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Purpose: A substantial proportion of patients undergoing surgery for chronic subdural hematoma (CSDH) use anticoagulation medication due to atrial fibrillation (AF). We assessed the risk of postoperative thromboembolic and hemorrhagic complications in CSDH surgery patients with a history of anticoagulation for AF and their association with outcome. Methods: This posthoc analysis of a nationwide multicenter randomized controlled trial conducted during 2020–2022 included CSDH patients undergoing surgery with a history of preoperative anticoagulation use for AF. We assessed the incidence of thromboembolic and hemorrhagic complications and their associations with functional outcomes and mortality. Results: Of 589 patients, 128 patients (median age 83 years, 24% females) were on anticoagulation medication due to AF. The incidences of postoperative thromboembolic and hemorrhagic complications were 8% and 6%, respectively. A significantly higher proportion of patients with a thromboembolic complication had unfavorable functional outcome (70% vs. 21%, p < 0.001) and higher mortality (50% vs. 14%) than those without. After adjusting for risk factors, a thromboembolic complication was independently associated with a higher risk for unfavorable outcome (OR 16.8, 95% CI 3.0–94.2) and death (OR 11.1, 95% CI 2.4–52.0). Similarly, hemorrhagic complications associated independently with unfavorable outcome, although the effect size was smaller than for thromboembolic complications. Conclusion: The risk for thromboembolic complications seemed to be slightly higher than the risk for postoperative hemorrhagic complications after CSDH surgery in patients with a history of preoperative anticoagulation medication use due to AF. The occurrence of a thromboembolic complication was detrimental for patient prognosis, underscoring the importance of strategies to prevent thromboembolic events. There is an urgent need for a trial assessing the optimal timing of restarting anticoagulation medication after CSDH surgery. Trial registration: ClinicalTrials.gov identifier NCT04203550. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical conditions. Although surgical evacuation is still the gold standard for treatment, recent advances have led to the development of other management strategies, such as medical therapies and endovascular middle meningeal artery (MMA) embolization. Through this international survey, we investigated the global trends in cSDH management, focusing on medical and endovascular treatments. Design and participants: A 14-question, web-based, anonymous survey was distributed to neurosurgeons worldwide. Results: Most responders do not perform MMA embolization (69.5%) unless for specific indications (29.6%). These indications include residual cSDH after surgical evacuation (58.9%) or cSDH in patients on antiplatelet medications to avoid surgical evacuation (44.8%). Survey participants from teaching versus non-teaching hospitals (p = 0.002), public versus private hospitals (p = 0.022), and Europe versus other continents (p < 0.001) are the most users of MMA embolization. A large number of participants (51%) declare they use a conservative/medical approach, mainly to avoid surgery in patients with small cSDH (74.8%). Conclusions: This survey highlights the current trends of cSDH management, focusing on conservative and MMA embolization treatment strategies. Most responders prefer a conservative approach for patients with small cSDHs not requiring surgical evacuation. However, in higher-risk scenarios such as residual hematomas after surgery or patients on antiplatelet medications, MMA embolization is regarded as a reasonable option by participants. Future studies should clarify the indications of MMA embolization, including appropriate patient selection and efficacy as a stand-alone procedure. [ABSTRACT FROM AUTHOR]

Background: The main surgical interventions for chronic subdural hematoma (CSDH) include craniotomy for hematoma evacuation, neuroendoscopic hematoma evacuation, and burr hole drainage.However, elderly patients often present with significant comorbidities, which limit their ability to tolerate general anesthesia and invasive surgical procedures.Minimally invasive soft-channel drainage under local anesthesia has emerged as a viable alternative, particularly suitable for elderly patients or those with high surgical risk.This study aims to evaluate the clinical outcomes and complication rates of minimally invasive soft-channel drainage assisted by 3D Slicer software for the treatment of CSDH. It also aims to provide new clinical evidence to help improve and optimize treatment protocols for this condition. Methods: A retrospective analysis was conducted involving 83 patients with CSDH treated in our department between January 2021 and December 2023. Patients were categorized into two groups based on the surgical intervention: the control group (burr-hole drainage, n = 42) and the intervention group (minimally invasive soft-channel drainage, n = 41).Baseline characteristics, anesthesia methods, perioperative metrics, and complications were compared. Clinical outcomes were evaluated using the Barthel Index and the modified Rankin Scale (mRS) preoperatively and three months postoperatively. Results: The drainage retention duration, operative time, and hospitalization period in the intervention group were significantly reduced compared to the control group, with reduced intraoperative blood loss (all P < 0.05). There was no significant difference in residual hematoma volume between the groups on postoperative day one (P > 0.05). The incidence of postoperative complications, including pulmonary infection, recurrent subdural hemorrhage, cerebrospinal fluid leakage, and intracranial pneumatosis, was significantly lower in the intervention group compared to the control group (all P < 0.05). No intracranial infections were observed in either group, and there was no statistically significant difference in hematoma recurrence rates (P > 0.05). Similarly, no significant differences were observed in the preoperative and three-month postoperative Barthel Index and mRS scores between groups (all P > 0.05). However, both groups demonstrated significant improvement in mRS and Barthel Index scores at three months postoperatively compared to preoperative levels(all P < 0.001). Conclusion: Both minimally invasive soft-channel drainage assisted by 3D Slicer and burr-hole drainage are safe and effective interventions for CSDH. Nevertheless, the minimally invasive approach provides significant benefits in terms of reducing intraoperative blood loss, shortening operative time, minimizing surgical trauma, and reducing the rate of complications. This approach is only advantageous for patients with well-liquefied hematomas and those with relative contraindications to general anesthesia. [ABSTRACT FROM AUTHOR]

Middle meningeal artery embolization (MMAE) has revolutionized the armamentarium for chronic subdural hematoma (CSDH) treatment. Technical and angiographic benchmarks to guide procedural and clinical success are less well established. A single-center database was reviewed to compare outcomes after standalone MMAE with and without resultant residual angiographic opacification of frontal and parietal (F/P) branches. Primary outcome was surgical rescue for CSDH progression. Secondary outcomes included the efficiency and accumulated efficacy of hematoma resolution. Effect sizes were adjusted via multivariable regression. Of 147 standalone MMAE for CSDH, the overall rate of surgical rescue was 6.8%. Nonopacification of F/P branches via proximal middle meningeal artery or meningo-ophthalmic anastomosis was achieved after 83% of procedures and was associated with a 7-fold decreased rate of surgical rescue (3.3% vs. 24%, P = 0.001). At 90-day follow-up, a higher rate of hematoma resolution ≥50% was achieved if no residual opacification was identified (82% vs. 56%, P = 0.03). The median time to 50% hematoma resolution was 44 days for the no-residual group versus 71 days for the residual group (P < 0.001). The unfavorable effects of residual opacification of F/P branches were verified in a multivariate analysis: a higher risk of surgical rescue (adjusted odds ratio 24.6; P = 0.001) and poor hematoma resolution were both confirmed (adjusted hazard ratio 0.3; P = 0.001). MMAE with nonopacification of F/P branches was associated with augmented efficacy. Nuanced MMAE adequately tackling culprit dural feeders should be considered for more effective procedures. [ABSTRACT FROM AUTHOR]

