Management of Recurrent Subdural Hematomas.
Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage. Most recurrent hematomas are managed successfully with burr hole craniostomies with postoperative closed-system drainage. Refractory hematomas may be managed with a variety of techniques, including craniotomy or subdural-peritoneal shunt placement.
Department of Neurosurgery, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA. Electronic address: vrdesai@houstonmethodist.org.
Virendra R
VR
Desai
Department of Neurosurgery, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA.
Robert A
RA
Scranton
Department of Neurosurgery, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA.
Gavin W
GW
Britz
D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D011182:Postoperative Care; D011183:Postoperative Complications; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
Chronic subdural hematoma; Recurrent hematoma; Recurrent subdural hematoma; Subdural hematoma