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Spreading Depolarization After Chronic Subdural Hematoma Evacuation: Associated Clinical Risk Factors and Influence on Clinical Outcome

  • Spreading cortical depolarization
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A Correction to this article was published on 18 November 2021

This article has been updated

Abstract

Background

Chronic subdural hematoma (cSDH) is a common neurosurgical condition responsible for excess morbidity, particularly in the geriatric population. Recovery after evacuation is complicated by fluctuating neurological deficits in a high proportion of patients. We previously demonstrated that spreading depolarizations (SDs) may be responsible for some of these events. In this study, we aim to determine candidate risk factors for probable SD and assess the influence of probable SD on outcome.

Methods

We used two cohorts who underwent surgery for cSDH. The first cohort (n = 40) had electrocorticographic monitoring to detect SD. In the second cohort (n = 345), we retrospectively identified subjects with suspected SD based on the presence of transient neurological symptoms not explained by structural etiology or ictal activity on electroencephalography. We extracted standard demographic and outcome variables for comparisons and modeling.

Results

Of 345 subjects, 80 (23%) were identified in the retrospective cohort as having probable SD. Potential risk factors included history of hypertension, worse clinical presentation on the Glasgow Coma Scale, and lower Hounsfield unit density and volume of the preoperative subdural hematoma. Probable SD was associated with multiple worse-outcome measures, including length of stay and clinical outcomes, but not increased mortality. On a multivariable analysis, probable SD was independently associated with worse outcome, determined by the Glasgow Outcome Scale score at the first clinic follow-up (odds ratio 1.793, 95% confidence interval 1.022–3.146) and longer hospital length of stay (odds ratio 7.952, 95% confidence interval 4.062–15.563).

Conclusions

Unexplained neurological deficits after surgery for cSDH occur in nearly a quarter of patients and may be explained by SD. We identified several potential candidate risk factors. Patients with probable SD have worse outcomes, independent of other baseline risk factors. Further data with gold standard monitoring are needed to evaluate for possible predictors of SD to target therapies to a high-risk population.

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Acknowledgements

Pedro Ramirez, William McKay, Benjamin Vidalis, Zoya Voronovich, Ross Green, and Jacqueline O’Neill for data collection and abstraction.

Funding

National Institutes of Health award P20 GM109089.

Author information

Authors and Affiliations

  1. Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Christine Meadows, Michel Torbey & Ali A. Alsarah

  2. Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Herbert Davis

  3. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Laila Mohammad

  4. Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, USA

    C. William Shuttleworth

  5. Clinical Translational Science Center, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Yiliang Zhu

  6. Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Andrew P. Carlson

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  1. Christine Meadows
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Contributions

CM performed article drafting, data collection and analysis. HD performed data analysis and critical review. LM performed data collection and analysis. CWS performed study conception and critical review. MT performed critical review. YZ performed data analysis and study design. AAA performed data analysis. APC performed study concept and design, data analysis, drafting manuscript and editing. Authorship requirements have been met and the final manuscript has been approved by all authors.

Corresponding author

Correspondence to Andrew P. Carlson.

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The authors have nothing to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (UNM HRPO# 16-352 and UNM HRPO# 15-564) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Meadows, C., Davis, H., Mohammad, L. et al. Spreading Depolarization After Chronic Subdural Hematoma Evacuation: Associated Clinical Risk Factors and Influence on Clinical Outcome. Neurocrit Care 35 (Suppl 2), 105–111 (2021). https://doi.org/10.1007/s12028-021-01339-5

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  • DOI: https://doi.org/10.1007/s12028-021-01339-5

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