The middle meningeal artery (MMA) is a major dural vessel that plays a significant role in developing chronic subdural hematomas (cSDHs). Understanding its variable anatomy is essential for the effective management of cSDH and the prevention of complications. MMA anatomy was retrospectively assessed in a population of 92 patients who underwent digital subtraction angiography of cerebral vessels before MMA embolization for cSDH. We assessed 121 MMAs in 92 patients who underwent digital subtraction angiography for cSDH treatment from October 2020 to July 2023. The most common type in the extended Adachi classification was IC (19.82%) and the rarest was IB (6.31%). The anterior branch of the MMA was the most frequently dominant, while the most common origin of the posterior branch was observed in the distal segment. We reported 4 cases (3.31%) of the MMA arising from the ophthalmic artery. The most common configuration of MMA was Adachi-type IC. The MMA most often originated from the maxillary artery. The posterior branch of the MMA was typically dominant and most frequently originated from the distal segment. There was no significant impact of Adachi type on treatment results or fluoroscopy time. [ABSTRACT FROM AUTHOR]

We assessed the effectiveness of a treatment strategy based on hematoma characteristics and volume. From September 2022 to December 2023 (the Study period), a 2-center retrospective observational study of initial chronic subdural hematoma was performed. The baseline period was from January 2018 to December 2019. Patients were classified into the high and low retreatment rate groups (Groups H and L, respectively). During the Study period, Group H was treated with drainage and middle meningeal artery embolization, while Group L was treated with drainage or middle meningeal artery embolization alone. During the Baseline period, all the patients were treated with drainage alone. The primary and secondary endpoints were group retreatment rates and severe procedure-related complications requiring surgical intervention and permanent sequelae, respectively. Fifty-two patients were included during the Study period (31 in Group H and 21 in Group L) and 53 during the Baseline period (32 in Group H and 21 in Group L). Three (5.8%) and 9 (17.0%) patients required retreatment in the Study and Baseline periods, respectively (P = 0.12). One (3.2%) and 9 (28.1%) patients in Group H required retreatment during the Study and Baseline periods, respectively (P = 0.01). Similarly, 2 patients (9.5%) and no patient in Group L required retreatment during the Study and Baseline periods, respectively (P = 0.49). No severe complications were reported throughout. Chronic subdural hematoma treatment strategies that consider to hematoma volume and characteristics have the potential to identify and reduce treatment rates in cases with high retreatment rates. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition that is known to recur and that leads to unfavorable clinical outcomes. Middle meningeal artery embolization (MMAE) has emerged as an alternative treatment to prevent recurrence. This study investigated the efficacy of combined 2 therapies in a hybrid operative suite for high-risk patients. This retrospective review provides evidence for the indications and benefits of one-stage combined therapy in a hybrid neurovascular operative suite. The procedures include burr hole craniostomy, irrigation, and drainage followed by adjuvant MMAE at the lesion site. Subsequently, routine cone beam computed tomography is conducted after the whole process. Five patients with symptomatic CSDH and mass effect were enrolled in this study. Among them, 3 patients had undergone burr hole surgery previously but experienced hematoma recurrence. Two patients presented with a history of recent cardiac stent placement due to coronary artery disease, precluding the cessation of antiplatelet or anticoagulant therapy. All patients experienced symptom resolution and demonstrated no evidence of CSDH recurrence during the follow-up period. In our initial case experiences, one-stage burr hole surgery and adjuvant MMAE for treating chronic subdural hematoma in a hybrid operative angiography suite could be a feasible and effective treatment modality. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma (cSDH) ranks among the most prevalent neurosurgical conditions, with burr-hole drainage typically yielding favorable prognoses. Nevertheless, perioperative complications may arise, with remote intraparenchymal hemorrhage and subarachnoid hemorrhage occurring infrequently, while acute subdural hematoma (aSDH) remains a relatively common complication post-cSDH removal. The standard treatment for aSDH, typically large craniotomy, substantially elevates surgical risk. Patients admitted over the course of 51 months (February 2022 to May 2024) to a single institution for treatment of cSDH were retrospectively evaluated, with three cases of postoperative aSDH in elderly patients with cSDH, examining potential causative factors and proposing pertinent strategies. Three elderly patients, admitted urgently due to exacerbating symptoms, underwent preoperative assessment followed by emergency parietal burr-hole drainage. Regrettably, all three patients developed aSDH postoperatively. Various treatment approaches were employed: two cases received thrombolysis with 50,000 units of urokinase, while one case required a large craniotomy. Despite the patients achieving satisfactory outcomes without significant neurological deficits, this study advocates thrombolytic therapy as a potentially superior option for aSDH following cSDH surgery. Urokinase-mediated subdural thrombolysis enhances hematoma clearance rates, suggesting a shift toward minimally invasive treatments to mitigate greater trauma. However, the paucity of evidence necessitates extensive research to validate its safety and efficacy. [ABSTRACT FROM AUTHOR]

Objective Chronic subdural hematoma (cSDH) is common, predominantly affects the elderly, often recurs after treatment, and can have serious complications, including death. Inflammation plays an important role in cSDH and it has been previously shown that some laboratory indices are useful as prognostic markers. The aim was to research the role of hematologic and inflammatory markers in cSDH. Materials and Methods A single-center archival database review to retrieve data on cSDH cases operated on between 2018 and 2020, including: (1) sociodemography (age, gender), (2) clinics (Glasgow Coma Score [GCS], anticoagulants, chronic conditions), (3) laboratory (leukocyte, neutrophil, platelet, C-reactive protein, hemoglobin, red cell distribution width [RDW], neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio [PLR], systemic immune-inflammatory index [SII]), (4) cSDH (size, location, midline shift), and (5) treatment (craniotomy/craniostomy, drainage). Primary outcome was Glasgow Outcome Score (GOS) at discharge and at 1 year, and secondary outcomes were 1 year mortality, resurgery, and recurrence. Hematological and inflammatory indices were compared across two cSDH thickness groups. Results Seventy-two patients were included, 25 women and 47 men, median age 77 years. Seventeen (23.6%) patients had chronic anticoagulant treatment. The majority had a chronic comorbidity: 19 (26.4%) diabetes, 48 (66.7%) hypertension, and 56 (77.8%) other chronic diseases. Median preoperative GCS was 15. Median cSDH thickness was 22.9 mm, sidedness was equally distributed, and midline shift occurred in 60 (83.3 %) patients, with median midline shift of 8.4 mm. The majority of patients underwent a single craniostomy (n = 44, 61.1%), and in all patients a subdural drainage was placed. Median GOS at discharge and at 1 year postoperatively was 5. Mortality was 11.1%, and 16.7% of patients were lost to follow-up. Within the 1-year follow-up, 27.8% of patients had disease recurrence, 25% underwent a repeat surgery. In the "above" versus "below" 15 mm cSDH thickness group there were significant differences in P count (211.5 vs. 279.5 × 10 9 /L, p = 0.009), RDW (13.3 vs. 12.6, p = 0.031), SII (1782 vs. 2653, p = 0.025), and PLR (26.2 vs. 36.7, p = 0.042). Conclusion Hematological indices bear a diagnostic and prognostic potential in cSDH management. [ABSTRACT FROM AUTHOR]

