Natural course of chronic subdural hematoma following surgical clipping of unruptured intracranial aneurysm by pterional approach
10.7461/jcen.2023.E2023.04.017
- Author:
Su-Bin KWEON
1
;
Suchel KIM
;
Min-Yong KWON
;
Chang-Hyun KIM
;
Sae Min KWON
;
Yong San KO
;
Chang-Young LEE
Author Information
1. Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
- Publication Type:Clinical Article
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2023;25(4):390-402
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:Chronic subdural hematoma (CSDH) is a neurological complication following clipping surgery. However, the natural course and ideal approach for the treatment of clipping-related-CSDH (CR-CSDH) have not been clearly established. We aimed to investigate the course of CR-CSDH using chronological radiological findings.
Methods:We performed a retrospective analysis of 28 (3.8%) patients who developed CSDH among 736 patients who underwent surgical clipping using pterional approach for unruptured aneurysms at our institution between December 2010 and December 2018. Patients underwent follow-up CT scan 6–8 weeks after clipping surgery and decision to pursue surgical intervention rests upon the patient’s symptom based on the Markwalder’s grading scale (MGS) and numeric rating scale (NRS).
Results:Of the 28 patients, 3 patients (10.7%) underwent surgery, while 25 (89.2%) showed spontaneous resolution of CR-CSDH. Eighteen patients (64.2%) had mild headache with MGS of 0–1. The mean maximum hematoma volume was 41.9±30.9 ml (5.8–135 ml), and 26 patients (92.8%) had homogeneous hematoma. The mean time to hematoma resolution was 126.7±52.9 days (46–228 days). Comparing group of CR-CSDH volume ≥43 ml or a midline shift ≥5 mm, the difference in presence of linear low-density area (p=0.002) and age (p=0.026) between the conservative and operative groups were found to be statistically significant.
Conclusions:Most CR-CSDH cases spontaneously resolved within 4 months. Therefore, we suggest that close observation should be performed if patient’s symptoms are mild and special radiologic findings are present, despite its relatively large volume and midline shifting.
