Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis

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• 作者：Yasemin Tahsim-Oglou (1)
  Kerim Beseoglu (1)
  Daniel H?nggi (1)
  Walter Stummer (2)
  Hans-Jakob Steiger (1)
  
• 关键词：Postoperative low ; dose heparin ; Chronic subdural haematoma ; Recurrence ; Subdural irrigation ; Burr ; hole drainage
• 刊名：Acta Neurochirurgica
• 出版年：2012
• 出版时间：June 2012
• 年：2012
• 卷：154
• 期：6
• 页码：1063-1068
• 全文大小：126KB
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• 作者单位：Yasemin Tahsim-Oglou (1)
  Kerim Beseoglu (1)
  Daniel H?nggi (1)
  Walter Stummer (2)
  Hans-Jakob Steiger (1)
  
  1. Department of Neurosurgery, Heinrich-Heine-Universit?t, Moorenstra?e 5, Geb. 13.71, 40225, Düsseldorf, Germany
  2. Department of Neurosurgery, Westf?lische-Wilhelms-Universit?t, Münster, Germany
  

文摘

Background Burr-hole drainage has become the accepted treatment of choice for chronic subdural haematoma (cSDH), although still burdened with a major recurrence rate. The current analysis was initiated to determine management-related risk factors for recurrence, i.e. postoperative low-molecular-weight heparin thromboprophylaxis, and the importance of rinsing the subdural space. Methods Two-hundred and forty-seven patients with computerised tomography (CT) defined symptomatic cSDH were managed by two burr-hole trepanations and drainage between January 2005 and November 2008. Postoperative thromboprophylaxis with 40?mg enoxaparine daily was given only during the first half of the study period. For the current analysis the amount of rinsing fluid, postoperative low-dose thromboprophylaxis, as well as age and gender, bilaterality, preoperative and postoperative blood coagulation studies, platelet counts and decrease of subdural fluid on early postoperative CT, were recorded and correlated with recurrence. Statistical calculation was done by univariate and multivariate analysis. Results A total of 62 of 247 patients needed revision surgery for recurrence (25.1?%). Recurrence rates were significantly lower in the patients treated without postoperative enoxaparine (18.84?%) than in the group with postoperative low-dose enoxaparine thromboprophylaxis (32.11?%) and enoxaparine was administered in a higher proportion of the patients suffering recurrence (P--.013). A median intraoperative irrigation volume of 863?ml saline was used in the patients suffering recurrence and 1,500?ml in patients without recurrence (P-lt;-.001). The median age was slightly higher in the patients suffering from recurrence. Male gender predominated in both groups but was slightly more pronounced in the recurrence group. Preoperative and postoperative platelet counts and plasmatic coagulation indices did not differ significantly between the groups. Relative residual subdural fluid collection on early postoperative CT remained larger in patients finally suffering recurrence (P--.03). Multivariate analysis confirmed a small amount of rinsing fluid, male gender and the use of enoxaparine as the most important risk factors for recurrence, although that latter factor did not reach statistical significance in the multivariate analysis. Conclusions The investigation provides evidence that copious intraoperative irrigation and avoidance of postoperative low-molecular-weight heparin thromboprophylaxis may reduce the recurrence rate of cSDH.