analysis of Emergency Surgical Outcomes for Pediatric Traumatic Brain Injury: A Ten-Year Single-Institute Retrospective Study in Taiwan
by Cheng-Yu Tsai, Keng-Liang Kuo, Chieh-Hsin Wu, Tai-Hsin Tsai, Hui-Yuan Su, Chih-Lung Lin, Ann-Shung Lieu, Aij-Lie Kwan, Yu-Feng Su and Joon-Khim Loh
Medicina 2024, 60(9), 1518; https://doi.org/10.3390/medicina60091518 - 18 Sep 2024
Viewed by 1784
Abstract
Background and Objectives: Pediatric traumatic brain injury (pTBI) remains a major pediatric public health problem, despite well-developed injury prevention programs. The purpose of this study is to analyze the emergency surgical outcomes of pTBI in a single institute ten-year retrospective study to [...] Read more.
Background and Objectives: Pediatric traumatic brain injury (pTBI) remains a major pediatric public health problem, despite well-developed injury prevention programs. The purpose of this study is to analyze the emergency surgical outcomes of pTBI in a single institute ten-year retrospective study to offer a real-world clinical result. Materials and Methods: Our institute presented a clinical retrospective, single-institute research study of 150 pediatric TBI cases that were diagnosed and underwent emergency surgical treatment from 2010 to 2019. Results: The incidence of radiological findings is detailed as follows: brain edema (30%, 45/150), followed by acute subdural hematoma (27.3%, 41/150), epidural hematoma (21.3%, 32/150), chronic subdural hemorrhage (10%, 15/150), skull fracture (6.7%, 10/150), and traumatic subarachnoid hemorrhage (4.7%, 7/150). Surgical intervention data revealed that decompressive craniectomy was still the main effective surgical method. The results showed longer hospital stays and higher morbidity rates in the brain edema, acute subdural hematoma, and chronic subdural hemorrhage groups, which were viewed as poor surgical outcome groups. Epidural hematoma, skull fracture and traumatic subarachnoid hemorrhage were categorized into good surgical outcome groups. Notably, the data revealed gross improvement in Glasgow Coma Scale/Score (GCS) evolution after surgical interventions, and the time to cranioplasty was a significant factor in the development of post-traumatic hydrocephalus (PTH). Conclusions: Our study provided real-world data for the distribution of etiology in pTBI and also categorized it into six groups, indicating disease-orientated treatment. In addition, our data supported that decompressive craniectomy (DC) remains a mainstay surgical treatment in pTBI and early cranioplasty could decrease the incidence of PTH. Full article
(This article belongs to the Special Issue Traumatic Brain Injury and Neurointensive Care in Intensive Care)
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11 pages, 1528 KiB  
Article
Social Determinants of Health and Long-Term Mortality of Patients with Chronic Subdural Hematoma: Is There an Association?
by Sanja Lepić, Aleksa Mićić, Milan Lepić, Lukas Rasulić and Stefan Mandić-Rajčević
Healthcare 2024, 12(16), 1627; https://doi.org/10.3390/healthcare12161627 - 15 Aug 2024
Viewed by 1270
Abstract
(1) Background: A chronic subdural hematoma (CSDH) is considered an acute life-threatening event that is easily treated surgically, but little is known about the longer-term mortality of these patients. The objective of this study was to evaluate the association of social determinants of [...] Read more.
(1) Background: A chronic subdural hematoma (CSDH) is considered an acute life-threatening event that is easily treated surgically, but little is known about the longer-term mortality of these patients. The objective of this study was to evaluate the association of social determinants of health (SDoH) and the long-term mortality of patients with a chronic subdural hematoma. (2) Methods: This retrospective cohort study included 121 (88 male and 33 female) patients with a surgically treated unilateral or bilateral CSDH. Mortality was evaluated at 1, 2, 6, and 12 months after treatment. (3) Results: Most of the patients were >65 and retired, N = 96 (79.3%); of them, the majority presented with a neurological deficit, N = 71 (73.9%). Patients who lived alone more often had a neurological deficit, N = 57 (75.0%), compared to those who lived in communities, N = 25 (55.5%). Mortality at 1, 2, 6, and 12 months after surgery was 10.7%, 17.4%, 19.0%, and 45.5%, respectively, and there was a significant difference in the median age between the survival and deceased groups at 1 month (p < 0.01), 2 months (p < 0.01), and 6 months (p < 0.01) of follow-up, but not in the long-term (12 months) follow-up (p = 0.200). Patients who lived alone had 3.7 times higher odds of dying at the 12-month follow-up (p < 0.01), compared to those who lived in the community. (4) Conclusions: Living alone is related to an increased case fatality risk after CSDH surgery in the Serbian context. Social determinants of health can be associated with CSDH presentation and survival, indicating that further studies should include SDoH to obtain a deeper understanding of the occurrence, presentation, and outcomes of SDoH and propose additional preventive measures. Full article
(This article belongs to the Section Nutrition and Public Health)
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12 pages, 1229 KiB  
Article
Effects of Angiotensin-Converting Enzyme Inhibition on the Recurrence and Internal Structure of Chronic Subdural Hematomas
by Michael Veldeman, Hani Ridwan, Mohamed Alzaiyani, Rastislav Pjontek, Benedikt Kremer, Anke Hoellig, Hans Clusmann and Hussam Hamou
J. Clin. Med. 2024, 13(16), 4591; https://doi.org/10.3390/jcm13164591 - 6 Aug 2024
Cited by 1 | Viewed by 1460
Abstract
Background/Objectives: Chronic subdural hematoma (cSDH) is a common disease of growing significance due to the increasing use of antithrombotic drugs and population aging. There exists conflicting observational evidence that previous treatment with angiotensin-converting enzyme (ACE) inhibitors reduces the rate of cSDH recurrence. This [...] Read more.
