Prediction model for poor short-term prognosis in patients with chronic subdural hematoma after burr hole drainage: a retrospective cohort study.

Chronic subdural hematoma (CSDH) is a common condition in neurosurgery. With an aging population, there is increasing attention on the prognosis of patients following surgical intervention. We developed a postoperative short-term prognostic prediction model using preoperative clinical indicators, aiming to assist in perioperative medical decision-making and management. The dataset was randomly divided into training and validation cohorts. An mRS score greater than 2 one month after discharge was considered indicative of a poor prognosis. In the training cohort, the least absolute shrinkage and selection operator (LASSO) regression analysis was used for multivariate analysis to identify independent risk factors and construct a prediction nomogram for poor prognosis one month after discharge. The performance of the nomogram was assessed using the Receiver Operating Characteristic (ROC) curve and calibration curve. A Decision Curve Analysis (DCA) was also conducted to determine the net benefit threshold of the prediction model. Among the 505 participants, 18.8% (95/505) had a poor prognosis one month after discharge. The baseline characteristics did not significantly differ between the training cohort and the validation cohort. LASSO regression analysis in the training cohort reduced the predictors to four potential factors. Further multivariate logistic analyses in the training cohort identified four independent predictors: age, admission Glasgow Coma Scale (GCS) score, hemiparesis, and hemoglobin count. These predictors were incorporated into the nomogram prediction model. Internal validation using ROC analysis, calibration curves, and other methods demonstrated a strong correlation between the observed and predicted likelihood of poor prognosis one month after discharge. The visualized nomogram prediction model we developed for short-term postoperative prognosis of chronic subdural hematoma after burr hole drainage aids in predicting short-term outcomes and guiding clinical treatment decisions. Further external validation is needed in the future to confirm its effectiveness.

Combining Clinical-Radiomics Features With Machine Learning Methods for Building Models to Predict Postoperative Recurrence in Patients With Chronic Subdural Hematoma: Retrospective Cohort Study.

BACKGROUND: Chronic subdural hematoma (CSDH) represents a prevalent medical condition, posing substantial challenges in postoperative management due to risks of recurrence. Such recurrences not only cause physical suffering to the patient but also add to the financial burden on the family and the health care system. Currently, prognosis determination largely depends on clinician expertise, revealing a dearth of precise prediction models in clinical settings. OBJECTIVE: This study aims to use machine learning (ML) techniques for the construction of predictive models to assess the likelihood of CSDH recurrence after surgery, which leads to greater benefits for patients and the health care system. METHODS: Data from 133 patients were amassed and partitioned into a training set (n=93) and a test set (n=40). Radiomics features were extracted from preoperative cranial computed tomography scans using 3D Slicer software. These features, in conjunction with clinical data and composite clinical-radiomics features, served as input variables for model development. Four distinct ML algorithms were used to build predictive models, and their performance was rigorously evaluated via accuracy, area under the curve (AUC), and recall metrics. The optimal model was identified, followed by recursive feature elimination for feature selection, leading to enhanced predictive efficacy. External validation was conducted using data sets from additional health care facilities. RESULTS: Following rigorous experimental analysis, the support vector machine model, predicated on clinical-radiomics features, emerged as the most efficacious for predicting postoperative recurrence in patients with CSDH. Subsequent to feature selection, key variables exerting significant impact on the model were incorporated as the input set, thereby augmenting its predictive accuracy. The model demonstrated robust performance, with metrics including accuracy of 92.72%, AUC of 91.34%, and recall of 93.16%. External validation further substantiated its effectiveness, yielding an accuracy of 90.32%, AUC of 91.32%, and recall of 88.37%, affirming its clinical applicability. CONCLUSIONS: This study substantiates the feasibility and clinical relevance of an ML-based predictive model, using clinical-radiomics features, for relatively accurate prognostication of postoperative recurrence in patients with CSDH. If the model is integrated into clinical practice, it will be of great significance in enhancing the quality and efficiency of clinical decision-making processes, which can improve the accuracy of diagnosis and treatment, reduce unnecessary tests and surgeries, and reduce the waste of medical resources.

Middle meningeal artery embolization following surgical evacuation of symptomatic chronic subdural hematoma improves outcomes, interim results of a prospective randomized trial.

BACKGROUND: Outcomes after surgical treatment of chronic subdural hematoma (cSDH) remain undesirable in a significant proportion of patients. We aimed to show the role of middle meningeal artery (MMA) embolization and to demonstrate its benefits. METHODS: Thirty-five patients with symptomatic cSDH were enrolled in a prospective randomized trial following evacuation surgery. Participants were randomized to embolization or control group (expectant management following surgical evacuation without embolization). Patients were followed throughout their hospitalization and outpatient follow-ups. The main goals of this planned interim analysis were to assess neurological outcome and resource utilization. RESULTS: The groups were comparable in terms of sex, age and follow-up retention rates. Side(s) of intervention(s) and hematoma size were similar. There was no statistical difference in neurological examination improvement at discharge, but at follow-up, we observed a decline in neurologic exam in the control group (p = 0.03). Control group participants required more re-interventions (p = 0.02) and were followed in clinic and during related readmissions for longer (p = 0.02). The number of imaging studies obtained in relation to the disease management was higher in the control group (p = 0.01). CONCLUSIONS: Our results suggest a beneficial role for the addition of MMA embolization to surgical intervention in the treatment of symptomatic chronic subdural hematoma. Neurological outcomes were significantly better in the embolization group. This contributed to less need for follow-up, re-interventions, and imaging studies.

