RESUMEN
Objective: The primary aim of this research is to investigate the predictive value of subdural effusion thickness in determining the progression of post-traumatic subdural effusion to chronic subdural hematoma. Studying this progression is crucial as it helps in early diagnosis and effective management of chronic subdural hematoma, which is a serious and life-threatening condition. This research is valuable and relevant for improving patient outcomes and reducing the associated risks and complications. Methods: We conducted a retrospective examination of the clinical data obtained from 124 patients who were treated for post-traumatic subdural effusion at our neurosurgery department between March 2017 and March 2021. The data collection process involved reviewing the patients' medical records, radiographic images, and follow-up visits. We used strict criteria for patient selection, including a confirmed diagnosis of post-traumatic subdural effusion, availability of follow-up data, and no prior history of chronic subdural hematoma. Patients who experienced a progression of subdural effusion to chronic subdural hematoma were assigned to the hematoma group (26 cases). In comparison, those who did not show such progression were categorized into the effusion group (98 cases). We endeavored to identify potential risk factors contributing to the progression from subdural effusion to chronic subdural hematoma. The predictive strengths of these risk factors were evaluated using receiver operating characteristic (ROC) curves. Results: There were no statistically significant disparities between the two groups in terms of gender, hypertension, COPD, and GCS scores (P > .05). However, significant differences were noted in the variables of age, tSAH, the location of subdural effusion, and subdural effusion thickness (P < .05). Multivariate logistic regression analysis disclosed age (1.213), tSAH (12.542), and subdural effusion thickness (1.786) as independent risk factors for the conversion of TSE to CSDH (P < .05). The ROC curve showed the AUC values of age, tSAH, and subdural effusion thickness for predicting CSDH to be 0.739, 0.670, and 0.820, respectively, with a combined AUC value of 0.942, thereby outperforming the individual tests. Conclusion: In patients suffering from post-traumatic subdural effusion, the thickness of the subdural effusion emerges as a strong predictor for its progression into a chronic subdural hematoma. Clinicians should be particularly cautious when the effusion thickness exceeds 10.7 mm, as the likelihood of transformation increases significantly. These findings have important implications for clinical practice and patient management, highlighting the need for prompt and effective treatment to prevent chronic complications.
RESUMEN
BACKGROUND: Intraventricular hemorrhage is a neurosurgical emergency, and a dangerous condition associated with high morbidity and mortality. Previously, hematoma evacuation is generally executed by external intracranial drainage (EVD) or surgical evacuation. Nowadays, endoscopic evacuation is emerging as a good alternative because it brings relatively less invasion and injury. However, successful endoscopic evacuation requires skilled manipulation of endoscopic devices and the evidence supporting its efficacy differs in different reports. AIM: To improve the technique usage and provide more evidence of endoscopic evacuation efficacy, we summarize our surgical experience and compared the outcomes of the endoscopic evacuation with EVD using real-world data. METHODS: We retrospectively studied 96 consecutive patients with intraventricular hemorrhage who underwent either endoscopic surgery (n = 43) or non-endoscopic surgery (n = 53) for hemorrhage evacuation between November 2013 and September 2019 in our center. Patients' conditions prior to and after the operation were evaluated and analyzed to assess the efficacy of the operation. The consciousness status improvement and perioperative in-hospital parameters in the two types of operation groups were assessed and compared. RESULTS: Patients in the endoscopic and non-endoscopic groups presented with a similar state of consciousness, with a comparable Glasgow Coma Scale (GCS) index. The average operation time of the endoscopic group was longer than that of the non-endoscopic group (median 2.42 h vs 1.08 h, P < 0.001). Although the endoscopic group was older and had a baseline Graeb score that indicated more severe hemorrhage than the non-endoscopic group (Graeb median: Endoscopic group = 9 vs non-endoscopic group = 8, P = 0.023), the clearance rate of hematoma was as high as 60.5%. Both the endoscopic and non-endoscopic groups showed an improved GCS index after surgery. However, this improvement was more marked in patients in the endoscopic group (median improvement of GCS index: Endoscope group = 4 vs non-endoscopic group = 1, P < 0.001). Additionally, the endoscopic group had a lower Graeb score than the non-endoscopic group after the operation. The intensive care unit stay of the endoscopic group was significantly shorter than that of the non-endoscopic group (median: endoscopic group = 6 d vs non-endoscope group = 7 d, P = 0.017). CONCLUSION: Endoscopic evacuation of intraventricular hemorrhage was generally an effective and efficient way for hemorrhage evacuation, and contributed remarkably to the improvement of consciousness in patients with intraventricular hemorrhage.