Intraoperative Arachnoid Plasty Has Possibility to Prevent Chronic Subdural Hematoma after Surgery for Unruptured Cerebral Aneurysms
Some patients develop chronic subdural hematomas (CSDHs) after the clipping/coating of unruptured aneurysms. The risk factors are not well understood and while no preventive methods are currently available, arachnoid plasty (ARP) may intercept the development of postoperative CSDH. We investigated t...
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| Published in | Neurologia medico-chirurgica Vol. 55; no. 6; pp. 493 - 497 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
The Japan Neurosurgical Society
2015
THE JAPAN NEUROSURGICAL SOCIETY |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0470-8105 1349-8029 1349-8029 |
| DOI | 10.2176/nmc.oa.2014-0455 |
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| Abstract | Some patients develop chronic subdural hematomas (CSDHs) after the clipping/coating of unruptured aneurysms. The risk factors are not well understood and while no preventive methods are currently available, arachnoid plasty (ARP) may intercept the development of postoperative CSDH. We investigated the risk factors for CSDH and the usefulness of ARP to prevent postoperative CSDH. Between January 2009 and June 2013, 393 patients underwent 416 aneurysm surgeries via the pterional approach at Kushiro Kojinkai Memorial Hospital. Of these, 394 aneurysms (371 patients) were included in this study. Using multivariate analysis we evaluated the relationship between the patient demographics and clinical characteristics, and the development of postoperative symptomatic CSDH. We also studied the effect of ARP performed during aneurysm surgery. We found that symptomatic CSDH developed after 20 (5.1%) of the 394 operations; it was addressed by burr hole surgery and evacuation/irrigation. Male gender, advanced age, and oral anticoagulant therapy were significant risk factors for CSDH. Additive ARP, performed in the course of 132 surgeries (33.5%) was found to be a significant negative risk factor. The incidence of CSDH was significantly lower in patients who had undergone ARP than in patients who had not undergone it (0.8% vs. 7.3%, p < 0.01). We first report that ARP is useful for the prevention of CSDH in patients treated by aneurysm surgery. |
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| AbstractList | Some patients develop chronic subdural hematomas (CSDHs) after the clipping/coating of unruptured aneurysms. The risk factors are not well understood and while no preventive methods are currently available, arachnoid plasty (ARP) may intercept the development of postoperative CSDH. We investigated the risk factors for CSDH and the usefulness of ARP to prevent postoperative CSDH. Between January 2009 and June 2013, 393 patients underwent 416 aneurysm surgeries via the pterional approach at Kushiro Kojinkai Memorial Hospital. Of these, 394 aneurysms (371 patients) were included in this study. Using multivariate analysis we evaluated the relationship between the patient demographics and clinical characteristics, and the development of postoperative symptomatic CSDH. We also studied the effect of ARP performed during aneurysm surgery. We found that symptomatic CSDH developed after 20 (5.1%) of the 394 operations; it was addressed by burr hole surgery and evacuation/irrigation. Male gender, advanced age, and oral anticoagulant therapy were significant risk factors for CSDH. Additive ARP, performed in the course of 132 surgeries (33.5%) was found to be a significant negative risk factor. The incidence of CSDH was