Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
J Clin Neurosci. 2021 Dec;94:244-249. doi: 10.1016/j.jocn.2021.10.037. Epub 2021 Nov 8.
The prevalence of chronic subdural hematoma (CSDH) associated with dural metastasis is uncertain, and appropriate treatment strategies have not been established. This study aimed to investigate the characteristics of and appropriate treatment strategies for CSDH associated with dural metastasis. We retrospectively reviewed the charts of 214 patients who underwent surgery for CSDH. The patients were divided into the dural metastasis group (DMG; n = 5, 2.3%) and no dural metastasis group (No-DMG; n = 209, 97.3%). Patient characteristics, treatment, and outcomes were compared between the two groups. Active cancer was detected in 31 out of 214 patients, 5 of whom (16.1%) had dural metastasis. In-hospital death (80.0% vs. 0%; p < 0.001) and recurrence within 14 days (80.0% vs. 2.9%; p < 0.001) and 60 days (80.0% vs. 13.9%; p = 0.002) were significantly prevalent in the DMG. All patients in the DMG developed subdural hematoma re-accumulation requiring emergent surgery because of brain herniation, and patients in the DMG had significantly worse recurrence-free survival (p < 0.001). This relationship remained significant (p < 0.001) even when the analysis was limited to the active cancer cohort (n = 31). CSDH associated with dural metastasis leads to early recurrence and death because of the difficulty in controlling subdural hematoma re-accumulation by common drainage procedures. Depending on the primary cancer status, withdrawal of active treatment and change to palliative care should be discussed after diagnosing CSDH associated with dural metastasis.
慢性硬脑膜下血肿（CSDH）合并硬脑膜转移的发生率尚不确定，也尚未建立合适的治疗策略。本研究旨在探讨CSDH 合并硬脑膜转移的特点和治疗策略。我们回顾性分析了 214 例行 CSDH 手术患者的病历。患者分为硬脑膜转移组（DMG；n=5，2.3%）和无硬脑膜转移组（No-DMG；n=209，97.3%）。比较两组患者的一般资料、治疗方式和预后。214 例患者中发现活动性癌症 31 例，其中 5 例（16.1%）发生硬脑膜转移。DMG 组患者住院期间死亡率（80.0% vs. 0%；p<0.001）和 14 天内（80.0% vs. 2.9%；p<0.001）及 60 天内（80.0% vs. 13.9%；p=0.002）复发率显著高于 No-DMG 组。所有 DMG 患者均因脑疝行紧急手术治疗，再次出现硬膜下血肿，且 DMG 组患者无复发生存率明显较差（p<0.001）。即使在仅分析活动性癌症队列（n=31）时，这种关系仍然具有统计学意义（p<0.001）。CSDH 合并硬脑膜转移会导致早期复发和死亡，因为普通引流术很难控制硬膜下血肿的再积聚。在诊断为 CSDH 合并硬脑膜转移后，应根据原发性癌症的状态，讨论停止积极治疗并转为姑息治疗。
