Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Room H2-241, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands.
J Neurol. 2024 Jun;271(6):3586-3594. doi: 10.1007/s00415-024-12307-2. Epub 2024 Mar 30.
Conservative therapy is a viable option for patients with chronic subdural hematoma (cSDH) who express no, or only mild symptoms. It is not clear which factors are associated with success of conservative therapy. This study aims to determine conservative therapy's success rate and to identify features possibly associated with success.
A monocenter retrospective cohort study, including cSDH patients treated conservatively (wait-and-watch) from 2012 to 2022, was performed. The primary outcome was success of conservative therapy, defined as 'no crossover to surgery' during the follow-up period. Secondary outcomes were (1) factors associated with success, analyzed with univariate and multivariable logistic regression analyses, (2) 30-day mortality (3) time to crossover and (4) reasons for crossover.
We included 159 patients. Conservative therapy was successful in 96 (60%) patients. Hematoma volume (OR 0.79, 95% CI 0.69-0.92) and hypodense hematoma type (OR 3.57, 95% 1.38-9.23) were associated with success. Thirty-day mortality rate was 5% and the median duration between diagnosis and surgery was 19 days (IQR 8-39). Clinical deterioration was the most frequent reason for crossover (in 61/63 patients, 97%) and was accompanied by radiological hematoma progression in 42 patients (67%).
In this selected group of patients, conservative therapy was successful in 60%. Smaller hematoma volume and hypodense hematoma type were associated with success. As time until crossover was approximately three weeks, deploying conservative therapy as primary treatment seems safe and could be rewarding as surgical complications can be avoided. Improvement in patient selection in future cohorts remains warranted.
对于表达无症状或仅有轻度症状的慢性硬脑膜下血肿（cSDH）患者，保守治疗是一种可行的选择。目前尚不清楚哪些因素与保守治疗的成功有关。本研究旨在确定保守治疗的成功率，并确定可能与成功相关的特征。
进行了一项单中心回顾性队列研究，纳入了 2012 年至 2022 年期间接受保守治疗（等待观察）的 cSDH 患者。主要结局是保守治疗的成功率，定义为随访期间无手术交叉。次要结局是（1）与成功相关的因素，采用单变量和多变量逻辑回归分析，（2）30 天死亡率，（3）交叉时间，（4）交叉原因。
我们纳入了 159 名患者。96 名（60%）患者保守治疗成功。血肿体积（OR 0.79，95%CI 0.69-0.92）和低密血肿类型（OR 3.57，95%CI 1.38-9.23）与成功相关。30 天死亡率为 5%，从诊断到手术的中位时间为 19 天（IQR 8-39）。临床恶化是最常见的交叉原因（63 例中有 61 例，97%），42 例（67%）伴有影像学血肿进展。
在这组选定的患者中，保守治疗的成功率为 60%。较小的血肿体积和低密血肿类型与成功相关。由于交叉时间约为三周，作为主要治疗手段部署保守治疗似乎是安全的，并且可以避免手术并发症，从而获得回报。在未来的队列中，仍需要改善患者选择。
