Elevated blood urea nitrogen is associated with recurrence of post-operative chronic subdural hematoma

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Abstract

Background

Chronic subdural hematoma (CSDH) is fundamentally treatable with about a 2–31% recurrence rate. Recently, there has been renewed interest in the association between Blood Urea Nitrogen (BUN) and intracranial lesion. Therefore, this paper attempts to show the relationship between BUN and CSDH recurrence.

Methods

A total of 653 CSDH cases with Burr-hole Irrigation (BHI) were enrolled from December 2014 to April 2019. The analyzed parameters included age, gender, comorbidities, laboratory investigations, medication use and hematoma location. The cases were divided into recurrence and non-recurrence groups while postoperative BUN concentration was further separated into quartiles (Q1 ≤ 4.0 mmol/L, 4.0 < Q2 ≤ 4.9 mmol/L, 4.9 < Q3 ≤ 6.4 mmol/L, Q4 > 6.4 mmol/L). Restricted cubic spline regressions and logistic regression models were performed to estimate the effect of BUN on CSDH recurrence.

Results

CSDH recurrence was observed in 96 (14.7%) cases. Significant distinctions were found between recurrence and non-recurrence groups in postoperative BUN quartiles of cases ( P = 0.003). After adjusting for the potential confounders, the odds ratio of recurrence was 3.069 (95%CI =1.488–6.330, p = 0.002) for the highest quartile of BUN compared with the lowest quartile. In multiple-adjusted spline regression, a high BUN level visually showed a significantly high OR value of recurrence risk.

Conclusions

Elevated BUN at post-operation is significantly associated with the recurrence of CSDH, and it is indicated that high levels of serum BUN after evacuation may serve as a risk factor for CSDH recurrence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-020-01985-w.

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Most cited references 26

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Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy

Ellie Edlmann, Susan Giorgi-Coll, Peter Whitfield … (2017)

Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and fluid on the surface of the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. This review focuses on several key processes involved in CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic membrane surrounding the CSDH has been identified as a source of fluid exudation and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels within membrane walls, whilst fibrinolytic processes prevent clot formation resulting in continued haemorrhage. An abundance of inflammatory cells and markers have been identified within the membranes and subdural fluid and are likely to contribute to propagating an inflammatory response which stimulates ongoing membrane growth and fluid accumulation. Currently, the mainstay of treatment for CSDH is surgical drainage, which has associated risks of recurrence requiring repeat surgery. Understanding of the underlying pathophysiological processes has been applied to developing potential drug treatments. Ongoing research is needed to identify if these therapies are successful in controlling the inflammatory and angiogenic disease processes leading to control and resolution of CSDH.

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Chronic subdural haematoma: modern management and emerging therapies.

Angelos G. Kolias, Aswin Chari, Thomas Santarius … (2014)

Chronic subdural haematoma (CSDH) is one of the most common neurological disorders, and is especially prevalent among elderly individuals. Surgical evacuation is the mainstay of management for symptomatic patients or haematomas exerting significant mass effect. Although burr hole craniostomy is the most widely practised technique worldwide, approximately 10-20% of surgically treated patients experience postoperative recurrence necessitating reoperation. Given the increasing incidence of CSDH in a growing elderly population, a need exists for refined techniques that combine a minimally invasive approach with clinical efficacy and cost-effectiveness. In addition, nonsurgical treatment modalities, such as steroids, are attracting considerable interest, as they have the potential to reduce postoperative recurrence or even replace the need for surgery in selected patients. This Review provides an overview of the contemporary management of CSDH and presents considerations regarding future approaches that could further optimize patient care and outcomes.

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The surgical management of chronic subdural hematoma.

Eric Sussman, Kristen Anderson, E Connolly … (2012)

Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

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Author and article information

Contributors

Sheng Ye:

ORCID: http://orcid.org/0000-0003-1281-1735

yesheng342@163.com

Journal

Journal ID (nlm-ta): BMC Neurol

Journal ID (iso-abbrev): BMC Neurol

Title: BMC Neurology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2377

Publication date (Electronic): 10 November 2020

Publication date PMC-release: 10 November 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 411

Affiliations

[1 ]GRID grid.414906.e, ISNI 0000 0004 1808 0918, Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, , The First Affiliated Hospital of Wenzhou Medical University, ; Wenzhou, 325000 China

[2 ]GRID grid.414906.e, ISNI 0000 0004 1808 0918, Department of Neurosurgery, , The First Affiliated Hospital of Wenzhou Medical University, ; Wenzhou, 325000 Zhejiang China

[3 ]GRID grid.266871.c, ISNI 0000 0000 9765 6057, Department of Pharmacology and Neuroscience, , University of North Texas Health Science Center, ; Fort Worth, TX 76107 USA

Author information

Sheng Ye http://orcid.org/0000-0003-1281-1735

Article

Publisher ID: 1985

DOI: 10.1186/s12883-020-01985-w

PMC ID: 7653870

SO-VID: 292198fd-e4a4-41fa-b2f8-94ee4f0767c3

License:

Open AccessThis 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/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 10 March 2020

Date accepted : 29 October 2020

Funding

Funded by: NationalNatural Science Foundation of China (CN)

Award ID: No. 81771262

Award Recipient : Qichuan Zhuge

Funded by: Zhejiang Health Science and Technology Project

Award ID: 2016RCA022

Award Recipient : Qichuan Zhuge

Funded by: FundRef http://dx.doi.org/10.13039/501100004731, Natural Science Foundation of Zhejiang Province;

Award ID: LQ20H090005

Award Recipient : Jianjing Yang

Funded by: Wenzhou Municipal Science and Technology Bureau Project of China

Award ID: Y20190568

Award Recipient : Linhui Ruan

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ScienceOpen disciplines: Neurology

Keywords: chronic subdural hematoma,blood urea nitrogen (bun),recurrence rate

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ScienceOpen disciplines: Neurology

Keywords: chronic subdural hematoma, blood urea nitrogen (bun), recurrence rate

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Elevated blood urea nitrogen is associated with recurrence of post-operative chronic subdural hematoma

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Abstract

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Supplementary Information

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Nanoparticles to cross the blood-brain barrier (BBB)

Most cited references 26

Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy

Chronic subdural haematoma: modern management and emerging therapies.

The surgical management of chronic subdural hematoma.

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Cited by 3

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