title: Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma.
abstract: OBJECTIVE
  There is inconsistency among the perioperative management strategies currently used for chronic subdural hematoma (cSDH). Moreover, postoperative complications such as acute intracranial bleeding and cSDH recurrence affect clinical outcome of cSDH surgery. This study evaluated the risk factors associated with acute intracranial bleeding and cSDH recurrence and identified an effective perioperative strategy for cSDH patients.
  
  
  METHODS
  A retrospective study of patients who underwent bur hole craniostomy for cSDH between 2008 and 2012 was performed.
  
  
  RESULTS
  A consecutive series of 303 cSDH patients (234 males and 69 females; mean age 67.17 years) was analyzed. Postoperative acute intracranial bleeding developed in 14 patients (4.57%) within a mean of 3.07 days and recurrence was observed in 37 patients (12.21%) within a mean of 31.69 days (range 10-104 days) after initial bur hole craniostomy. The comorbidities of hematological disease and prior shunt surgery were clinical factors associated with acute bleeding. There was a significant risk of recurrence in patients with diabetes mellitus, but recurrence did not affect the final neurological outcome (p = 0.776). Surgical details, including the number of operative bur holes, saline irrigation of the hematoma cavity, use of a drain, and type of postoperative ambulation, were not significantly associated with outcome. However, a large amount of drainage was associated with postoperative acute bleeding.
  
  
  CONCLUSIONS
  Bur hole craniostomy is an effective surgical procedure for initial and recurrent cSDH. Patients with hematological disease or a history of prior shunt surgery are at risk for postoperative acute bleeding; therefore, these patients should be carefully monitored to avoid overdrainage. Surgeons should consider informing patients with diabetes mellitus that this comorbidity is associated with an increased likelihood of recurrence.
authors: Department of Neurosurgery, Seoul National University Hospital;
authors: Chang Hwan
authors: CH
authors: Pang
authors: Department of Neurosurgery, Seoul National University Hospital;
authors: Soo Eon
authors: SE
authors: Lee
authors: Department of Neurosurgery, Seoul National University Hospital;
authors: Chang Hyeun
authors: CH
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Jeong Eun
authors: JE
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Hyun-Seung
authors: HS
authors: Kang
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Chul-Kee
authors: CK
authors: Park
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Sun Ha
authors: SH
authors: Paek
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Chi Heon
authors: CH
authors: Kim
authors: Department of Neurosurgery, Bundang Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Tae-Ahn
authors: TA
authors: Jahng
authors: Department of Neurosurgery, Bundang Seoul National University Hospital;
authors: Jin Wook
authors: JW
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital;
authors: Yong Hwy
authors: YH
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Dong Gyu
authors: DG
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Chun Kee
authors: CK
authors: Chung
authors: Department of Neurosurgery, Seoul National University Hospital;|Department of Neurosurgery, Seoul National University College of Medicine; and.
authors: Hee-Won
authors: HW
authors: Jung
authors: Department of Neurosurgery, National Cancer Center, Seoul, Korea.
authors: Heon
authors: H
authors: Yoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004322:Drainage / Q000009:adverse effects; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012886:Skull / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: SDH = subdural hematoma; VP = ventriculoperitoneal; acute intracranial bleeding; bur hole craniostomy; cSDH = chronic SDH; chronic subdural hematoma; recurrence; traumatic brain injury