| Objective: Although chronic subdural hematomas(CSDHs)are one of the most common neurosurgical diseases,bilateral CSDHs are more rare than unilateral CSDHs,and the knowledge of the clinical and radiological characteristics of bilateral CSDHs are limited.The purpose of this study was to analyze etiologies,epidemiology,clinical presentations,computed tomography(CT)findings,treatment,mortality,postoperative outcomes and recurrence of bilateral CSDHs compared with unilateral CSDHs by retrospectively reviewing CSDH cases that were treated in the department of neurosurgery at Affiliated Hospital of Southwest Medical University in the past 6 years.Finally,we hope to provide some useful information for the clinical prevention and management of bilateral CSDHs.Methods: A total of 470 patients with CSDH who were treated in the department of neurosurgery at Affiliated Hospital of Southwest Medical University from August 2013 through August 2019 were enrolled in this study.These patients were divided into bilateral and unilateral groups.One hundred and twenty eight of them were diagnosed of bilateral CSDHs,and the rest 342 were diagnosed of unilateral CSDHs by CT examinations.We collected the information of their personal details,clinical presentations,past medical history,imaging findings,treatment,operation and postoperative outcomes by the EMRS(Electronic Medical Record System).Comparisons between the 2 groups were made by using the independent samples t-test or one-way ANOVA and chi-square test or Fisher's exact test.Results: Bilateral CSDHs were identified in 128 of 470 patients with CSDH(27.2%).The proportion of patients over 75 years old in bilateral CSDH group was 37.5%,which was significantly higher than that in unilateral CSDH group(P=0.001).The patients with bilateral CSDH were more likely to present with nausea or vomiting(P=0.019)and have a GCS of grade 9-12(P=0.013).Compared with the unilateral CSDH group,lesser mean maximal thickness of hematoma(17.58±6.42 mm vs 21.59±8.02 mm,P<0.001)and degree of midline shift(3.84±4.74 mm vs 9.50±5.09 mm,P<0.001)were observed by computed tomography(CT)in the bilateral group.Additionally,the CT scan imaging appearances of homogenous and laminar types were more common in the bilateral group(75.8% vs 65.5%,P=0.033).There were no significant differences in the terms of management and total hospital mortality between groups(P>0.05).However,compared with the unilateral group,the mortality due to brain herniation in the bilateral CSDH group was significantly higher(3.1% vs 0.3%,P=0.031).80.2% of patients underwent burr-hole drainage,and most of them had a favorable postoperative outcome.Although a poorer postoperative outcome(mRS3-6)was observed in the bilateral CSDH group,it was not significantly different between the two groups(10.5% vs 5.1%,P=0.062).In addition,no significant differences were found in terms of recurrence and complications after burr-hole drainage between the two groups(P>0.05).Conclusion: Our study suggested that bilateral CSDHs accounted for about 1/4 of CSDHs,and were prone to occur in patients over 75 years.Compared to patients with unilateral CSDH,patients with bilateral CSDH presented more commonly with nausea or vomiting,had a lower GCS,and had more homogenous and laminar types,lesser mean maximal thickness of hematoma and degree of midline shift on CT scan.Burr-hole drainage is a safe and effective surgical technique for the treatment of bilateral CSDHs,and early surgical decompression for bilateral CSDHs should be implemented to prevent neurological deterioration.Most patients had a favorable postoperative outcome,and recurrence and complications were similar in the two groups. |
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