Letter to the editor: "Therapeutic efficacy of drilling drainage combined with intraoperative middle meningeal artery occlusion in the management of chronic subdural hematoma: a clinical study".

This letter addresses the research presented by Sun et al. on the integration of digital subtraction angiography (DSA) with conventional surgical drainage for chronic subdural hematoma (CSDH), focusing on precision in targeting the middle meningeal artery (MMA). The study demonstrates a reduction in hematoma recurrence and drainage tube indwelling times, highlighting the procedural benefits without added complications. The letter suggests further research directions, including the potential for personalized surgical approaches based on MMA anatomy variations, and emphasizes the importance of this technique in enhancing neurosurgical outcomes.

Medical management of chronic subdural hematoma with low-dose hydrocortisone: a case series.

Chronic subdural hematomas (cSDH) are often managed with a burr-hole craniostomy and drainage, but surgery is associated with elevated mortality, morbidity, and recurrence. Despite reports of steroid use for such patients, its efficacy and feasibility are still debated. We present our patient series treated with low-dose hydrocortisone. We retrospectively reviewed data from patients treated with hydrocortisone between 2017 and 2023. Demographics, clinical and radiological data were collected. Of 27 patients identified, nine required a burr-hole craniotomy for an average volume of 120.23 cm3, average midline shift of 9 mm, and neurological deficits. Eighteen met the criteria for inclusion. The mean age was 78.5 years; 13 were male. None had severe symptoms requiring urgent intervention. Except for one with a Karnofsky Performance Scale score of 70, all could maintain normal activity before treatment. The mean baseline volume was 52.6 cm3. Midline shift, present in six, averaged 6.8 mm. Patients underwent treatment for an average of 5.15 months. Nine had complete resolution within 3 months, while nine required longer treatment, including one who needed 9 months for a re-bleed after a fall. Paired t-tests indicated significant reductions in hematoma volumes at the second week (p = 0.01), first month (p < 0.0001), and third month (p < 0.0001) of treatment. No complications occurred and the post-treatment Karnofsky scores ranged from 90 to 100. Treatment for cSDH should be tailored to the patient. Low-dose hydrocortisone is safe and effective in asymptomatic patients, those with mild to moderate symptoms, and those who are either unsuitable for or decline surgical intervention.

Concomitant spontaneous subdural and intracystic hematoma in arachnoid cyst: a case report and review of the literature.

BACKGROUND: Intracystic hematoma in arachnoid cyst are a very rare pathology that commonly occurs after head trauma, while spontaneous intracystic hematomas in arachnoid cyst associated with subdural hematoma is extremely rare. Currently there are 33 patients of spontaneous intracystic hematomas in arachnoid cyst reported in the literature. In this case report we present an adult patient with concomitant chronic subdural hematoma with intracystic hematoma in arachnoid cyst. CASE PRESENTATION: A 19-year-old Egyptian Arabian female patient presented to the outpatient clinic complaining of severe headache of 1-month duration that was progressive in nature. Provisionally, it was thought that it might be an arachnoid cyst with associated chronic subdural hematoma along with intracystic hematoma. Decision to proceed with craniotomy and cyst evacuation was made. CONCLUSION: Concomitant intracystic hematoma in arachnoid cyst along with subdural hematoma is a serious condition that might be life-threatening if not well managed.

Comparison of adjunctive middle meningeal artery embolization using embosphere particles versus surgical drainage alone for the treatment of chronic subdural hematoma: A prospective study.

BACKGROUND: Middle meningeal artery embolization (MMAE) has emerged as a primary and adjunctive therapy for chronic subdural hematoma (CSDH) in addition to conventional treatment. However, there is a scarcity of data that explicitly compares the effectiveness of adjunctive MMAE to surgical drainage alone (SDA), as well as the use of Embosphere particles. The objective of this study was to assess the safety and efficacy of adjunctive MMAE in the treatment of symptomatic CSDH compared to SDA. METHODS: This prospective study included 43 patients with 52 CSDH sides, treated at a single institution between 2022 and 2023. The primary outcome was postoperative hematoma volume at 14, 30, 90, and 180 days after surgical drainage, which was analyzed using the generalized estimating equation. The secondary outcomes were the complications and recurrence/reoperation rate. Adjunctive MMAE was performed within 7 days following the surgery, utilizing Embosphere as the embolic material. RESULTS: The patients were assigned to either the adjunctive MMAE group (n = 20, 26 CSDH sides) or the SDA group (n = 23, 26 CSDH sides). The adjunctive MMAE group demonstrated a more significant reduction in hematoma volume (p = 0.007) and maximal hematoma thickness (p = 0.016) at all follow-up intervals. A trend towards lower recurrence and reoperation rates was observed with adjunctive MMAE; particularly, none of the patients in the adjunctive MMAE group experienced a recurrence of CSDH, compared to 19.2 % in the SDA group (p = 0.051). One procedural-related complication (3.8 %) in the adjunctive MMAE group. CONCLUSION: Our results suggested that adjunctive MMAE, compared to SDA, may enhance hematoma resolution and reduce the need for reoperation due to recurrence.