Analysis of risk factors for contralateral progression of bilateral chronic subdural hematoma after unilateral evacuation
Objective To explore the risk factors for contralateral hematoma progression(CHP)after unilateral drilling drainage of bilateral chronic subdural hematoma(bCSDH).Methods A retrospective study was conducted on 87 patients with bCSDH who underwent unilateral drilling and drainage at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from November 2011 to April 2021.Three months after surgery,the patients were divided into CHP group and non-CHP group according to whether the contralateral hematoma progressed.The clinical data and imaging data of the two groups of patients were compared and analyzed,and the multivariate logistic regression was used to analyze the risk factors affecting CHP for variables with statistically significant differences.Results Three months after surgery,16 of 87 patients developed CHP,with an incidence rate of 18.4％.Among them,9 cases occurred within 1 month after surgery,and 7 cases occurred 1 to 2 months after surgery.Five patients underwent conservative treatment for hematoma absorption,and 11 patients underwent surgical treatment to remove the hematoma.Among the patients with surgical treatment,8(72.7％)cases occurred within 1 month.There were 2 cases of hematoma recurrence on the operated side within 6 months after surgery,both of which were non-CHP patients.Compared with 71 patients in the non-CHP group,the maximum thickness of the contralateral hematoma before extubation was significantly increased in 16 patients in the CHP group(P＜0.001);the contralateral hematoma was located on the curved side(P=0.018)and was extensive(P=0.001),and the CT classification was mixed type(P=0.034)with a high proportion.Multivariate logistic regression analysis of only preoperative related factors showed that extensive hematoma(OR=5.34,95％CI:1.29-22.06,P=0.021)was a risk factor for CHP;after including postoperative variables for analysis,extensive hematoma(OR=4.60,95％CI:1.02-20.72,P=0.047)and maximum thickness of contralateral hematoma before extubation(OR=21.99,95％CI:1.85-260.81,P=0.014)were the risk factors of CHP.Conclusions The period of high incidence of CHP in patients with bCSDH is within 2 months after unilateral cranial burr hole drainage.Extensive hematoma is an independent risk factor for CHP before surgery;the maximum thickness before extubation is also an independent risk factor for CHP after surgery.
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