Objective Chronic subdural hematoma (CSDH) is a common neurological problem with significant recurrence after surgery. Risk considerations can vary, ranging from patient-related factors to those related to the surgical procedure. This study explores the association between preoperative eosinophil count and systemic immune inflammation (SII) with CSDH recurrence. Materials and Methods We conducted a prospective analysis of 105 patients with equal numbers of CSDHs who underwent surgery for CSDH between January 2023 and January 2024. The preoperative eosinophil counts, along with other differential leukocyte counts, were measured. The SII index was calculated using the standard formula (SII = neutrophil count × platelet count/lymphocyte count). Multivariate and univariate regression analyses were performed to assess the association between risk factors and CSDH recurrence. Results The preoperative eosinophil count showed a significant correlation with recurrence (p < 0.001). The SII index was significantly higher in patients with recurrent CSDH (p = 0.003). Neutrophils were found to be significantly associated with CSDH recurrence (p = 0.038). Age (p < 0.001) and SII (p = 0.005) were found to be independent predictors of CSDH recurrence, whereas hematoma volume (p < 0.001) and the antiplatelet regimen were a significant predictor of CSDH recurrence (p = 0.047). Variables like male gender, diabetes mellitus, anticoagulants, and hematoma volume were associated with eosinophil-rich or eosinophil-poor status. Conclusion Preoperative eosinophil count, neutrophils, and the SII index may serve as potential predictors of CSDH recurrence. Further studies with larger sample sizes are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Purpose: Clinicians treating patients with atrial fibrillation (AF) on oral anticoagulants who undergo surgery for chronic subdural hematoma (CSDH) face a dilemma: while early postoperative resumption of anticoagulation is necessary to prevent embolism, it may increase the risk of CSDH recurrence. To date, however, no study has evaluated this question while adequately addressing common biases in observational studies. Here, we assessed this issue using target trial emulation framework. Methods: We identified patients undergoing initial CSDH surgery who had received anticoagulation for AF preoperatively from two hospital‐based administrative databases (2014–2022). We compared two treatment strategies: resumption of anticoagulation within 14 days postoperatively versus no resumption during this period. Using a three‐step method of cloning, censoring, and weighting, we estimated the risk of CSDH recurrence, along with the risk ratio and risk difference at postoperative day 90. Results: 291 CSDH patients with AF were eligible, of whom 29 (10.0%) underwent CSDH reoperation. The weighted estimated 90‐day reoperation risk was 11.7% (95% confidence interval [CI], 6.0 to 14.3) for resuming anticoagulation within 14 days postoperatively and 9.4% (95% CI, 4.1 to 12.8) for not resuming within 14 days, corresponding to a risk ratio of 1.20 (95% CI, 0.67 to 2.36) and risk difference of 1.9% (95% CI, −4.0 to 6.6). Conclusions: 90‐day risk of CSDH recurrence may not differ between early and non‐early resumption of anticoagulation, although early resumption could modestly accelerate recurrence. Allowing for the imprecision of the estimates, these findings provide important insights for clinical decision‐making regarding anticoagulation resumption. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma (cSDH) is one of the most prevalent neurosurgical diseases, especially in the elderly. Yet, its incidence is predicted to increase further, paralleling the growth of the geriatric population. While surgical evacuation is technically straightforward, it is associated with significant morbidity and mortality. In fact, 30% of patients are expected to have hematoma recurrence and to need repeat surgical evacuation, and 20% of patients are expected to lose independence and require long-term care. A pathophysiology more complex than originally presumed explains the disappointing results observed for decades. At its core, the formation of microcapillaries and anastomotic channels with the middle meningeal artery (MMA) perpetuates a constant cycle resulting in persistence of hematoma. The rationale behind MMA embolization is simple: to stop cSDH at its source. Over the last few years, this "newer" option has been heavily studied. It has shown tremendous potential in decreasing hematoma recurrence and improving neurological outcomes. Whether combined with surgical evacuation or performed as the only treatment, the scientific evidence to its benefits is unequivocal. Here, we aimed to review cSDH in the elderly and discuss its more recent treatment options with an emphasis on MMA embolization. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is a type of spontaneous or post-traumatic intracranial hemorrhage located between the dura mater and arachnoid membrane. It is a neurosurgical disease that often occurs in the elderly. Burr-hole drainage is the main treatment method, and smear microscopic examination of the drainage fluid is a common laboratory method. Methods: A cranial magnetic resonance imaging (MRI) was performed, then blood and drainage fluid from patients with CSDH was collected and sent to the laboratory for routine laboratory tests. Results: Both patients' cranial MRI indicated CSDH, while no significant abnormalities were found in blood-related tests. Microscopic examination of postoperative drainage fluid revealed a significantly increased proportion of eosinophils. Conclusions: It is found that the mechanism of eosinophil infiltration in CSDH and its significance for patients are still unclear by combining the cases and relevant literatures. Further research is needed to study the distribution and changes of eosinophils and related chemokines in the peripheral blood and postoperative drainage fluid from CSDH patients, which is of great significance for the treatment and recurrence prediction of CSDH patients. [ABSTRACT FROM AUTHOR]

