Subdural Hematoma due to Dural Metastasis: A Systematic Review on Frequency, Clinical Characteristics, and Neurosurgical Management.

IF 0.9 4区医学 Q4 CLINICAL NEUROLOGY

Journal of neurological surgery. Part A, Central European neurosurgery Pub Date : 2024-03-04 DOI:10.1055/s-0044-1782141

Bhavya Pahwa, Anish Tayal, Atulya Chandra, Joe M Das

{"title":"Subdural Hematoma due to Dural Metastasis: A Systematic Review on Frequency, Clinical Characteristics, and Neurosurgical Management.","authors":"Bhavya Pahwa, Anish Tayal, Atulya Chandra, Joe M Das","doi":"10.1055/s-0044-1782141","DOIUrl":null,"url":null,"abstract":"Background: Subdural hematoma (SDH) occasionally accompanies dural metastasis and is associated with high recurrence rate, significantly impacting patient morbidity and mortality. This systematic review aims to evaluate the characteristics, management options, and outcomes of patients with SDH associated with dural metastasis.Methods: A comprehensive search of the PubMed and Cochrane databases was conducted for English-language studies published from inception to March 20, 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors reviewed cases of histopathologically confirmed SDH with non-central nervous system (non-CNS) tumor metastasis, focusing on therapeutic management of SDH. Statistical analysis was performed using SPSS software, with a significance level set at 0.05.Results: This review included 32 studies comprising 37 patients with 43 SDH cases associated with dural metastasis. Chronic SDH was the most frequently observed presentation (n = 28, 65.12%). The systemic malignancies most commonly associated with SDH due to dural metastasis were prostate carcinoma (n = 9, 24.32%) and gastric carcinoma (n = 5, 13.51%). A statistically significant association was found between metastatic melanoma and subacute SDH (p = 0.010). The majority of patients were treated with burr holes (n = 15, 40.54%) or craniotomies (n = 14, 37.84%), with no statistically significant difference in mortality rates between the two techniques (p = 0.390). Adjuvant therapy was administered to a limited number of patients (n = 5, 13.51%), including chemotherapy (n = 2, 5.41%), whole brain radiotherapy (n = 1, 2.70%), a combination of chemotherapy and whole brain radiotherapy (n = 1, 2.70%), and transcatheter arterial chemoembolization (n = 1, 2.70%). The overall recurrence rate was 45.95% (n = 17), with burr holes being the most common management approach (n = 4, 10.81%). Within a median of 8 days, 67.57% (n = 25) of patients succumbed, primarily due to rebleeding (n = 3, 8.11%), disseminated intravascular coagulation (n = 3, 8.11%), and pneumonia (n = 3, 8.11%).Conclusion: This review highlights the need for improving existing neurosurgical options and exploring novel treatment methods. It also emphasizes the importance of dural biopsy in patients with suspected metastasis to rule out a neoplastic etiology.","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurological surgery. Part A, Central European neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/s-0044-1782141","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Subdural hematoma (SDH) occasionally accompanies dural metastasis and is associated with high recurrence rate, significantly impacting patient morbidity and mortality. This systematic review aims to evaluate the characteristics, management options, and outcomes of patients with SDH associated with dural metastasis.

Methods: A comprehensive search of the PubMed and Cochrane databases was conducted for English-language studies published from inception to March 20, 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors reviewed cases of histopathologically confirmed SDH with non-central nervous system (non-CNS) tumor metastasis, focusing on therapeutic management of SDH. Statistical analysis was performed using SPSS software, with a significance level set at 0.05.