Background/Objectives: Chronic subdural hematoma (cSDH) is a common disease of growing significance due to the increasing use of antithrombotic drugs and population aging. There exists conflicting observational evidence that previous treatment with angiotensin-converting enzyme (ACE) inhibitors reduces the rate of cSDH recurrence. This study assesses the hypothesis that ACE inhibitors may affect recurrence rates by altering hematoma membrane formation. Methods: All patients with chronic subdural hematoma who were operated upon in a single university hospital between 2015 and 2020 were considered for inclusion. Hematomas were classified according to their structural appearance in computed tomography (CT) imaging into one of eight subtypes. Patients’ own medication, prior to hospitalization for cSDH treatment, was noted, and the use of ACI-inhibitors was identified. Results: Of the included 398 patients, 142 (35.9%) were treated with ACE inhibitors before admission for cSDH treatment. Of these, 115 patients (81.0%) received ramipril, 13 received patients lisinopril (11.3%), and 11 patients (9.6%) received enalapril. Reflecting cardiovascular comorbidity, patients on ACE inhibitors were more often simultaneously treated with antithrombotics (63.4% vs. 42.6%; p ≤ 0.001). Hematomas with homogenous hypodense (OR 11.739, 95%CI 2.570 to 53.612; p = 0.001), homogenous isodense (OR 12.204, 95%CI 2.669 to 55.798; p < 0.001), and homogenous hyperdense (OR 9.472, 95%CI 1.718 to 52.217; p < 0.001) architectures, as well as the prior use of ACE inhibitors (OR 2.026, 95%CI 1.214 to 3.384; p = 0.007), were independently associated with cSDH recurrence. Conclusions: Once corrected for hematoma architecture, type of surgery, and use of antithrombotic medication, preoperative use of ACE inhibitors was associated with a twofold increase in the likelihood of hematoma recurrence. Full article
(This article belongs to the Section Brain Injury)
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13 pages, 1169 KiB  
Article
Aquaporin 2 in Cerebral Edema: Potential Prognostic Marker in Craniocerebral Injuries
by Wojciech Czyżewski, Jan Korulczyk, Michał Szymoniuk, Leon Sakwa, Jakub Litak, Dominik Ziemianek, Ewa Czyżewska, Marek Mazurek, Michał Kowalczyk, Grzegorz Turek, Adrian Pawłowski, Radosław Rola and Kamil Torres
Int. J. Mol. Sci. 2024, 25(12), 6617; https://doi.org/10.3390/ijms25126617 - 16 Jun 2024
Cited by 2 | Viewed by 1607
Abstract
Despite continuous medical advancements, traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Consequently, there is a pursuit for biomarkers that allow non-invasive monitoring of patients after cranial trauma, potentially improving clinical management and reducing complications and mortality. Aquaporins [...] Read more.
