Publication year: 2012
Source:World Neurosurgery
Takayuki Ohno, Koji Iihara, Jun C. Takahashi, Norio Nakajima, Tetsu Satow, Tomohito Hishikawa, Izumi Nagata, Kazuo Yamada, Susumu Miyamoto
Objective Chronic subdural hematoma (CSDH) after aneurysmal clipping is a rare complication, but its incidence and riskfactors are not known in detail. We retrospectively reviewed our cases requiring surgery for CSDH after clipping. Methods Between January 2000 and December 2006, 794 patients (unruptured: 58.0%) underwent clipping surgery for aneurysm of anterior circulation in our hospital. We reviewed incidence and risk factors of CSDH after clipping. For the last two years, we reviewed all CT scans for 163 unruptured cases, and examined the relationship between increase of subdural fluid collection (SFC) and development of CSDH. Results 15 patients (1.9%) developed post clipping CSDH which required evacuation. Among those, 13 were unruptured cases (2.8%), a much higher percentage than for ruptured cases (0.9%). On univariate statistical analysis, risk factors of CSDH were associated with advanced age (p=0.0005), male gender (p=0.04) and unruptured cases (p=0.02). Aneurysmal location was not related to the development of postoperative CSDH. Contralateral CSDH occurred in 3 cases, but no MCA aneurysm developed contralateral CSDH. Increase of postoperative SFC over 1 week was a significant risk factor for CSDH (p=0.001). Conclusion In addition to the classical risk factors, this study showed that clipping for unruptured cases carries higher risk for CSDH as compared to ruptured cases. We suggest that an increase of SFC over 1 week postoperatively can be a factor in predicting CSDH after clipping.
Júlio Leonardo B. Pereira
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