Background: The procedure of middle meningeal artery embolization (MMAE) has emerged as a minimally invasive therapy for chronic subdural hematoma (CSDH). Previous studies comparing MMAE with conventional treatment for CSDH did not differentiate primary/upfront, adjunct, or rescue MMAE, and included both conservative and surgical treatment in the comparison group. We conducted a systematic review and meta-analysis to compare outcomes after adjunct MMAE (MMAE combined with surgical evacuation) versus surgery alone for CSDH. Methods: PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched to August 2023. Primary outcomes were treatment failure and reoperation. Secondary outcomes were complications, mortality, length of hospital stay, 30-day readmission, and follow-up modified Rankin Scale (mRS) > 2. Additional data from our institution was included. Results: 12 published studies and our data yielded 57,165 patients, of whom 1,065 (1.9%) received adjunct MMAE and 56,100 (98.1%) surgery alone. Compared to surgery alone, adjunct MMAE was associated with lower rates of treatment failure (OR = 0.43 [0.23–0.83], p = 0.01), reoperation (OR = 0.45 [0.22–0.90], p = 0.02), and 30-day readmission (OR = 0.50 [0.34–0.73], p < 0.001). Length of hospital stay (MD = 2.49 [–0.51, 5.49], p = 0.10) was non-significantly longer in the adjunct MMAE group. Both groups had comparable rates of treatment-related complications (OR = 0.89 [0.52–1.53], p = 0.67), mortality (OR = 1.05 [0.75–1.46], p = 0.78), and follow-up mRS > 2 (OR = 0.91 [0.39–2.12], p = 0.83). Conclusions: Adjunct MMAE reduces treatment failure, reoperation, and readmission rates without increasing morbidity and mortality. MMAE may be considered as an adjunct to surgical evacuation to reduce CSDH recurrence. Randomized trials will further establish the evidence for adjunct MMAE and its role in the management of CSDH. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is increasingly common due to the aging population and widespread use of anticoagulant and antiplatelet medications. The objective of this study is to examine the internal composition of CSDH and explore potential risk factors associated with its recurrence. Methods: This retrospective study analyzed data from 189 patients who underwent surgery in our department between 2014 and 2018. Recorded data included demographics, clinical information, details of surgical interventions, computer tomography (CT) scans, neurological assessments, and follow-up data. The outcome was evaluated clinically and through CT follow-up conducted 4–12 weeks post-surgery. CT scans measured various parameters, including hematoma thickness, hyperdense regions, chronic components, and membrane presence. Results: Patients after the evacuation of CSDH were significantly more common males (66.1%, p > 0.001) had a significantly higher BMI (p < 0.001, 61.6%), arterial hypertension (p < 0.001, 68.3%), and the intake of anticoagulant therapy (p < 0.001, 58%). The recurrence rate was 18.6% after 4 weeks and 2.1% after 8–12 weeks. After uni- and multivariable analysis, the initial hemispheric type (p = 0.019, HR: 3.191; p = 0.012, HR: 3.810) and the increasing preoperative midline shift in CT (p = 0.028, HR: 1.114; p = 0.041, HR: 1.107) were found as independent predictors for recurrence. Overall, outcomes were favorable with a modified Rankin scale (mRS) of 0–2 at discharge (72%), after 4 (89.7%) and 12 (87%) weeks. Conclusion: According to our data, increasing midline shift before surgery and initial hemispheric type of hematoma were independent predictors of recurrence. Most patients achieved an excellent outcome with a low-risk profile. [ABSTRACT FROM AUTHOR]

Objective: The optimal timing of surgical intervention for chronic subdural hematomas (CSDH), specifically night-time versus daytime, remains a subject of debate, with concerns about the potential impact of circadian timing on surgical outcomes. This study evaluated the association between the timing of burr-hole drainage for CSDH and postoperative outcomes, comparing night-time and daytime surgeries. Methods: In a post-hoc analysis of the FINISH trial, we included adult patients with symptomatic unilateral or bilateral CSDH who underwent burr-hole drainage between January 2020 and August 2022. Night-time surgery was defined as procedures starting between 23:00 and 06:00, with daytime surgeries occurring between 06:01 and 22:59. The primary outcome was functional outcome at six months post-surgery, assessed using the modified Rankin Scale (mRS), with favorable outcomes defined as an mRS of 0–3. Secondary outcomes included mortality, reoperation rates, and adverse events within six months. Results: Our analysis of 589 patients (83% daytime surgery, 17% night-time surgery) revealed no significant differences in baseline characteristics. The unadjusted analysis suggested a higher rate of favorable functional outcomes in the night-time surgery group than in the daytime group (94% vs. 86%, p = 0.037). Mortality, adverse events, and reoperation rates were similar in the groups. Adjusted logistic regression analyses, accounting for potential confounders, indicated that night-time surgery was not associated with a higher risk of unfavorable functional outcomes compared to daytime surgery. Conclusions: Our findings suggest that night-time surgery versus daytime surgery is not associated with worse postoperative outcomes. These findings challenges the traditional preference for daytime CSDH surgery and emphasizes the potential for flexibility in surgical scheduling to optimize patient care in CSDH management. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is an important medical condition characterized by the accumulation of blood in the subdural space. Several methods have been explored, including surgical intervention and administration of tranexamic acid, which is a conservative treatment option. This meta-analysis aimed to assess the effectiveness and safety of tranexamic acid in CSDH management. Methods: A systematic literature search was performed according to the PRISMA and MOOSE guidelines. This study included cohort and randomized controlled trials involving adults with chronic subdural hematoma (CSDH) who were treated with intravenous tranexamic acid. The primary outcome measures were recurrence and adverse events. Results: Six studies encompassing 2024 participants were included. Studies have shown that tranexamic acid reduced recurrence rates (OR, 0.32; 95% CI: 0.27–0.38, p = 0.16; I2 = 0%), although the result was non-significant. However, the analysis of adverse events indicated a moderate level of heterogeneity (OR, 1.14; 95% CI: 0.60–2.15, p = 0.07; I2 = 57%), suggesting a potential safety concern. Conclusion: In conclusion, this meta-analysis suggests tranexamic acid (TXA) may reduce chronic subdural hematoma (CSDH) recurrence, though significance varied across studies. Adverse effects with TXA were similar to controls. Larger trials are needed to confirm TXA's role in CSDH management. [ABSTRACT FROM AUTHOR]

Background: Standard treatment for symptomatic chronic subdural hematoma (CSDH) is a burr-hole evacuation. However, in patients in whom surgical evacuation carries a very high risk, we do not have an established practice guideline. Objective: To analyze the outcome of symptomatic CSDH treated only by tranexamic acid. Material and Methods: A total of 22 admitted patients with symptomatic chronic subdural hematoma from 2018 to 2019 were included in the study. All patients were managed conservatively with oral tablet tranexamic acid 250 mg thrice daily till the resolution of hematoma. Patients were followed up every month with CT scan brain. Data regarding the volume of hematoma, resolution of hematoma, and recurrence of hematoma were anonymized and analyzed. Results: The median duration of treatment was 60 days (range 30–98). The median volume of hematoma before the initiation of the therapy was 74 ml (range 66–96), and it was reduced to 2 ml after the therapy with tranexamic acid. The median midline shift before the initiation of the therapy was 15 mm (range 10–20), and it was zero in all patients following the treatment. There was no progression or recurrence of hematoma in any one of patients. No major complications (thromboembolic events) due to the use of tranexamic acid were seen in any patient. Conclusion: Even symptomatic patients with chronic subdural hematoma can be effectively managed with tranexamic acid when the surgical drainage is risky or not possible. It can be used as an alternative to surgery when there is no immediate threat to life. [ABSTRACT FROM AUTHOR]

