Risk factors of delayed surgical evacuation for initially nonoperative acute subdural hematomas following mild head injury

详细信息    查看全文

• 作者：Bum-Joon Kim (1)
  Kyung-Jae Park (1)
  Dong-Hyuk Park (1)
  Dong-Jun Lim (1)
  Taek-Hyun Kwon (1)
  Yong-Gu Chung (1)
  Shin-Hyuk Kang (1)
  
• 关键词：Mild head injury ; Acute subdural hematoma ; Delayed hematoma enlargement ; Risk factor
• 刊名：Acta Neurochirurgica
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：156
• 期：8
• 页码：1605-1613
• 全文大小：1,119 KB
• 参考文献：1. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE (2006) Surgical management of acute subdural hematomas. Neurosurgery 58:S2-16-S12-24
  2. Choudhry OJ, Prestigiacomo CJ, Gala N, Slasky S, Sifri ZC (2013) Delayed neurological deterioration after mild head injury: cause, temporal course, and outcomes. Neurosurgery 73:753-60, discussion 760 CrossRef
  3. Croce MA, Dent DL, Menke PG, Robertson JT, Hinson MS, Young BH, Donovan TB, Pritchard FE, Minard G, Kudsk KA et al (1994) Acute subdural hematoma: nonsurgical management of selected patients. J Trauma 36:820-26, discussion 826-27 CrossRef
  4. Erol FS, Kaplan M, Topsakal C, Ozveren MF, Tiftikci MT (2004) Coexistence of rapidly resolving acute subdural hematoma and delayed traumatic intracerebral hemorrhage. Pediatr Neurosurg 40:238-40 CrossRef
  5. Feliciano CE, De Jesus O (2008) Conservative management outcomes of traumatic acute subdural hematomas. P R Health Sci J 27:220-23
  6. Gebel JM, Sila CA, Sloan MA, Granger CB, Weisenberger JP, Green CL, Topol EJ, Mahaffey KW (1998) Comparison of the ABC/2 estimation technique to computer-assisted volumetric analysis of intraparenchymal and subdural hematomas complicating the GUSTO-1 trial. Stroke 29:1799-801 CrossRef
  7. Gomori JM, Steiner I, Melamed E, Cooper G (1984) The assessment of changes in brain volume using combined linear measurements. A CT-scan study. Neuroradiology 26:21-4 CrossRef
  8. Itshayek E, Rosenthal G, Fraifeld S, Perez-Sanchez X, Cohen JE, Spektor S (2006) Delayed posttraumatic acute subdural hematoma in elderly patients on anticoagulation. Neurosurgery 58:E851–E856, discussion E851-856 CrossRef
  9. Kasner SE, Gebel JM, Sila CA (1999) Geometry and subdural hematoma volume response. Stroke 30:188 CrossRef
  10. Kato N, Tsunoda T, Matsumura A, Yanaka K, Nose T (2001) Rapid spontaneous resolution of acute subdural hematoma occurs by redistribution–two case reports. Neurol Med Chir (Tokyo) 41:140-43 CrossRef
  11. Kwon TH, Park YK, Lim DJ, Cho TH, Chung YG, Chung HS, Suh JK (2000) Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume. J Neurosurg 93:796-99 CrossRef
  12. Lee K (1998) The pathogenesis and clinical significance of traumatic subdural hygroma. Brain Inj 12:595-03 CrossRef
  13. Lee K-S, Shim J-J, Yoon S-M, Doh J-W, Yun I-G, Bae H-G (2011) Acute-on-chronic subdural hematoma: not uncommon events. J Korean Neurosurg Soc 50:512-16 CrossRef
  14. Livingston DH, Lavery RF, Passannante MR, Skurnick JH, Baker S, Fabian TC, Fry DE, Malangoni MA (2000) Emergency department discharge of patients with a negative cranial computed tomography scan after minimal head injury. Ann Surg 232:126-32 CrossRef
  15. Mack LR, Chan SB, Silva JC, Hogan TM (2003) The use of head computed tomography in elderly patients sustaining minor head trauma. J Emerg Med 24:157-62 CrossRef
  16. Markwalder T-M (1981) Chronic subdural hematomas: a review. J Neurosurg 54:637-45 CrossRef
  17. Mori K, Maeda M (2001) Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41:371-81 CrossRef
  18. Murakami H, Hirose Y, Sagoh M, Shimizu K, Kojima M, Gotoh K, Mine Y, Hayashi T, Kawase T (2002) Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 96:877-84 CrossRef
  19. Niikawa S, Sugimoto S, Hattori T, Ohkuma A, Kimura T, Shinoda J, Funakoshi T (1989) Rapid resolution of acute subdural hematoma–report of four cases. Neurol Med Chir (Tokyo) 29:820-24 CrossRef
  20. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M (2001) Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo) 41:382-86 CrossRef
  21. Petridis AK, Dorner L, Doukas A, Eifrig S, Barth H, Mehdorn M (2009) Acute subdural hematoma in the elderly; clinical and CT factors influencing the surgical treatment decision. Cent Eur Neurosurg 70:73-8 CrossRef
  22. Rakier A, Guilburd JN, Soustiel JF, Zaaroor M, Feinsod M (1995) Head injuries in the elderly. Brain Inj 9:187-93 CrossRef
  23. Sachs J, Sachs E Jr (1977) A simple formula for calculating the volume of subdural hematomas. Neurosurgery 1:60-1 CrossRef
  24. Saito K, Ito H, Hasegawa T, Yamamoto S (1989) Plasmin-alpha 2-plasmin inhibitor complex and alpha 2-plasmin inhibitor in chronic subdural hematoma. J Neurosurg 70:68-2 CrossRef
  25. Servadei F, Nasi MT, Cremonini AM, Giuliani G, Cenni P, Nanni A (1998) Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. J Trauma 44:868-73 CrossRef
  26. Sifri ZC, Homnick AT, Vaynman A, Lavery R, Liao W, Mohr A, Hauser CJ, Manniker A, Livingston D (2006) A prospective evaluation of the value of repeat cranial computed tomography in patients with minimal head injury and an intracranial bleed. J Trauma 61:862-67 CrossRef
  27. Son S, Yoo CJ, Lee SG, Kim EY, Park CW, Kim WK (2013) Natural course of initially non-operated cases of acute subdural hematoma: the risk factors of hematoma progression. J Korean Neurosurg Soc 54:211-19 CrossRef
  28. Stanisic M, Lyngstadaas SP, Pripp AH, Aasen AO, Lindegaard K-F, Ivanovic J, Ilstad E, Konglund A, Sandell T, Ellingsen O (2012) Chemokines as markers of local inflammation and angiogenesis in patients with chronic subdural hematoma: a prospective study. Acta Neurochir (Wien) 154:113-20 CrossRef
  29. Tanaka Y, Ohno K (2013) Chronic subdural hematoma-an up-to-date concept. J Med Dent Sci 60:55
  30. Tang J, Ai J, Macdonald RL (2011) Developing a model of chronic subdural hematoma. Acta Neurochir Suppl 111:25-9 CrossRef
  31. Tsui EY, Fai Ma K, Cheung YK, Chan JH, Yuen MK (2000) Rapid spontaneous resolution and redistribution of acute subdural hematoma in a patient with chronic alcoholism: a case report. Eur J Radiol 36:53-7 CrossRef
  
