Clinical investigation of refractory chronic subdural hematoma: a comparison of clinical factors between single and repeated recurrences
Article in Press: Accepted Manuscript
• Hiroaki Matsumoto M. D., Ph. D., Hiroaki Hanayama M.D., Takashi Okada M.D., Yasuo Sakurai M.D., Hiroaki Minami M.D., Ph. D., Atsushi Masuda M.D., Shogo Tominaga M.D., Ph. D., Katsuya Miyaji M.D., Ph. D., Ikuya Yamaura M.D., Ph. D., Yasuhisa Yoshida M.D., Ph.D. and Kozo Yoshida M.D., Ph. D.
World Neurosurgery, Copyright © 2017 Elsevier Inc.
Abstract
Background
Chronic subdural hematoma (CSDH) is sometimes refractory, and this is troublesome for neurosurgeons. Although many studies have reported risk factors or treatments in efforts to prevent recurrence, those have focused on single recurrence, and little cumulative data is available to analyze refractory CSDH.
Methods
We defined refractory CSDH as ?2 recurrences, then analyzed and compared clinical factors between patients with single recurrence and those with refractory CSDH in a cohort study, to clarify whether patients with refractory CSDH experience different or more risk factors than patients with single recurrence, and whether burr-hole irrigation with closed-system drainage reduces refractory CSDH.
Results
Seventy-five patients had at least one recurrence, with single recurrence in 62 patients and ?2 recurrences in 13 patients. In comparing clinical characteristics, patients with refractory CSDH were significantly younger (P=0.04) and showed shorter interval to first recurrence (P<0.001). Organized CSDH was also significantly associated with refractory CSDH (P=0.02). Multivariate logistic regression analysis identified first recurrence interval <1 month (OR 6.66, P<0.001) and age <71 years (OR 4.16, P<0.001) as independent risk factors for refractory CSDH. On the other hand, burr-hole irrigation with closed-system drainage did not reduce refractory CSDH.
Conclusions
When patients with risk factors for refractory CSDH experience recurrence, alternative surgical procedures may be considered as the second surgery, because burr-hole irrigation with closed-system drainage did not reduce refractory CSDH in our study.
