Stavrinou Pantelis, Katsigiannis Sotirios, Lee Jong Hun, Hamisch Christina, Krischek Boris, Mpotsaris Anastasios, Timmer Marco, Goldbrunner Roland
Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
World Neurosurg. 2017 Mar;99:465-470. doi: 10.1016/j.wneu.2016.12.058. Epub 2016 Dec 23.
Chronic subdural hematoma (CSDH), a common condition in elderly patients, presents a therapeutic challenge with recurrence rates of 33%. We aimed to identify specific prognostic factors for recurrence using quantitative analysis of hematoma volume and density.
We retrospectively reviewed radiographic and clinical data of 227 CSDHs in 195 consecutive patients who underwent evacuation of the hematoma through a single burr hole, 2 burr holes, or a mini-craniotomy. To examine the relationship between hematoma recurrence and various clinical, radiologic, and surgical factors, we used quantitative image-based analysis to measure the hematoma and trapped air volumes and the hematoma densities.
Recurrence of CSDH occurred in 35 patients (17.9%). Multivariate logistic regression analysis revealed that the percentage of hematoma drained and postoperative CSDH density were independent risk factors for recurrence. All 3 evacuation methods were equally effective in draining the hematoma (71.7% vs. 73.7% vs. 71.9%) without observable differences in postoperative air volume captured in the subdural space.
Quantitative image analysis provided evidence that percentage of hematoma drained and postoperative CSDH density are independent prognostic factors for subdural hematoma recurrence.
慢性硬膜下血肿（CSDH）是老年患者的常见病症，其复发率为33%，给治疗带来了挑战。我们旨在通过对血肿体积和密度进行定量分析，确定复发的特定预后因素。
我们回顾性分析了195例连续患者的227例CSDH的影像学和临床数据，这些患者通过单孔钻孔、双孔钻孔或微创开颅术进行了血肿清除术。为了研究血肿复发与各种临床、放射学和手术因素之间的关系，我们使用基于图像的定量分析来测量血肿和积气的体积以及血肿密度。
35例患者（17.9%）发生了CSDH复发。多因素逻辑回归分析显示，血肿引流百分比和术后CSDH密度是复发的独立危险因素。所有3种清除方法在引流血肿方面同样有效（分别为71.7%、73.7%和71.9%），硬膜下腔术后积气体积无明显差异。
定量图像分析表明，血肿引流百分比和术后CSDH密度是硬膜下血肿复发的独立预后因素。