significantly lower in patients who had undergone ARP than in patients who had not undergone it (0.8% vs. 7.3%, p < 0.01). We first report that ARP is useful for the prevention of CSDH in patients treated by aneurysm surgery. [Abstract] Some patients develop chronic subdural hematomas (CSDHs) after the clipping/coating of unruptured aneurysms. The risk factors are not well understood and while no preventive methods are currently available, arachnoid plasty (ARP) may intercept the development of postoperative CSDH. We investigated the risk factors for CSDH and the usefulness of ARP to prevent postoperative CSDH. Between January 2009 and June 2013, 393 patients underwent 416 aneurysm surgeries via the pterional approach at Kushiro Kojinkai Memorial Hospital. Of these, 394 aneurysms (371 patients) were included in this study. Using multivariate analysis we evaluated the relationship between the patient demographics and clinical characteristics, and the development of postoperative symptomatic CSDH. We also studied the effect of ARP performed during aneurysm surgery. We found that symptomatic CSDH developed after 20 (5.1%) of the 394 operations; it was addressed by burr hole surgery and evacuation/irrigation. Male gender, advanced age, and oral anticoagulant therapy were significant risk factors for CSDH. Additive ARP, performed in the course of 132 surgeries (33.5%) was found to be a significant negative risk factor. The incidence of CSDH was significantly lower in patients who had undergone ARP than in patients who had not undergone it (0.8% vs. 7.3%, p<0.01). We first report that ARP is useful for the prevention of CSDH in patients treated by aneurysm surgery. |
| Author | NAKAGAWA, Hiroshi NAGAHIRO, Shinji YAGI, Kenji SAITO, Osamu LEE, Tejin IRIE, Shinsuke SAITO, Koji INAGAKI, Toru ISHII, Yosuke |
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| Cites_doi | 10.3171/jns.1972.37.5.0552 10.1007/s00701-010-0762-y 10.1016/0090-3019(87)90286-2 10.2335/scs1987.28.1_25 10.1007/s00701-006-0777-6 10.1016/j.clineuro.2012.10.008 10.2335/scs.37.350 10.1016/j.wneu.2012.09.025 10.1371/journal.pone.0068732 10.1007/s00701-003-0026-1 10.1007/s10143-004-0337-6 10.1016/j.jocn.2012.09.024 10.2176/nmc.50.608 10.1016/0090-3019(87)90010-3 |
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| References | 6) Tanaka Y, Mizuno M, Kobayashi S, Sugita K: Subdural fluid collection following craniotomy. Surg Neurol 27: 353–356, 1987 15) Kanazawa R, Sato S, Iwamoto N, Teramoto A: Allergic reaction following arachnoid plasty with a fibrin sealant. Neurol Med Chir (Tokyo) 50: 608–610, 2010 1) Aspegren OP, Astrand R, Lundgren MI, Romner B: Anticoagulation therapy a risk factor for the development of chronic subdural hematoma. Clin Neurol Neurosurg 115: 981–984, 2013 14) Wakamoto H, Miyazaki H, Orii M, Ishiyama N, Akiyama K, Konohana I: [Aseptic meningitis as a complication caused by an allergic reaction after microvascular decompression: two case reports]. No Shinkei Geka 30: 1331–1335, 2002 13) Gazzeri R, Galarza M, Neroni M, Alfieri A, Giordano M: Hemostatic matrix sealant in neurosurgery: a clinical and imaging study. Acta Neurochir (Wien) 153: 148–154; discussion 155, 2011 12) Watanabe S, Shimada H, Ishii S: Production of clinical form of chronic subdural hematoma in experimental animals. J Neurosurg 37: 552–561, 1972 8) Koizumi H, Fukamachi A, Nukui H: Postoperative subdural fluid collections in neurosurgery. Surg Neurol 27: 147–153, 1987 5) Ohno T, Iihara K, Takahashi JC, Nakajima N, Satow T, Hishikawa T, Nagata I, Yamada K, Miyamoto S: Incidence and risk factors of chronic subdural