Oh Hyuk-Jin, Seo Youngbeom, Choo Yoon-Hee, Kim Young Il, Kim Kyung Hwan, Kwon Sae Min, Lee Min Ho, Chong Kyuha
Neurotrauma Clinical Practice Guidelines Committee of the Korean Neurotraumatology Society (KNTS-NCPGC), Seoul, Korea.
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea.
J Korean Neurosurg Soc. 2022 Mar;65(2):255-268. doi: 10.3340/jkns.2021.0138. Epub 2021 Nov 4.
Chronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence.
We enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women.
The median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017).
This is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.
慢性硬膜下血肿（CSDH）是神经外科的常见疾病，但尚未确立最佳围手术期管理指南。我们旨在评估CSDH患者当前的临床管理和预后，并确定CSDH复发的预后因素。
我们纳入了2018年在7家机构接受钻孔颅骨造瘘术的293例连续的CSDH患者。分析了临床和手术相关特征及手术结果。该队列包括208名男性和85名女性。
患者年龄中位数为75岁。105例患者使用了抗血栓药物。59%的患者有头部外伤史。293例患者中有227例（77.5%）为单侧血肿，46.1%为均匀血肿类型。约70%的患者在全身麻醉下接受手术，74.7%的患者接受了单孔钻孔颅骨造瘘术。293例患者中有17例（5·8%）出现需要手术的复发，复发中位数为32天。术后并发症发生率为4.1%。多因素分析显示，与CSDH复发相关的因素为血肿类型分离（比值比，3.906；P=0.017），且在全身麻醉下接受手术的患者复发较少（比值比，0.277；P=0.017）。
这是韩国第一项回顾性多中心广义队列试点研究，是制定韩国CSDH临床实践指南的第一步。血肿类型和麻醉与CSDH复发有关。尽管具体手术方法因机构而异，但CSDH的手术治疗是有效的。进一步的研究可能会制定适当的管理指南，以尽量减少CSDH的复发。
