Foppen M, Slot K M, Vandertop W P, Verbaan D
Department of Neurosurgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.
Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands.
Acta Neurochir (Wien). 2025 May 19;167(1):147. doi: 10.1007/s00701-025-06552-1.
Burr hole drainage is the mainstay of treatment for chronic subdural hematoma (cSDH). However, the impact of the interval between diagnosis and surgery on clinical outcome is unknown. This study investigates whether surgical timing affects outcome in patients with mild to moderate symptoms who do not require immediate surgery.
We performed a single center, retrospective cohort study of 330 surgically treated cSDH patients with a Markwalder Grading Scale score of 1-2, at the Amsterdam UMC, between 2012 and 2022. The interval between diagnosis and surgery was measured in hours and dichotomized (surgery within vs. after 24 h). To account for potential confounding by hematoma mass effect, patients were stratified based on midline shift (greater than 10 mm vs < 10 mm). Primary outcomes included reoperation rate, complication rate, 30-day mortality, length of hospital stay and discharge destination. Univariable and multivariable regression analyses were performed for each stratum.
The mean age of the cohort was 73 years, and 241 (73%) were male. The median time to surgery was 25 h (IQR 15-54). Among the 330 patients, 157 (48%) underwent surgery within 24 h after diagnosis. Patients who received early surgery (< 24 h) had a significantly higher proportion of midline shift > 10 mm compared to those undergoing later surgery (56% vs. 34%, p < 0.001). The use of anticoagulant or antiplatelet therapy did not differ between groups (47% vs 54%, p = 0.27). No significant association was found between surgical timing and any primary outcome across all strata.
In patients with cSDH presenting with mild to moderately symptoms, the timing of surgery did not affect clinical outcome, particularly as delayed surgery did not result in poorer outcomes. These findings suggest that postponing surgery to daytime hours may be safe in this subgroup. Validation in prospective studies, ideally incorporating functional outcomes, is nevertheless required to confirm these results and guide clinical practice.
钻孔引流是慢性硬膜下血肿（cSDH）治疗的主要方法。然而，诊断与手术之间的时间间隔对临床结局的影响尚不清楚。本研究调查手术时机是否会影响症状轻至中度、无需立即手术的患者的结局。
我们在阿姆斯特丹大学医学中心进行了一项单中心回顾性队列研究，研究对象为2012年至2022年间330例接受手术治疗、Markwalder分级量表评分为1-2级的cSDH患者。诊断与手术之间的时间间隔以小时为单位进行测量，并分为两组（24小时内手术与24小时后手术）。为了考虑血肿占位效应可能造成的混杂因素，根据中线移位情况（大于10毫米与小于10毫米）对患者进行分层。主要结局包括再次手术率、并发症发生率、30天死亡率、住院时间和出院去向。对每个分层进行单变量和多变量回归分析。
该队列的平均年龄为73岁，男性241例（73%）。手术的中位时间为25小时（四分位间距15-54）。在330例患者中，157例（48%）在诊断后24小时内接受了手术。与接受较晚手术的患者相比，接受早期手术（<24小时）的患者中线移位>10毫米的比例显著更高（56%对34%，p<0.001）。两组之间抗凝或抗血小板治疗的使用情况无差异（47%对54%，p=0.27）。在所有分层中，未发现手术时机与任何主要结局之间存在显著关联。
对于表现为轻至中度症状的cSDH患者，手术时机不影响临床结局，特别是延迟手术并未导致更差的结局。这些发现表明，在该亚组中推迟手术至白天可能是安全的。不过，仍需要在前瞻性研究中进行验证，理想情况下纳入功能结局，以证实这些结果并指导临床实践。