hematoma after aneurysmal clipping. World Neurosurg 80: 534–537, 2013 2) Mori K, Maeda M: Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures. Acta Neurochir (Wien) 145: 533–539; discussion 539–540, 2003 4) Baechli H, Nordmann A, Bucher HC, Gratzl O: Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 27: 263–266, 2004 11) Mino Y, Hirashima Y, Hamada H, Masuoka T, Yamatani K, Takeda S, Masuda R, Nogami K, Endo S: Effect of arachnoid plasty using fibrin glue membrane after clipping of ruptured aneurysm on the occurrence of complications and outcome in the elderly patients. Acta Neurochir (Wien) 148: 627–631; discussion 631, 2006 7) Inamasu J, Watabe T, Ganaha T, Yamada Y, Nakae S, Ohmi T, Imizu S, Kaito T, Ito K, Nishiyama Y, Hayashi T, Sano H, Kato Y, Hirose Y: Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms. J Clin Neurosci 20: 1095–1098, 2013 3) De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A, Anile C, Mangiola A: Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS ONE 8: e68732, 2013 9) Nagata K: A proposal of the arachnoid closure for the prevention of postoperative subdural hygoma: a new appliance of mesh-and glue technique. Surg Cereb Stroke (Jpn) 28: 25–30, 2000 10) Nishimura S, Fujita T, Hiroyuki S, Hori E, Mino M, Michiharu N: Chronic subdural hematoma and remote cerebellar hemorrhage developing after unruptured aneurysmal surgery. Surg Cereb Stroke (Jpn) 37: 350–356, 2009 11 12 13 14 15 1 2 3 4 5 6 7 8 9 10 23072878 - World Neurosurg. 2013 Nov;80(5):534-7 20671393 - Neurol Med Chir (Tokyo). 2010;50(7):608-10 16763872 - Acta Neurochir (Wien). 2006 Jun;148(6):627-31; discussion 631 3824141 - Surg Neurol. 1987 Apr;27(4):353-6 23128014 - Clin Neurol Neurosurg. 2013 Jul;115(7):981-4 23874740 - PLoS One. 2013;8(7):e68732 4627704 - J Neurosurg. 1972 Nov;37(5):552-61 20703888 - Acta Neurochir (Wien). 2011 Jan;153(1):148-54; discussion 155 23669172 - J Clin Neurosci. 2013 Aug;20(8):1095-8 15148652 - Neurosurg Rev. 2004 Oct;27(4):263-6 3810442 - Surg Neurol. 1987 Feb;27(2):147-53 12491585 - No Shinkei Geka. 2002 Dec;30(12):1331-5 12910395 - Acta Neurochir (Wien). 2003 Jul;145(7):533-39; discussion 539-40 |
| References_xml | – reference: 7) Inamasu J, Watabe T, Ganaha T, Yamada Y, Nakae S, Ohmi T, Imizu S, Kaito T, Ito K, Nishiyama Y, Hayashi T, Sano H, Kato Y, Hirose Y: Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms. J Clin Neurosci 20: 1095–1098, 2013 – reference: 1) Aspegren OP, Astrand R, Lundgren MI, Romner B: Anticoagulation therapy a risk factor for the development of chronic subdural hematoma. Clin Neurol Neurosurg 115: 981–984, 2013 – reference: 11) Mino Y, Hirashima Y, Hamada H, Masuoka T, Yamatani K, Takeda S, Masuda R, Nogami K, Endo S: Effect of arachnoid plasty using fibrin glue membrane after clipping of ruptured aneurysm on the occurrence of complications and outcome in the elderly patients. Acta Neurochir (Wien) 148: 627–631; discussion 631, 2006 – reference: 8) Koizumi H, Fukamachi A, Nukui H: Postoperative subdural fluid collections in neurosurgery. Surg Neurol 27: 147–153, 1987 – reference: 4) Baechli H, Nordmann A, Bucher HC, Gratzl O: Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 27: 263–266, 2004 – reference: 12) Watanabe S, Shimada H, Ishii S: Production of clinical form of chronic subdural hematoma in experimental animals. J Neurosurg 37: 552–561, 1972 – reference: 10) Nishimura S, Fujita T, Hiroyuki S, Hori E, Mino M, Michiharu N: Chronic subdural hematoma and remote cerebellar hemorrhage developing after unruptured aneurysmal surgery. Surg Cereb Stroke (Jpn) 37: 350–356, 2009 – reference: 15) Kanazawa