Comparing Intraoperative Ultrasound and Postoperative Computed Tomography in Predicting Chronic Subdural Haemorrhage Clearance – A Pilot Study
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Abstract
Background: Recurrence following chronic subdural hematoma (CSDH) surgery remains a vexing problem. A clinically useful method of accurately predicting recurrence would be of utility in risk-stratifying patients and reduce the morbidity of further surgery. This study is a prospective single armed study comparing the use of intraoperative ultrasound to predict recurrence compared to postoperative computed tomography imaging.
Methods: Data were collected prospectively on patients who had surgery for CSDH in a single centre for over one year. Intraoperative ultrasound was performed prior to and after drainage. Postoperative computed tomography (CT) scans were also obtained for all patients. Demographic and radiologic data, recurrence rate, complication rate and functional outcomes were analysed.
Results: Twenty-five patients were included in the study, with 16 males (64%) and nine females (36%), averaging 69 years of age, with 48% on antiplatelets and/or anticoagulants. All underwent burr-hole and drainage. A 48% clearance rate as determined by ultrasound was achieved, with a 52% rate of hematoma clearance seen on postoperative CT scan. Inpatient mortality was one patient (4%), and four (16%) patients had recurrence. One patient (4%) suffered a postoperative wound infection. Intraoperative ultrasound clearance showed a trend toward reduced recurrence [RR 0.476 (95% CI: 0.304, 0.746)].
Conclusion: Intraoperative ultrasound-determined clearance may be more predictive of clearance than postoperative CT scan for CSDHs. This finding needs to be confirmed with larger studies.
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