Estimation of Chronic Subdural Hematoma Size Using CT Imaging; a Comparison of In-Plane Thickness to 3D Volumetry


Backgrounds: Pre- and postoperative chronic subdural hematoma (CSDH) sizes have been used in clinical trials to predict the risk of postoperative recurrence. Commonly, dimensions of the pre- and postoperative lesions have been assessed by computerized tomography (CT) scans using maximum thickness as a linear measurement. Our goal was to characterize this common method for quantification of pre- and postoperative lesion sizes and to assess its estimation validity compared to estimation by hematoma volumetry. Methods: We prospectively investigated pre- and 1st postoperative day CT scans of 107 adult surgical patients with uni- or bilateral CSDH. Pre- and postoperative thickness of CSDH was determined and then compared to pre- and postoperative lesion volume measured with 3D hematoma volumetry. Results: Pearson correlation coefficients between mean pre- and postoperative lesion thickness and mean pre- and postoperative lesion volume in the unilateral subgroup were 0.491 and 0.498, respectively; in the bilateral subgroup 0.505 and 0.579, respectively; and in the whole series 0.653 and 0.472, respectively. Conclusions: Pre- and postoperative thickness of CSDH does not offer reasonable approximations of the pre- and postoperative lesion size when compared with results from 3D volumetry in the unilateral subgroup, bilateral subgroup or overall.

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M. Stanišić, I. Groote, J. Hald and A. Pripp, "Estimation of Chronic Subdural Hematoma Size Using CT Imaging; a Comparison of In-Plane Thickness to 3D Volumetry," Open Journal of Modern Neurosurgery, Vol. 4 No. 1, 2014, pp. 1-6. doi: 10.4236/ojmn.2014.41001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. E. Baé, H. Wessling, H. C. Salca and P. H. Echeverría, “Use of Twist-Drill Craniostomy with Drain in Evacuation of Chronic Subdural Hematomas: Independent Predictors of Recurrence,” Acta Neurochirurgica, Vol. 153, No. 5, 2011, pp. 1097-1103.
[2] K. H. Chon, J. M. Lee, E. J. Koh and H. Y. Choi, “Independent Predictors for Recurrence of Chronic Subdural Hematoma,” Acta Neurochirurgica, Vol. 154, No. 9, 2012, pp. 1541-1548.
[3] H. El-Kadi, V. J. Miele and H. H. Kaufman, “Prognosis of Chronic Subdural Hematomas,” Neurosurgery Clinics of North America, Vol. 11, No. 3, 2000, pp. 553-567.
[4] K. Mori and M. Maeda, “Surgical Treatment of Chronic Subdural Hematoma in 500 Consecutive Cases: Clinical Characteristics, Surgical Outcome, Complications, and Recurrence Rate,” Neurologia Medico-Chirurgica (Tokyo), Vol. 41, No. 8, 2001, pp. 371-381.
[5] H. Nakaguchi, T. Tanishima and N. Yoshimasu, “Relationship between Drainage Catheter Location and Postoperative Recurrence of Chronic Subdural Hamatoma after Burr-Hole Irrigation and Closed-System Drainage,” Journal of Neurosurgery, Vol. 93, No. 5, 2000, pp. 791-795.
[6] K. Torihashi, N. Sadamasa, K. Yoshida, O. Narumi, M. Chin and S. Yamagata, “Independent Predictors for Recurrence of Chronic Subdural Hematoma: A Revive of 343 Consecutive Surgical Cases,” Neurosurgery, Vol. 63, No. 6, 2008, pp. 1125-1129.
[7] Y. Okada, T. Akai, K. Okamoto, T. Iida, H. Takata and H. Iizuka, “A Comparative Study of the Treatment of Chronic Subdural Hematoma-Burr Hole Drainage versus Burr Hole Irrigation,” Surgical Neurology, Vol. 57, No. 6, 2002, pp. 405-409.
[8] C. Smely, A. Madlinger and R. Scheremet, “Chronic Subdural Hematoma—A Comparison of Two Different Treatment Modalities,” Acta Neurochirurgica (Wien), Vol. 139, No. 9, 1997, pp. 818-826.
[9] M. Stanisic, M. Lund-Johansen and R. Mahesparan, “Treatment of Chronic Subdural Hematoma by Burr-Hole Craniostomy in Adults: Influence of Some Factors on Post-operative Recurrence,” Acta Neurochirurgica (Wien), Vol. 147, No. 12, 2005, pp. 1249-1257.
[10] T. Sundstrom, C. A. Helland, M. Aarhus and K. Wester, “What Is the Pressure in Chronic Subdural Hematomas? A Prospective, Population-Based Study,” Journal of Neurotrauma, Vol. 29, No. 1, 2012, pp. 137-142.
[11] A. Frati, M. Salvati, F. Mainiero, F. Ippoliti, G. Rocchi, A. Roco, E. Caroli, G. Cantore and R. Delfini, “Inflammation Markers and Risk Factors for Recurrence in 35 Patients with a Posttraumatic Chronic Subdural Hematoma: A Prospective Study,” Journal of Neurosurgery, Vol. 100, No. 1, 2004, pp. 24-32.
[12] A. R. Kristof, M. J. Grimm and B. Stoffel-Wagner, “Cerebrospinal Fluid Leakage into the Subdural Space: Possible Influence on the Pathogenesis and Recurrence Frequency of Chronic Subdural Hematoma and Subdural Hygroma,” Journal of Neurosurgery, Vol. 108, No. 2, 2008, pp. 275-280.
[13] K. Matsumoto, K. Akagi, M. Abekura, H. Ryujin, M. Ohkawa, N. Iwasa and C. Akiyama, “Recurrence Factors for Chronic Subdural Hematomas after Burr-Hole Craniostomy and Closed System Drainage,” Neurological Research, Vol. 21, No. 3, 1999, pp. 277-280.
[14] P. Taussky, J. Fandino and H. Landolt, “Number of Burr Holes as Independent Predictor of Postoperative Recurrence in Chronic Subdural Haematoma,” British Journal of Neurosurgery, Vol. 22, No. 2, 2008, pp. 279-282.
[15] H. Yamamoto, Y. Hirashima, H. Hamada, N. Hayashi, H. Origasa and S. Endo, “Independent Predictors of Recurrence of Chronic Subdural Hematoma: Results of Multivariate Analysis Performed Using a Logistic Regression Model,” Journal of Neurosurgery, Vol. 98, No. 6, 2003, pp. 1217-1221.
[16] M. Stanisic, J. Hald, I. A. Rasmussen, A. H. Pripp, J. Ivanovic, F. Kolstad, J. Sundseth, M. Züchner and K. F. Lindegaard, “Volume and Densities of Chronic Subdural Haematoma Obtained from CT Imaging as Predictors of Postoperative Recurrence: A Prospective Study of 107 Operated Patients,” Acta Neurochirurgica, Vol. 155, No. 2, 2013, pp. 323-333.
[17] H. K. Sucu, M. Gokmen and F Gelal, “The Value of XYZ/2 Technique Compared with Computer-Assisted Volumetric Analysis to Estimate the Volume of Chronic Subdural Hematoma,” Stroke, Vol. 36, No. 5, 2005, pp. 998-1000.

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