Despite continuous medical advancements, traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Consequently, there is a pursuit for biomarkers that allow non-invasive monitoring of patients after cranial trauma, potentially improving clinical management and reducing complications and mortality. Aquaporins (AQPs), which are crucial for transmembrane water transport, may be significant in this context. This study included 48 patients, with 27 having acute (aSDH) and 21 having chronic subdural hematoma (cSDH). Blood plasma samples were collected from the participants at three intervals: the first sample before surgery, the second at 15 h, and the third at 30 h post-surgery. Plasma concentrations of AQP1, AQP2, AQP4, and AQP9 were determined using the sandwich ELISA technique. CT scans were performed on all patients pre- and post-surgery. Correlations between variables were examined using Spearman’s nonparametric rank correlation coefficient. A strong correlation was found between aquaporin 2 levels and the volume of chronic subdural hematoma and midline shift. However, no significant link was found between aquaporin levels (AQP1, AQP2, AQP4, and AQP9) before and after surgery for acute subdural hematoma, nor for AQP1, AQP4, and AQP9 after surgery for chronic subdural hematoma. In the chronic SDH group, AQP2 plasma concentration negatively correlated with the midline shift measured before surgery (Spearman’s ρ −0.54; p = 0.017) and positively with hematoma volume change between baseline and 30 h post-surgery (Spearman’s ρ 0.627; p = 0.007). No statistically significant correlation was found between aquaporin plasma levels and hematoma volume for AQP1, AQP2, AQP4, and AQP9 in patients with acute SDH. There is a correlation between chronic subdural hematoma volume, measured radiologically, and serum AQP2 concentration, highlighting aquaporins’ potential as clinical biomarkers. Full article
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9 pages, 2060 KiB  
Article
Clinical Outcomes in Elderly Patients with Chronic Subdural Hematoma: Validation of Irrigation Assignment Based on Hematoma Characteristics
by Takuma Maeda, Yuichiro Kikkawa, Takuro Ehara, Ryosuke Tsuchiya, Shinya Tabata, Koki Onodera, Tatsuki Kimura, Yushiro Take, Kaima Suzuki and Hiroki Kurita
Life 2024, 14(4), 518; https://doi.org/10.3390/life14040518 - 17 Apr 2024
Cited by 1 | Viewed by 2219
Abstract
The number of elderly patients with chronic subdural hematomas (CSDH) is increasing worldwide; however, there is limited data regarding the clinical outcomes in this population. Our therapeutic method using burr hole evacuation for CSDH is based on the hematoma characteristics, using simple drainage [...] Read more.
The number of elderly patients with chronic subdural hematomas (CSDH) is increasing worldwide; however, there is limited data regarding the clinical outcomes in this population. Our therapeutic method using burr hole evacuation for CSDH is based on the hematoma characteristics, using simple drainage for single-layer lesions and drainage with irrigation for multiple-layer lesions. This study aimed to compare the postoperative outcomes of elderly and younger patients, identify the predictors of outcomes in elderly patients, and verify the validity of our therapeutic methods. In total, we included 214 patients who underwent burr hole evacuation between April 2018 and March 2022. Baseline characteristics, hematoma characteristics, recurrence, and clinical outcomes were compared between the elderly and younger patients. Overall, 96 elderly patients (44.9%) were included in the study, and more elderly patients underwent antithrombotic therapy than younger patients (33.3% vs. 19.5%, p = 0.027). Moreover, elderly patients had significantly fewer favorable outcomes than younger patients (70.8% vs. 91.5%; p < 0.001); however, this was not significant after adjusting for the baseline modified Rankin Scale (mRS). Similarly, elderly patients had higher recurrence rates than younger patients (10.4% vs. 2.5%; p = 0.021). However, the baseline mRS score was the only predictor of unfavorable outcomes. In conclusion, although the clinical outcomes of elderly patients were comparable to those of younger patients, the higher rate of preoperative antithrombotic therapy in elderly patients may result in a higher rate of recurrence requiring a long-term follow-up. Full article
(This article belongs to the Section Medical Research)
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14 pages, 3622 KiB  
Article
AI-Based Approach to One-Click Chronic Subdural Hematoma Segmentation Using Computed Tomography Images
by Andrey Petrov, Alexey Kashevnik, Mikhail Haleev, Ammar Ali, Arkady Ivanov, Konstantin Samochernykh, Larisa Rozhchenko and Vasiliy Bobinov
Sensors 2024, 24(3), 721; https://doi.org/10.3390/s24030721 - 23 Jan 2024
Cited by 4 | Viewed by 2251
Abstract
This paper presents a computer vision-based approach to chronic subdural hematoma segmentation that can be performed by one click. Chronic subdural hematoma is estimated to occur in 0.002–0.02% of the general population each year and the risk increases with age, with a high [...] Read more.
This paper presents a computer vision-based approach to chronic subdural hematoma segmentation that can be performed by one click. Chronic subdural hematoma is estimated to occur in 0.002–0.02% of the general population each year and the risk increases with age, with a high frequency of about 0.05–0.06% in people aged 70 years and above. In our research, we developed our own dataset, which includes 53 series of CT scans collected from 21 patients with one or two hematomas. Based on the dataset, we trained two neural network models based on U-Net architecture to automate the manual segmentation process. One of the models performed segmentation based only on the current frame, while the other additionally processed multiple adjacent images to provide context, a technique that is more similar to the behavior of a doctor. We used a 10-fold cross-validation technique to better estimate the developed models’ efficiency. We used the Dice metric for segmentation accuracy estimation, which was 0.77. Also, for testing our approach, we used scans from five additional patients who did not form part of the dataset, and created a scenario in which three medical experts carried out a hematoma segmentation before we carried out segmentation using our best model. We developed the OsiriX DICOM Viewer plugin to implement our solution into the segmentation process. We compared the segmentation time, which was more than seven times faster using the one-click approach, and the experts agreed that the segmentation quality was acceptable for clinical usage. Full article
(This article belongs to the Special Issue Multimodal Image Analysis with Advanced Computational Intelligence)
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