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Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis
PURPOSE: Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803717/ https://www.ncbi.nlm.nih.gov/pubmed/33094383 http://dx.doi.org/10.1007/s00234-020-02558-x |
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author | Miah, Ishita P. Tank, Yeliz Rosendaal, Frits R. Peul, Wilco C. Dammers, Ruben Lingsma, Hester F. den Hertog, Heleen M. Jellema, Korné van der Gaag, Niels A. |
author_facet | Miah, Ishita P. Tank, Yeliz Rosendaal, Frits R. Peul, Wilco C. Dammers, Ruben Lingsma, Hester F. den Hertog, Heleen M. Jellema, Korné van der Gaag, Niels A. |
author_sort | Miah, Ishita P. |
collection | PubMed |
description | PURPOSE: Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. METHODS: Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. RESULTS: Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). LIMITATIONS: Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. CONCLUSIONS: Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures. |
format | Online Article Text |
id | pubmed-7803717 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-78037172021-01-21 Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis Miah, Ishita P. Tank, Yeliz Rosendaal, Frits R. Peul, Wilco C. Dammers, Ruben Lingsma, Hester F. den Hertog, Heleen M. Jellema, Korné van der Gaag, Niels A. Neuroradiology Review PURPOSE: Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. METHODS: Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. RESULTS: Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). LIMITATIONS: Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. CONCLUSIONS: Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures. Springer Berlin Heidelberg 2020-10-22 2021 /pmc/articles/PMC7803717/ /pubmed/33094383 http://dx.doi.org/10.1007/s00234-020-02558-x Text en © The Author(s) 2020, corrected publication 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Review Miah, Ishita P. Tank, Yeliz Rosendaal, Frits R. Peul, Wilco C. Dammers, Ruben Lingsma, Hester F. den Hertog, Heleen M. Jellema, Korné van der Gaag, Niels A. Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis |
title | Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis |
title_full | Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis |
title_fullStr | Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis |
title_full_unstemmed | Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis |
title_short | Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis |
title_sort | radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803717/ https://www.ncbi.nlm.nih.gov/pubmed/33094383 http://dx.doi.org/10.1007/s00234-020-02558-x |
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