Department of Neurosurgery, Chonbuk National University Hospital & Medical School, 664-14, Deokjin-Gu, Jeonju, Jeonbuk, 561-756, Republic of Korea.
Acta Neurochir (Wien). 2012 Sep;154(9):1541-8. doi: 10.1007/s00701-012-1399-9. Epub 2012 Jun 1.
Chronic subdural hematoma is characterized by blood in the subdural space that evokes an inflammatory reaction. Numerous factors potentially associated with recurrence of chronic subdural hematoma have been reported, but these factors have not been sufficiently investigated. In this study, we evaluated the independent risk factors of recurrence.
We analyzed data for 420 patients with chronic subdural hematoma treated by the standard surgical procedure for hematoma evacuation at our institution.
Ninety-two (21.9 %) patients experienced at least one recurrence of chronic subdural hematoma during the study period. We did not identify any significant differences between chronic subdural hematoma recurrence and current antiplatelet therapy. The recurrence rate was 7 % for the homogeneous type, 21 % for the laminar type, 38 % for the separated type, and 0 % for the trabecular type. The rate of recurrence was significantly lower in the homogeneous and trabecular type than in the laminar and separated type. We performed a multivariate logistic regression analysis and found that postoperative midline shifting (OR, 3.6; 95 % CI, 1.618-7.885; p = 0.001), diabetes mellitus (OR, 2.2; 95 % CI, 1.196-3.856; p = 0.010), history of seizure (OR, 2.6; 95 % CI, 1.210-5.430; p = 0.014), width of hematoma (OR, 2.1; 95 % CI, 1.287-3.538; p = 0.003), and anticoagulant therapy (OR, 2.7; 95 % CI, 1.424-6.960; p = 0.005) were independent risk factors for the recurrence of chronic subdural hematoma.
We have shown that postoperative midline shifting (≥5 mm), diabetes mellitus, preoperative seizure, preoperative width of hematoma (≥20 mm), and anticoagulant therapy were independent predictors of the recurrence of chronic subdural hematoma. According to internal architecture of hematoma, the rate of recurrence was significantly lower in the homogeneous and the trabecular type than the laminar and separated type.
慢性硬脑膜下血肿的特征是硬脑膜下腔中有血液，引发炎症反应。已经报道了许多可能与慢性硬脑膜下血肿复发相关的因素，但这些因素尚未得到充分研究。在这项研究中，我们评估了复发的独立危险因素。
我们分析了在我们机构接受标准血肿清除手术治疗的 420 例慢性硬脑膜下血肿患者的数据。
92 例（21.9%）患者在研究期间至少经历了一次慢性硬脑膜下血肿复发。我们没有发现慢性硬脑膜下血肿复发与当前抗血小板治疗之间存在任何显著差异。同质性类型的复发率为 7%，层状类型为 21%，分离类型为 38%，小梁类型为 0%。同质性和小梁型的复发率明显低于层状和分离型。我们进行了多变量逻辑回归分析，发现术后中线移位（OR，3.6；95%CI，1.618-7.885；p=0.001）、糖尿病（OR，2.2；95%CI，1.196-3.856；p=0.010）、癫痫发作史（OR，2.6；95%CI，1.210-5.430；p=0.014）、血肿宽度（OR，2.1；95%CI，1.287-3.538；p=0.003）和抗凝治疗（OR，2.7；95%CI，1.424-6.960；p=0.005）是慢性硬脑膜下血肿复发的独立危险因素。
我们已经表明，术后中线移位（≥5mm）、糖尿病、术前癫痫发作、术前血肿宽度（≥20mm）和抗凝治疗是慢性硬脑膜下血肿复发的独立预测因素。根据血肿的内部结构，同质性和小梁型的复发率明显低于层状和分离型。
