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The relationship between surgical methods and recurrence for chronic subdural hematoma (CSDH) and an analysis of postoperative computed tomography (CT) scan for delayed CSDH recurrence
Author(s): ,
Y.I. Kim
Affiliations:
St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Neurosurgery, Suwon-si, Korea, Republic of
,
M.H. Lee
Affiliations:
St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Neurosurgery, Suwon-si, Korea, Republic of
,
S.U. Kim
Affiliations:
Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea, Republic of
,
D.H. Lee
Affiliations:
St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Neurosurgery, Suwon-si, Korea, Republic of
,
S.H. Yang
Affiliations:
St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Neurosurgery, Suwon-si, Korea, Republic of
,
I.S. Kim
Affiliations:
St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Neurosurgery, Suwon-si, Korea, Republic of
,
J.T. Hong
Affiliations:
St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Neurosurgery, Suwon-si, Korea, Republic of
C.B. Cho
Affiliations:
St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Neurosurgery, Suwon-si, Korea, Republic of
EANS Academy. Kim Y. Oct 21, 2018; 225774; EP5009
Young Il Kim
Young Il Kim
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Abstract
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Introduction: In this study, we investigated the relationship between surgical method and recurrence. We also analyzed the postoperative computed tomography (CT) images at serial time points to evaluate the predictive factors for delayed recurrence and re-operation.
Methods: Between January 2010 and December 2016, a total of 246 patients were retrospectively analyzed. The analysis of surgical methods included the following: number (one or two) and size of burr-hole, direction, depth and indwelling duration (included in the surgical method in a broad sense) of drainage catheter. Postoperative CT findings were evaluated by dividing into five stages at postoperative day (POD) 1, POD 3 and POD 7, respectively. Receiver operating characteristic (ROC) curve was used for evaluation of compatibility as predictive factor about delayed (after POD 7) recurrence.
Results: Thirty one patients underwent re-operation for recurrence (31/246, 12.6%) within follow up period (mean 12 months). A depth of drainage catheter was significantly longer in recurrence group (50.0 mm [33.3 mm; 65.0 mm] - median [quartiles 1; 3]) than no recurrence group (36.9 mm [26.3 mm; 53.6 mm] - median [quartiles 1; 3]) (p < 0.05). A univariate and multivariate analysis using logistic regression model revealed that occipital direction of drainage catheter was significantly associated with the recurrence of CSDH (p=0.022 and p=0.001). The area under the ROC curve (AUC) of POD 1, POD 3 and POD 7 were 0.536 (95% CI, 0.471 to 0.601), 0.577 (95% CI, 0.512 to 0.641) and 0.708 (95% CI, 0.646 to 0.765), respectively.
Conclusion: In our study, depth and occipital direction of drainage catheter was a factor affecting the recurrence of CSDH among the various components of the BHC procedure. We also found that the CT findings of POD 7 were apt for predicting delayed recurrence of CSDH.
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