Results: This review included 32 studies comprising 37 patients with 43 SDH cases associated with dural metastasis. Chronic SDH was the most frequently observed presentation (n = 28, 65.12%). The systemic malignancies most commonly associated with SDH due to dural metastasis were prostate carcinoma (n = 9, 24.32%) and gastric carcinoma (n = 5, 13.51%). A statistically significant association was found between metastatic melanoma and subacute SDH (p = 0.010). The majority of patients were treated with burr holes (n = 15, 40.54%) or craniotomies (n = 14, 37.84%), with no statistically significant difference in mortality rates between the two techniques (p = 0.390). Adjuvant therapy was administered to a limited number of patients (n = 5, 13.51%), including chemotherapy (n = 2, 5.41%), whole brain radiotherapy (n = 1, 2.70%), a combination of chemotherapy and whole brain radiotherapy (n = 1, 2.70%), and transcatheter arterial chemoembolization (n = 1, 2.70%). The overall recurrence rate was 45.95% (n = 17), with burr holes being the most common management approach (n = 4, 10.81%). Within a median of 8 days, 67.57% (n = 25) of patients succumbed, primarily due to rebleeding (n = 3, 8.11%), disseminated intravascular coagulation (n = 3, 8.11%), and pneumonia (n = 3, 8.11%).

Conclusion: This review highlights the need for improving existing neurosurgical options and exploring novel treatment methods. It also emphasizes the importance of dural biopsy in patients with suspected metastasis to rule out a neoplastic etiology.

查看原文本刊更多论文

硬膜转移导致的硬膜下血肿：关于发病率、临床特征和神经外科处理的系统性综述。

背景：硬膜下血肿（SDH）偶尔会伴随硬膜转移，且复发率高，对患者的发病率和死亡率有显著影响。本系统综述旨在评估硬膜转移相关 SDH 患者的特征、治疗方案和预后：按照系统综述和荟萃分析首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南，对 PubMed 和 Cochrane 数据库中从开始到 2023 年 3 月 20 日发表的英文研究进行了全面检索。作者回顾了经组织病理学证实的SDH合并非中枢神经系统（非中枢神经系统）肿瘤转移的病例，重点关注SDH的治疗管理。统计分析使用 SPSS 软件进行，显著性水平设定为 0.05：本综述共纳入 32 项研究，包括 37 名患者，其中 43 例 SDH 患者伴有硬脑膜转移。慢性 SDH 是最常见的表现形式（n = 28，65.12%）。硬膜转移导致的SDH最常见的全身恶性肿瘤是前列腺癌（9例，24.32%）和胃癌（5例，13.51%）。转移性黑色素瘤与亚急性 SDH 之间存在统计学意义上的关联（p = 0.010）。大多数患者接受了钻孔（n = 15，40.54%）或开颅手术（n = 14，37.84%）治疗，两种技术的死亡率差异无统计学意义（p = 0.390）。少数患者（5 例，13.51%）接受了辅助治疗，包括化疗（2 例，5.41%）、全脑放疗（1 例，2.70%）、化疗和全脑放疗联合治疗（1 例，2.70%）以及经导管动脉化疗栓塞（1 例，2.70%）。总复发率为 45.95%（n = 17），最常见的治疗方法是钻孔（n = 4，10.81%）。在中位数 8 天内，67.57%（n = 25）的患者死亡，主要原因是再出血（n = 3，8.11%）、弥散性血管内凝血（n = 3，8.11%）和肺炎（n = 3，8.11%）：本综述强调了改进现有神经外科方案和探索新型治疗方法的必要性。结论：本综述强调了改进现有神经外科方案和探索新型治疗方法的必要性，同时也强调了对疑似转移患者进行硬脑膜活检以排除肿瘤病因的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of neurological surgery. Part A, Central European neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

2.30

自引率

0.00%

发文量

期刊介绍： The Journal of Neurological Surgery Part A: Central European Neurosurgery (JNLS A) is a major publication from the world''s leading publisher in neurosurgery. JNLS A currently serves as the official organ of several national neurosurgery societies. JNLS A is a peer-reviewed journal publishing original research, review articles, and technical notes covering all aspects of neurological surgery. The focus of JNLS A includes microsurgery as well as the latest minimally invasive techniques, such as stereotactic-guided surgery, endoscopy, and endovascular procedures. JNLS A covers purely neurosurgical topics.