Conservative treatments for minimally symptomatic chronic subdural hematoma (cSDH) are debated, with surgery as the primary option. To assess failure rates of a conservative approach for management of cSDH. We searched PubMed, SCOPUS, Web of Science, and ClinicalTrials.gov for studies on conservative management of cSDH and analyzed the data using R (version 4.1.2). A total of 35 studies including 2095 patients were analyzed: 950 (45%) of the patients were in the observation group, 671 (32%) in the corticosteroid group, 355 (17%) in the atorvastatin group, 43 (2%) in the mannitol group, 52 (2.5%) in the tranexamic acid group, and 24 (1.1%) in the etizolam group. Our pooled analysis showed that 19.82% of patients required rescue surgery (95% confidence interval [CI]: 12.98% to 26.66%, P < 0.0001). The overall pooled risk ratio (RR) for the effect of interventions on the need for rescue surgery was 0.2424 (95% CI: 0.1577 to 0.3725, Iˆ2 = 90.5%, P < 0.0001). Subgroup analysis showed varied effects: observation group (RR = 0.3482, 95% CI: 0.1045 to 1.1609, Iˆ2 = 94.0%), corticosteroids (RR = 0.2988, 95% CI: 0.1671 to 0.5344, Iˆ2 = 90.8%), atorvastatin (RR = 0.1609, 95% CI: 0.0985 to 0.2627, Iˆ2 = 53.2%), mannitol (RR = 0.0370, 95% CI: 0.0009 to 1.5244), and tranexamic acid (RR = 0.0585, 95% CI: 0.0026 to 1.2924). The rate of rescue surgery in conservatively managed cSDH patients remains high. Corticosteroids or atorvastatin demonstrates some potential benefit in reducing the failure rate but collective effectiveness is unknown. [ABSTRACT FROM AUTHOR]

Background/Objectives: MMAE (middle meningeal artery embolization) has emerged as a potential effective treatment for cSDH (chronic subdural hematoma). In this study, MMAE efficiency with regards to cSDH cause and architecture was explored. The comparability of cSDH thickness and volume as parameters for cSDH pre- and post-MMAE assessment was also analyzed. Methods: In this retrospective cohort study, 52 consecutive cSDH patients treated with MMAE in a single tertiary center were included. The cohort was divided into two group pairs pertaining to cSDH cause (spontaneous or traumatic) and cSDH architecture (non-mature or mature). The radiological outcome was compared in each group before and after MMAE and between each group pair using CT imaging. A correlation analysis between cSDH thickness and volume before and after MMAE was also performed. Results: A statistically significant positive linear association between cSDH thickness and volume at admission and at each follow-up interval (1–3, 3–6, 6–12 months) was noticed. cSDH thickness and volume reduction in each group was statistically significant, except for a traumatic cSDH volume reduction at 6–12 months. There was no statistically significant difference between each group pair in the cSDH thickness and volume reduction difference at all the follow-up intervals. Conclusions: A comparable efficiency of MMAE may be achieved in non-mature and mature as well as in spontaneous and traumatic cSDH, with an advantage for spontaneous cSDH at 6–12 months follow-up compared to traumatic cSDH. Traumatic cSDH may require a relatively long-term follow-up post-MMAE. cSDH thickness and volume, as parameters for pre- and post-MMAE cSDH evaluation, appear similar. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is commonly treated by burr-hole drainage with subgaleal or subdural drain insertion, mostly based on surgeon's preference. We analyzed the recurrence rate and clinical outcomes after burr-hole drainage for CSDH and subdural or subgaleal drain insertion in a single center, retrospective cohort study. Methods: 700 cases of burr-hole drainage for CSDH between 2017 and 2022 were included. Subdural drain insertion was compared to subgaleal drain insertion. The primary outcome were the rates of recurrence and reoperation. The secondary outcomes consisted of morbidity, postoperative complications, and mortality. Results: Baseline characteristics were comparable. The recurrence and reoperation rate after subdural drainage were respectively 15.3% (38/249) and 9.6% (24/249). The recurrence and reoperation rate after subgaleal drainage were respectively 13.4% (55/409) and 10.8% (44/409). There were no significant associations found in recurrence and reoperation rate between both drain insertions. No differences in morbidity, complication rate and mortality between drain insertion locations was found. Conclusion: We found relative equipoise between subdural or subgaleal drain insertion concerning recurrence, reoperation rate or clinical outcome. A large multicenter randomized controlled trial could be designed to further assess the outcomes of subdural and subgaleal drain placement after burr-hole drainage for CSDH. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, particularly in elderly individuals. Although most patients present with unilateral CSDH, bilateral involvement is not rare. Furthermore, bilateral CSDHs are associated with rapid deterioration and poorer outcomes because of a higher risk of brain herniation than unilateral hematomas. The most contentious issue is the potential herniation of the medial temporal lobe, which remains on the unevacuated side during the brief interval between right and left procedures. We compared simultaneous burr-hole craniostomy with consecutive burr-hole craniostomy for treating bilateral CSDH and to determine whether consecutive evacuation is riskier in terms of brain stem complications. Over a 6.5-year period, patients with bilateral CSDH who had an indication for operation were allocated into two groups randomly. The first group (n = 18) underwent simultaneous evacuation, and the second group (n = 25) underwent consecutive evacuation. Glasgow Coma Scale and Markwalder grades were recorded during the postoperative period. Patients were followed up during the inpatient period and postoperatively at 1, 3, 6, and 12 months after discharge. Mortality, morbidity, surgical complications, reoperation, and, as a combination of all of these, treatment success rates were compared. Treatment success rates were worse in patients with mixed-density hematomas and in female patients at the end of 12 months, but there was no significant difference between the simultaneous and consecutive evacuation groups at any time. Therefore, the choice of technique can be decided by the surgeon.

OBJECTIVE: Middle meningeal artery embolization (MMAe) has burgeoned as a treatment for chronic subdural hematoma (cSDH). This study evaluates the safety and short-term outcomes of MMAe patients relative to traditional treatment approaches. METHODS: In this retrospective large database study, adult patients in the National Inpatient Sample from 2012-2019 with a diagnosis of cSDH were identified. Cost of admission, length of stay (LOS), discharge disposition, and complications were analyzed. Propensity score matching (PSM) was utilized. RESULTS: A total of 123,350 patients with cSDH were identified: 63,450 without intervention, 59,435 surgery only, 295 MMAe only, and 170 surgery plus MMAe. On PSM analysis, MMAe did not increase the risk of inpatient complications or prolong the length of stay compared to conservative management (p>0.05); MMAe had higher cost ($31,170 vs. $10,768, p0.05). CONCLUSIONS: MMAe had similar LOS and decreased odds of adverse discharge with a modest cost increase compared to conservative management. There was no difference in inpatient complications. Compared to surgery, MMAe treatment was associated with decreased LOS and rates of neurological complications and nonroutine discharge. This nationwide analysis supports the safety of MMAe to treat cSDH.