• 作者单位：Bum-Joon Kim (1)
  Kyung-Jae Park (1)
  Dong-Hyuk Park (1)
  Dong-Jun Lim (1)
  Taek-Hyun Kwon (1)
  Yong-Gu Chung (1)
  Shin-Hyuk Kang (1)
  
  1. Department of Neurosurgery, Korea University College of Medicine, #126, 5-ga, Anam-Dong, Seongbuk-Gu, Seoul, 136-705, Korea
  
• ISSN：0942-0940

文摘

Background Although the majority of patients with minimal acute subdural hematomas (aSDHs) can be managed conservatively, some require delayed aSDH evacuation due to hematoma enlargement. This study was designed to determine the risk factors associated with delayed hematoma enlargement leading to surgery in patients with aSDHs who did not initially require surgical intervention. Methods From 2002 to 2012, 98 patients were treated for nonoperative aSDHs following mild head injury (Glasgow Coma Scale scores of 13-5). The outcome variables were radiographic evidence of SDH enlargement on serially obtained computed tomography (CT) images and later surgical evacuation. Univariate and multivariate analyses were applied to both the demographic and initial radiographic features to identify risk factors for SDH progression and surgery. Results Overall, 64 patients (65?%) revealed minimal SDH or spontaneous hematoma resolution (conservative group) with conservative management at their last follow-up CT scan. The remaining 34 patients (35?%) received delayed hematoma evacuation (delayed surgery group) a median of 17?days after the head trauma. There were no significant differences between the two groups for baseline characteristics, including age, injury type, degree of brain atrophy, prior history of antithrombotic drugs, and coagulopathy. The presence of cerebral contusions and subarachnoid hemorrhages was more common in the conservative group (p--.003 and p--.003, respectively). On multivariate analysis, hematoma volume (p--.01, odds ratio [OR]--.094, 95?% confidence interval [CI]--.021-.173) and degree of midline shift (p--.01, OR--.433, 95?% CI--.088-.888) on the initial CT scan were independently associated with delayed hematoma evacuation. Conclusions A critical proportion of patients with minimal aSDHs occurring after mild head injury can progress over several weeks and require hematoma evacuation. Especially patients with a large initial SDH volume and accompanying midline shift require careful monitoring of hematoma progression.