R, Sato S, Iwamoto N, Teramoto A: Allergic reaction following arachnoid plasty with a fibrin sealant. Neurol Med Chir (Tokyo) 50: 608–610, 2010 – reference: 3) De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A, Anile C, Mangiola A: Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS ONE 8: e68732, 2013 – reference: 5) Ohno T, Iihara K, Takahashi JC, Nakajima N, Satow T, Hishikawa T, Nagata I, Yamada K, Miyamoto S: Incidence and risk factors of chronic subdural hematoma after aneurysmal clipping. World Neurosurg 80: 534–537, 2013 – reference: 6) Tanaka Y, Mizuno M, Kobayashi S, Sugita K: Subdural fluid collection following craniotomy. Surg Neurol 27: 353–356, 1987 – reference: 13) Gazzeri R, Galarza M, Neroni M, Alfieri A, Giordano M: Hemostatic matrix sealant in neurosurgery: a clinical and imaging study. Acta Neurochir (Wien) 153: 148–154; discussion 155, 2011 – reference: 9) Nagata K: A proposal of the arachnoid closure for the prevention of postoperative subdural hygoma: a new appliance of mesh-and glue technique. Surg Cereb Stroke (Jpn) 28: 25–30, 2000 – reference: 14) Wakamoto H, Miyazaki H, Orii M, Ishiyama N, Akiyama K, Konohana I: [Aseptic meningitis as a complication caused by an allergic reaction after microvascular decompression: two case reports]. No Shinkei Geka 30: 1331–1335, 2002 – reference: 2) Mori K, Maeda M: Risk factors for the occurrence of chronic subdural haematomas after neurosurgical procedures. Acta Neurochir (Wien) 145: 533–539; discussion 539–540, 2003 – ident: 12 doi: 10.3171/jns.1972.37.5.0552 – ident: 13 doi: 10.1007/s00701-010-0762-y – ident: 8 doi: 10.1016/0090-3019(87)90286-2 – ident: 9 doi: 10.2335/scs1987.28.1_25 – ident: 11 doi: 10.1007/s00701-006-0777-6 – ident: 14 – ident: 1 doi: 10.1016/j.clineuro.2012.10.008 – ident: 10 doi: 10.2335/scs.37.350 – ident: 5 doi: 10.1016/j.wneu.2012.09.025 – ident: 3 doi: 10.1371/journal.pone.0068732 – ident: 2 doi: 10.1007/s00701-003-0026-1 – ident: 4 doi: 10.1007/s10143-004-0337-6 – ident: 7 doi: 10.1016/j.jocn.2012.09.024 – ident: 15 doi: 10.2176/nmc.50.608 – ident: 6 doi: 10.1016/0090-3019(87)90010-3 – reference: 23128014 - Clin Neurol Neurosurg. 2013 Jul;115(7):981-4 – reference: 23669172 - J Clin Neurosci. 2013 Aug;20(8):1095-8 – reference: 3810442 - Surg Neurol. 1987 Feb;27(2):147-53 – reference: 4627704 - J Neurosurg. 1972 Nov;37(5):552-61 – reference: 12910395 - Acta Neurochir (Wien). 2003 Jul;145(7):533-39; discussion 539-40 – reference: 15148652 - Neurosurg Rev. 2004 Oct;27(4):263-6 – reference: 20671393 - Neurol Med Chir (Tokyo). 2010;50(7):608-10 – reference: 23874740 - PLoS One. 2013;8(7):e68732 – reference: 12491585 - No Shinkei Geka. 2002 Dec;30(12):1331-5 – reference: 3824141 - Surg Neurol. 1987 Apr;27(4):353-6 – reference: 16763872 - Acta Neurochir (Wien). 2006 Jun;148(6):627-31; discussion 631 – reference: 23072878 - World Neurosurg. 2013 Nov;80(5):534-7 – reference: 20703888 - Acta Neurochir (Wien). 2011 Jan;153(1):148-54; discussion 155 |
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| Snippet | Some patients develop chronic subdural hematomas (CSDHs) after the clipping/coating of unruptured aneurysms. The risk factors are not well understood and while... [Abstract] Some patients develop chronic subdural hematomas (CSDHs) after the clipping/coating of unruptured aneurysms. The risk factors are not well... |
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| Title | Intraoperative Arachnoid Plasty Has Possibility to Prevent Chronic Subdural Hematoma after Surgery for Unruptured Cerebral Aneurysms |
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