A 74-year-old man presented with persistent hiccups and headache persisting for 2 days. An anticoagulant was administered for his coronary heart disease. Cranial computed tomography (CT) revealed an intracerebral hemorrhage (ICH) located in the right occipital lobe, without any abnormal findings around the brainstem. The patient underwent endoscopic hematoma evacuation via a burr hole, resulting in immediate resolution of hiccups. Following an uneventful postoperative course, the patient experienced recurrent hiccups on the 47th day postsurgery. A subsequent CT scan taken on the 50th day revealed a compressive chronic subdural hematoma (CSDH) situated in the right frontoparietal convexity. The patient underwent burr-hole irrigation, leading to prompt cessation of the hiccups. Persistent hiccup should be recognized as potential manifestation of supratentorial lesions, including ICH or CSDH. Surgical evacuation of such lesions can rapidly alleviate hiccups associated with these pathologies.

Abstract Background Chronic subdural hematoma (CSDH) is one of the most common diseases in neurosurgery. It is the result of chronic intracranial hemorrhage that converges between the dura mater and arachnoid three weeks after externally injuring the head. Chronic subdural hematomas are a common complication in neurosurgery. With the gradual increase in the amount of hematoma, the surrounding brain tissue is pushed and compressed, resulting in corresponding clinical symptoms and signs. It is reported that the overall incidence rate of CSDH is 1.72 to 20.6 per 100,000 people every year, and the incidence rate of the elderly is particularly high. Methods The computer retrieves eight databases to obtain controlled trials at home and abroad on the effects of neuroendoscopy-assisted surgery in patients with chronic subdural hematoma. After a rigorous literature quality evaluation, data analysis was performed using RevMan 5.3 software. Results Twenty studies were ultimately included in this meta-analysis. Seventeen studies reported the Recurrence rate of the test group and the control group, which was significantly lower (OR 0.27; 95% Cl 0.18, 0.38; P

A 50-year-old man presented with headache and left hemiparesis. No noticeable preceding head trauma was observed. Computed tomography (CT) scans revealed a compressive chronic subdural hematoma (CSDH). The patient underwent burr-hole irrigation, during which he was considerably restless. In addition, extensive avulsion was found in the parietal dura mater posterior to the burr hole. CT performed immediately after the surgery revealed the emergence of a thick epidural hematoma (EDH) located posterior to the burr-hole. During emergency craniotomy for the EDH, there was no identifiable injury to the dura mater or the meningeal vessels. However, a review of the CT scans confirmed well-developed diploic spaces just above the center of the EDH, with connecting channels between the diploic spaces and extracranial sites. Based on these observations, we assumed that the diploic vein might have caused the EDH. Diploic veins can cause AEDH after burr hole irrigation for CSDH. Appropriate intraoperative sedation and protective irrigation maneuvers can reduce the risk of such AEDH.

Objective: Chronic subdural hematoma (CSDH) is a common neurologic disorder with increasing incidence, which can be preceded by head trauma or occur in the absence of trauma. In order to deeply understand the clinical characteristics of this disease, we conducted this retrospective study to explore the clinical differences between traumatic and not otherwise specified (NOS) CSDH. Methods: According to the inclusion and exclusion criteria, 168 traumatic CSDH patients and 133 NOS CSDH patients were recruited from January 2015 to October 2023 in our cohort. The collected data and compared parameters including baseline clinical features and radiological outcomes of hematoma within 24 h of hospital admission, as well as the treatment method and clinical outcome of traumatic and NOS CSDH patients. Results: Compared to NOS CSDH patients, the average age was younger, epilepsy was more frequent, asymptomatic cases were more common, and the taking of anticoagulants and antiplatelet drugs were rarer in traumatic CSDH patients (all P < 0.05). However, no differences were found in the radiological presentations of hematoma at admission, the treatment methods and clinical outcomes of traumatic and NOS CSDH patients (all P > 0.05). Conclusion: Traumatic CSDH patients were more likely to be asymptomatic or have seizures, while NOS CSDH were more common in elder people and in individuals with the history of taking anticoagulants and antiplatelet drugs. The treatment methods and clinical outcomes were similar in traumatic and NOS CSDH patients. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is one of the most common diseases in neurosurgery. It is the result of chronic intracranial hemorrhage that converges between the dura mater and arachnoid three weeks after externally injuring the head. Chronic subdural hematomas are a common complication in neurosurgery. With the gradual increase in the amount of hematoma, the surrounding brain tissue is pushed and compressed, resulting in corresponding clinical symptoms and signs. It is reported that the overall incidence rate of CSDH is 1.72 to 20.6 per 100,000 people every year, and the incidence rate of the elderly is particularly high. Methods: The computer retrieves eight databases to obtain controlled trials at home and abroad on the effects of neuroendoscopy-assisted surgery in patients with chronic subdural hematoma. After a rigorous literature quality evaluation, data analysis was performed using RevMan 5.3 software. Results: Twenty studies were ultimately included in this meta-analysis. Seventeen studies reported the Recurrence rate of the test group and the control group, which was significantly lower (OR 0.27; 95% Cl 0.18, 0.38; P < 0.01) than the control group, Recovery rate (OR 1.18; 95% Cl 1.01, 1.38; P = 0.03), Total effective rate (OR 1.11; 95% Cl 1.04, 1.17; P < 0.01), Operative time (SMD 15.78; 95% Cl 9.69, 21.86; P < 0.01), Hospital stay (SMD − 1.66; 95% Cl − 2.17, − 1.14; P < 0.01) and Complications (OR 0.48; 95% Cl 0.30, 0.78; P < 0.01). Conclusion: The results of this study suggest that neuroendoscopy-assisted surgery may be effective in patients with chronic subdural hematoma, as evidenced by recurrence rate, recovery rate, total effective rate, operative time, hospital stay, complications, and the above conclusions need to be verified by more high-quality studies. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study is to identify the risk factors associated with chronic subdural hematoma (CSDH) in the Pakistani population, to compare various surgical techniques commonly used in its management, and to analyze the outcomes of patients, including early, that is, at the time of discharge, and late, that is, the disability status of patients on follow-up after ≥6 weeks. Materials and Methods: This retrospective study was carried out at a tertiary care hospital in Pakistan between March 2023 and October 2023 and included 100 patients with CSDH. All patients underwent surgical procedures, and outcomes were assessed at six weeks. Results: The mean age of the patients diagnosed with CSDH in this study was 53.81 ± 11.54 years. The most commonly reported symptom was an altered level of consciousness (30%), but most patients presented with more than one symptom (50%). Mortality was associated with only 10% of cases, and 90% reported no complications or significant morbidity. The most commonly used surgical technique was two burr-hole drainage (67%). The risk of recurrence was increased with the presence of comorbidities (P = 0.001) and remarkably reduced with intraoperative subdural drain placement (P = 0.000). Conclusion: The choice of surgical technique had no influence on the length of stay in the hospital or functional status post-discharge but surgery with intraoperative subdural drain placement proved to yield definitive favorable outcomes. [ABSTRACT FROM AUTHOR]

Middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDHs) is becoming increasingly prevalent. It is essential to optimize the safety and cost effectiveness of the postprocedural management. In this study, we examined our cases over time to determine the most appropriate postprocedural destination. This is a retrospective study of patients who underwent MMA embolization for cSDH at our institution. The study cohort was divided into 2 groups based on the year of embolization. Baseline characteristics, postprocedural complications, and length of stay were compared. Patients with shorter intensive care unit (ICU) stay were also compared to those with longer stay. Univariate statistical analysis was performed. 92 MMA embolizations for cSDH have been performed at our institution, of which 36 (39.1%) were done between 2019 and 2022 and 56 (60.9%) after 2023. No patients experienced stroke, cranial nerve palsy, or intraparenchymal hemorrhage after embolization. All but 5 patients were admitted to the ICU postembolization, of which 59 (64.1%) were downgraded after one day. Factors associated with a longer ICU stay included preoperative location (P = 0.002) and need for surgery (P = 0.02). Of those who came from home or nonmonitored bed, 82% were downgraded from the ICU in less than 2 days. The average cost of one night in the ICU, intermediate care, and nonmonitored unit was $3671.75, $2605.22, and $2303.81 respectively. MMA embolization for cSDH is a safe procedure with low rate of procedure-related complications. In carefully selected patients, the necessity ICU admission postoperatively should be weighed against better hospital resource utilization. [ABSTRACT FROM AUTHOR]

Despite numerous articles about middle meningeal artery embolization (MMAE) highlighting its efficacy and safety for recurrent chronic subdural hematoma (CSDH), the appropriateness of adjunctive MMAE after hematoma evacuation for initial CSDH remains unclear from a cost-effectiveness perspective. Patients with CSDH were enrolled in this study and were prospectively divided into 2 groups: the "conventional treatment" group, which was treated with hematoma evacuation alone, and the "MMAE" group, which was treated with adjunctive MMAE after hematoma evacuation. The proportion of patients requiring retreatment, length of hospital stay, economic costs, and modified Rankin Score were compared between the 2 groups. In this study, 53 cases were included, with 30 classified into the conventional treatment group and 23 classified into the MMAE group. In the conventional treatment group, the proportion of patients who required surgical retreatment was higher than that in the MMAE group (16.7% vs. 8.7%). The relative risk was 0.522 (95% confidence interval, 0.111–2.45). Although the addition of MMAE increased the cost per hospitalization by 26%, the increase in cost per patient was limited to 12%, owing to the reduction in patients who relapsed and required a second hospitalization. The increase in cost was not statistically significant. The MMAE group had a significantly higher proportion of patients with favorable outcomes (modified Rankin Score 0–2) (56.7% vs. 87.0%, P = 0.0328). By minimizing the increase in hospitalization days and procedure costs, MMAE following hematoma evacuation for initial CSDH could decrease the retreatment rate and balance the total medical costs associated with MMAE. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: As the prevalence of neuroendovascular interventions increases, it is critical to mitigate unnecessary radiation for patients, providers, and health care staff. Our group previously demonstrated reduced radiation dose and exposure during diagnostic angiography by reducing the default pulse and frame rates. We applied the same technique for basic neuroendovascular interventions. Methods: We performed a retrospective review of prospectively acquired data after implementing a quality improvement protocol in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. We studied consecutive, unilateral middle meningeal artery embolizations treated with particles. Total radiation dose, radiation per angiographic run, total radiation exposure, and exposure per run were calculated. Multivariable log-linear regression was performed to account for patient body mass index (BMI), number of angiographic runs, and number of vessels catheterized. Results: A total of 20 consecutive, unilateral middle meningeal artery embolizations were retrospectively analyzed. The radiation reduction protocol was associated with a 39.2% decrease in the total radiation dose and a 37.1% decrease in radiation dose per run. The protocol was associated with a 41.6% decrease in the total radiation exposure and a 39.5% decrease in exposure per run. Conclusions: Radiation reduction protocols can be readily applied to neuroendovascular interventions without increasing overall fluoroscopy time and reduce radiation dose and exposure by 39.2% and 41.6% respectively. We strongly encourage all interventionalists to be cognizant of pulse rate and frame rate when performing routine interventions. [ABSTRACT FROM AUTHOR]

The study evaluates chronic subdural hematoma (cSDH) middle meningeal artery (MMA) embolization efficacy and safety. A prospective interventional study was conducted in Viet Duc Hospital from November 2021 to April 2024. All consecutive cSDH MMA embolization patients were included. Clinical and imaging data were collected before and one month after treatment. The study included 31 42-cSDH patients. Of these, 25.8% had hematoma evacuation, 83.9% were treated with surgery and embolization, and 16.1% with embolization alone. 92.9% of procedures used polyvinyl alcohol particles. The success rate was 92.9% and complications 7.1%. Asymptomatic external carotid artery vasospasm and MMA rupture occurred. Functional improvement occurred in 91.7% of patients one month after treatment. Significantly lower mean modified Rankin Scale (mRS) score (0.2±0.7 vs. 1.7±0.9; P=0.000) and higher proportion of patients with =2 mRS score (95.8% vs. 74.1%) were observed after treatment. Hematoma thickness decreased significantly (P=0.00) from 21.5±7.9 mm to 8.3±4.1 mm. The midline shift decreased significantly from 7.4±5.0 mm to 0.7±1.2 mm (P=0.00). Just one patient (4.2%) needed surgery. MMA embolization alone or with surgery appears to treat cSDH safely and effectively. [ABSTRACT FROM AUTHOR]

Chronic subdural hematoma (cSDH), a condition that develops over time, is characterized by inflammation, angiogenesis, and membrane development. As the population's average age increases, the incidence of cSDH is expected to grow. While surgery is the primary treatment technique, medicinal therapy options are being explored for high-risk patients. Currently, the most effective therapy combination is dexamethasone (Dex) and atorvastatin (Ato); however, it is associated with an increased risk of mortality. This study explored the effects of bevacizumab (Bev), a vascular endothelial growth factor antagonist, on cSDH. Ninety-five rats were divided into four groups (n = 18): sham, control hematoma, Dex-Ato, and Bev. Two separate autologous blood injections into the subdural space were used as the model. Weight was monitored for all rats to assess changes in their overall health. The control group was given i.p. saline, the Dex-Ato treatment was given by gavage, and the Bev treatment was given i.p. On seventh, 14th and 21st days six rats from each group were sacrificed and analyzed, while 23 rats were excluded from the experiment. The maximum immunological response to cSDH was observed on day 14. Hematoma volume decreased over time in all groups. Dex-Ato and Bev were both found effective, while Dex-Ato caused weight loss. Bev had similar effects to the Dex-Ato group and was well tolerated by rats. Given that cSDH is a disease of the elderly and vulnerable populations, Bev may be a viable alternative that can shed light on the disease's etiology for future research. [ABSTRACT FROM AUTHOR]

