Chronic subdural hematoma associated with dural metastasis leads to early recurrence and death: A single-institute, retrospective cohort study. (December 2021)

• Record Type: Journal Article
• Authors: Yamaguchi, Izumi; Kanematsu, Yasuhisa; Mizobuchi, Yoshifumi; Tada, Yoshiteru; Miyamoto, Takeshi; Sogabe, Shu; Ishihara, Manabu; Kagusa, Hiroshi; Yamamoto, Yoko; Matsuda, Taku; Kitazato, Keiko T.; Okayama, Yoshihiro; Takagi, Yasushi
• Is Part Of: Journal of clinical neuroscience. Volume 94(2021)
• Page Start: 244
• Page End: 249
• Publication Date: 2021-12
• Subjects: APTT activated partial thromboplastin time -- CSDH chronic subdural hematoma -- CT computed tomography -- DMG dural metastasis group -- MMA middle meningeal artery -- MRI magnetic resonance imaging -- No-DMG no dural metastasis group -- PT-INR prothrombin time-international normalized ratio; Cancer -- Chronic subdural hematoma -- Dural metastasis -- Recurrence; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.10.037
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: CSDH associated with dural metastasis leads to early recurrence and death. The prevalence was 16.1% among CSDH patients with active cancer. Dura mater/subdural hematoma biopsies may be considered in CSDH with active cancer. Withdrawal of active treatment and change to palliative care may be considered. Abstract: The prevalence of chronic subdural hematoma (CSDH) associated with dural metastasis is uncertain, and appropriate treatment strategies have not been established. This study aimed to investigate the characteristics of and appropriate treatment strategies for CSDH associated with dural metastasis. We retrospectively reviewed the charts of 214 patients who underwent surgery for CSDH. The patients were divided into the dural metastasis group (DMG; n = 5, 2.3%) and no dural metastasis group (No-DMG; n = 209, 97.3%). Patient characteristics, treatment, and outcomes were compared between the two groups. Active cancer was detected in 31 out of 214 patients, 5 of whom (16.1%) had dural metastasis. In-hospital death (80.0% vs. 0%; p < 0.001) and recurrence within 14 days (80.0% vs. 2.9%; p < 0.001) and 60 days (80.0% vs. 13.9%; p = 0.002) were significantly prevalent in the DMG. All patients in the DMG developed subdural hematoma re-accumulation requiring emergent surgery because of brain herniation, and patients in the DMG had significantly worse recurrence-free survival (p < 0.001). This relationship remained significant (p < 0.001) even when the analysis was limited to the active cancer cohort (n = 31). CSDH associated with dural metastasis leads to early recurrence and death because of the difficulty in controlling subdural hematoma re-accumulation by common drainage procedures. Depending on the primary cancer status, withdrawal of active treatment and change to palliative care should be discussed after diagnosing CSDH associated with dural metastasis.