Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Sashima, Ibaraki, Japan; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Sashima, Ibaraki, Japan.
Clin Neurol Neurosurg. 2024 Sep;244:108434. doi: 10.1016/j.clineuro.2024.108434. Epub 2024 Jul 5.
The recurrence of chronic subdural hematoma (CSDH) after surgical treatment is a severe problem with no effective prevention method. This retrospective study aimed to investigate factors associated with CSDH recurrence after burr hole surgery and hematoma changes on computed tomography before surgery to examine prevention methods for recurrence. A total of 166 hematomas were enrolled in this study, with 139 patients undergoing burr hole surgery for CSDH. Among these patients, 17 (12 %) had recurrence. Propensity score matching was performed based on postoperative drug therapy, including goreisan, carbazochrome sodium sulfonate hydrate, and tranexamic aid, resulting in 39 matched cases in 0-2 and 3 drug therapy groups. The recurrence rates were 18 % for the 0-2-drug therapy group and 3 % for the 3-drug therapy group. Univariate analysis revealed that the use of 0-2 drugs was associated with a higher risk of CSDH recurrence (odds ratio [OR], 8.31; 95 % confidence interval [CI], 0.97-71.17; p = 0.05) compared to the use of 3 drugs. Multivariate regression analysis further confirmed that 0-2 drug therapy after surgery was associated with an increased risk of CSDH recurrence (OR, 11.06; 95 % CI, 1.16-105.4; p = 0.037). Additionally, 36 hematomas were evaluated before surgery, with hematoma changes such as lower density and new trabecular formation detected in 14 CSDHs (39 %). Multivariate regression analysis showed that 3-drug therapy was associated with more cases of hematoma change than 0-2-drug therapy (OR, 13.9; 95 % CI, 1.09-177.65; p = 0.043). The 3-drug therapy was effective in reducing the recurrence of hematoma after burr hole surgery and promoted hematoma thrombosis.
慢性硬脑膜下血肿（CSDH）术后复发是一个严重的问题，目前尚无有效的预防方法。本回顾性研究旨在探讨影响钻孔引流术后 CSDH 复发的因素，以及术前 CT 血肿变化，以寻找预防复发的方法。共纳入 166 例血肿，其中 139 例行钻孔引流术治疗 CSDH。术后 17 例（12%）复发。根据术后药物治疗（如和血明目片、卡络磺钠、氨甲环酸）进行倾向评分匹配，0-2 种药物治疗组和 3 种药物治疗组各纳入 39 例。0-2 种药物治疗组复发率为 18%，3 种药物治疗组为 3%。单因素分析显示，与使用 3 种药物相比，使用 0-2 种药物治疗与 CSDH 复发风险增加相关（优势比[OR]，8.31；95%置信区间[CI]，0.97-71.17；p=0.05）。多因素回归分析进一步证实，术后使用 0-2 种药物与 CSDH 复发风险增加相关（OR，11.06；95%CI，1.16-105.4；p=0.037）。术前对 36 例血肿进行评估，14 例 CSDH 显示血肿密度降低和新小梁形成等变化（39%）。多因素回归分析显示，与 0-2 种药物治疗相比，3 种药物治疗与更多的血肿变化相关（OR，13.9；95%CI，1.09-177.65；p=0.043）。3 种药物治疗可有效降低钻孔引流术后血肿复发率，促进血肿血栓形成。