Introduction: Chronic subdural hematoma (CSDH) often occurs 3 weeks to 3 months after brain injury, which is mainly caused by bleeding of the bridging vein. For patients with ventriculoperitoneal (V-P) shunt, excessive drainage can also cause CSDH. We present a rare case of CSDH caused by shunt valve breakdown in brain injury. Case Report: We report a 68-year-old man with V-P shunt for 8 years. He presented with bilateral CSDH with disappearance of lateral ventricles nearly 1 month after a brain injury caused by being hit with a stick. After burr hole drainage (BHD), the patient's symptoms improved and lateral ventricles reappeared, but disappeared rapidly with CSDH recurrence within a short time. We considered the cause to be medium pressure shunt valve breakdown caused by hitting with a stick, which was confirmed by the engineer's test after the operation and excessive drainage of cerebrospinal fluid. BHD replaced the adjustable pressure shunt valve, and the patient recovered. Conclusion: V-P shunt is a common operation in neurosurgery, and postoperative shunt valve breakdown may lead to poor outcome. We report a rare case of CSDH caused by shunt valve breakdown due to excessive external forces, suggesting that patients after V-P shunt should pay attention to the protection of the shunt valve. [ABSTRACT FROM AUTHOR]

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Background: Chronic subdural hematoma (CSDH) is a common complication of neurosurgery. Craniocerebral trauma is the likely cause. There are no reports relating CSDH with nephrotic syndrome. Its pathogenesis is very rare, and there are no previous reports on treatments for this disease. We report a case of chronic subdural hematoma that may be caused by nephrotic syndrome and review the previous literature on this subject. Case summary: We report a rare case of chronic subdural hematoma that may be caused by nephrotic syndrome. After the patient was admitted to the hospital, relevant laboratory tests were conducted, and a large amount of protein was detected in the patient's urine, indicating hypoproteinaemia and hyperlipidemia. The patient was diagnosed with nephrotic syndrome. After the exclusion of related surgical contraindications, the patient underwent trepanation and drainage of the chronic subdural hematoma. Subsequent treatment with oral atorvastatin was provided after surgery. The patient was transferred to the nephrology department for further treatment of nephrotic syndrome if his neurological condition improved. No neurological sequelae were detected at the follow-up visit 3 months after the operation. Conclusion: Chronic subdural hematomas are rarely caused by nephrotic syndrome. Trepanation and drainage may be considered for patients confirmed to have adequate hematoma liquefaction on imaging and who can tolerate craniotomy. Atorvastatin should be supplemented as prophylactic treatment after the operation. Nephrotic syndrome should be treated as soon as the patient's neurological condition is stable. [ABSTRACT FROM AUTHOR]

Background/Objectives: Chronic subdural hematoma (cSDH) is a common disease of growing significance due to the increasing use of antithrombotic drugs and population aging. There exists conflicting observational evidence that previous treatment with angiotensin-converting enzyme (ACE) inhibitors reduces the rate of cSDH recurrence. This study assesses the hypothesis that ACE inhibitors may affect recurrence rates by altering hematoma membrane formation. Methods: All patients with chronic subdural hematoma who were operated upon in a single university hospital between 2015 and 2020 were considered for inclusion. Hematomas were classified according to their structural appearance in computed tomography (CT) imaging into one of eight subtypes. Patients' own medication, prior to hospitalization for cSDH treatment, was noted, and the use of ACI-inhibitors was identified. Results: Of the included 398 patients, 142 (35.9%) were treated with ACE inhibitors before admission for cSDH treatment. Of these, 115 patients (81.0%) received ramipril, 13 received patients lisinopril (11.3%), and 11 patients (9.6%) received enalapril. Reflecting cardiovascular comorbidity, patients on ACE inhibitors were more often simultaneously treated with antithrombotics (63.4% vs. 42.6%; p ≤ 0.001). Hematomas with homogenous hypodense (OR 11.739, 95%CI 2.570 to 53.612; p = 0.001), homogenous isodense (OR 12.204, 95%CI 2.669 to 55.798; p < 0.001), and homogenous hyperdense (OR 9.472, 95%CI 1.718 to 52.217; p < 0.001) architectures, as well as the prior use of ACE inhibitors (OR 2.026, 95%CI 1.214 to 3.384; p = 0.007), were independently associated with cSDH recurrence. Conclusions: Once corrected for hematoma architecture, type of surgery, and use of antithrombotic medication, preoperative use of ACE inhibitors was associated with a twofold increase in the likelihood of hematoma recurrence. [ABSTRACT FROM AUTHOR]

(1) Background: A chronic subdural hematoma (CSDH) is considered an acute life-threatening event that is easily treated surgically, but little is known about the longer-term mortality of these patients. The objective of this study was to evaluate the association of social determinants of health (SDoH) and the long-term mortality of patients with a chronic subdural hematoma. (2) Methods: This retrospective cohort study included 121 (88 male and 33 female) patients with a surgically treated unilateral or bilateral CSDH. Mortality was evaluated at 1, 2, 6, and 12 months after treatment. (3) Results: Most of the patients were >65 and retired, N = 96 (79.3%); of them, the majority presented with a neurological deficit, N = 71 (73.9%). Patients who lived alone more often had a neurological deficit, N = 57 (75.0%), compared to those who lived in communities, N = 25 (55.5%). Mortality at 1, 2, 6, and 12 months after surgery was 10.7%, 17.4%, 19.0%, and 45.5%, respectively, and there was a significant difference in the median age between the survival and deceased groups at 1 month (p < 0.01), 2 months (p < 0.01), and 6 months (p < 0.01) of follow-up, but not in the long-term (12 months) follow-up (p = 0.200). Patients who lived alone had 3.7 times higher odds of dying at the 12-month follow-up (p < 0.01), compared to those who lived in the community. (4) Conclusions: Living alone is related to an increased case fatality risk after CSDH surgery in the Serbian context. Social determinants of health can be associated with CSDH presentation and survival, indicating that further studies should include SDoH to obtain a deeper understanding of the occurrence, presentation, and outcomes of SDoH and propose additional preventive measures. [ABSTRACT FROM AUTHOR]