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Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalus
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience. Departments of Cardiology and Health, Medicine and Caring Services, Linkoping University, Vrinnevi General Hospital Norrköping.
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
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2020 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, p. 1-10Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Subdural hematomas and hygromas (SDHs) are common complications in idiopathic normal pressure hydrocephalus (iNPH) patients with shunts. In this registry-based study, patients with shunted iNPH were screened nationwide to identify perioperative variables that may increase the risk of SDH.

METHODS: The Swedish Hydrocephalus Quality Registry was reviewed for iNPH patients who had undergone shunt surgery in Sweden in 2004-2014. Potential risk factors for SDH were recorded preoperatively and 3 months after surgery. Drug prescriptions were identified from a national pharmacy database. Patients who developed SDHs were compared with those without SDHs.

RESULTS: The study population consisted of 1457 patients, 152 (10.4%) of whom developed an SDH. Men developed an SDH more often than women (OR 2.084, 95% CI 1.421-3.058, p < 0.001). Patients on platelet aggregation inhibitors developed an SDH more often than those who were not (OR 1.733, 95% CI 1.236-2.431, p = 0.001). At surgery, shunt opening pressures had been set 5.9 mm H2O lower in the SDH group than in the no-SDH group (109.6 ± 24.1 vs 115.5 ± 25.4 mm H2O, respectively, p = 0.009). Antisiphoning devices (ASDs) were used in 892 patients but did not prevent SDH. Mean opening pressures at surgery and the follow-up were lower with shunts with an ASD, without causing more SDHs. No other differences were seen between the groups.

CONCLUSIONS: iNPH patients in this study were diagnosed and operated on in routine practice; thus, the results represent everyday care. Male sex, antiplatelet medication, and a lower opening pressure at surgery were risk factors for SDH. Physical status and comorbidity were not. ASD did not prevent SDH, but a shunt with an ASD allowed a lower opening pressure without causing more SDHs.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons , 2020. p. 1-10
Keywords [sv]
hydrocephalus, normal pressure, hygroma, chronic subdural hematoma, cerebrospinal shunt, complications
National Category
Neurology
Research subject
Neurosurgery
Identifiers
URN: urn:nbn:se:umu:diva-167468DOI: 10.3171/2019.10.JNS191223PubMedID: 31923893OAI: oai:DiVA.org:umu-167468DiVA, id: diva2:1387696
Note

Abbreviations: ASD = antisiphoning device; CSF = cerebrospinal fluid; iNPH = idiopathic normal pressure hydrocephalus; NSAID = nonsteroidal anti-inflammatory drug; SDH = subdural hematoma/hygroma; SHQR = Swedish Hydrocephalus Quality Registry; SPDR = Swedish Prescribed Drug Register.

Available from: 2020-01-22 Created: 2020-01-22 Last updated: 2020-03-24

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Sundström, NinaEklund, AndersKoskinen, Lars-Owe D.Malm, Jan

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Department of Pharmacology and Clinical NeuroscienceDepartment of Radiation Sciences
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