Endoscopic Management of Chronic Subdural Hematoma

Abstract Background Twist drill evacuation, burr hole aspiration, mini-craniotomy, and craniotomy are some of the surgical methods to remove chronic subdural hematoma (CSDH). Endoscopic treatment was also recently found to be useful. Methods We conducted a prospective study of 72 hematomas in 68 patients. Computed tomography was performed in all cases. Endoscopic surgery was performed in all CSDH patients. Surgical procedure A 4-cm skin incision was performed at the most curved part of skull with the CSDH. A mini-craniotomy or enlarged burr hole was made. The inner and outer table of the burr hole margin was drilled to provide a straight trajectory to the hematoma cavity. An endoscope supported by a telescope holder was used. A modified silicone brain retractor was used in five patients. A subgaleal drain was left in all patients for 3 to 5 days. Results There were 42 male and 26 female patients. The age ranged from 45 to 79 years (average: 69 years). All patients had a history of head trauma. Preoperative average Glasgow Coma Scale Score was 14. The procedure was effective in hematoma evacuation and a good visualization of the whole cavity in all patients. The endoscopic technique helped in complete hematoma removal in organized/solid clot, septations, and bridging vessels in 17, 2, and 2 cases, respectively. Duration of surgery ranged from 35 to 80 minutes. One death occurred. There was no recurrence, infection, fresh bleed, or injury to the brain or membrane. Conclusion The endoscopic technique is an effective alternative technique for treating CSDH. Although the study has limitations because of the small number of patients with a short follow-up, the study indicated that thick and vascular membranes, septations, and organized and solid clots can be removed effectively using this technique.

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Chronic Subdural Hematoma - A Dilemma to Put Drain

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i1.42921 ◽

2019 ◽

Vol 9 (1) ◽

pp. 26-32

Author(s):

Md Amir Ali ◽

Md Aminul Islam ◽

RU Chowdhury ◽

Ahmed Mursalin ◽

Md Al Amin Salek ◽

...

Keyword(s):

Closed System ◽

Subdural Hematoma ◽

Drainage System ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Chronic Subdural Haematoma ◽

Burr Hole ◽

Air Entrapment ◽

Number Of Patients ◽

Group A

Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain. Objectives: our study is to compare the clinical outcome of CSDH with or without drain. Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS. Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %). Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone. Bang. J Neurosurgery 2019; 9(1): 26-32

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Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

Eastern Green Neurosurgery ◽

10.3126/egn.v2i1.27459 ◽

2020 ◽

Vol 2 (1) ◽

pp. 30-34

Author(s):

Suresh Sapkota ◽

Kiran Niraula ◽

Subash Lohani ◽

Shikher Shrestha ◽

Bibhusan Shrestha ◽

...

Keyword(s):

Local Anesthesia ◽

Subdural Hematoma ◽

Surgical Outcome ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Midline Shift ◽

External Drainage ◽

Presenting Symptoms ◽

Number Of Patients ◽

Significant Difference

Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

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Efficacy of the direct aspiration-irrigation maneuver for the treatment of chronic subdural hematoma: A single hospital's experience

10.21203/rs.3.rs-273418/v1 ◽

2021 ◽

Author(s):

Zhenjiang Pan ◽

Jing Bao ◽

Shepeng Wei

Keyword(s):

Subdural Hematoma ◽

Chart Review ◽

Chronic Subdural Hematoma ◽

Retrospective Chart Review ◽

Burr Hole ◽

Attractive Alternative ◽

Presenting Symptoms ◽

Significant Difference ◽

Duration Of Surgery ◽

Space Volume

Abstract OBJECTIVE The traditional methods for managing symptomatic chronic subdural hematoma (CSDH) at our hospital include evacuation via single burr-hole irrigation with continuous closed subdural drainage (SBID). The single burr-hole aspiration and irrigation technique with continuous closed subdural drainage (SBAID) is an attractive alternative method. The goal of this study was to evaluate the radiographic and clinical outcomes of SBAID compared with traditional SBID methods. METHODS A database of 51 CSDH patients treated with the SBAID method and 35 CSDH patients treated with the SBID method was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcomes was collected. Predictors of recurrence requiring reoperation and other outcomes were analyzed. RESULTS Compared to the patients in the SBID group, the patients in the SBAID group had a shorter mean duration of surgery (56.6 ± 5.6 minutes vs 59.5 ± 4.8 minutes, respectively, P = 0.02); a shorter mean interval from procedure to discharge (6.2 ± 1.2 days vs 6.8 ± 1.3 days, respectively, P = 0.046); no significant difference in preoperative hematoma volume (106.4 ± 21.7 cm3 vs 101.3 ± 16.3 cm3, respectively, P = 0.25); and a smaller subdural space volume 48 hours after the operation (43.6 ± 7.4 cm3 vs 47.4 ± 9.1 cm3, respectively, P = 0.03).

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Chronic Subdural Hematoma A Prospective Study

Journal of the Faculty of Medicine Baghdad ◽

10.32007/jfacmedbagdad.v60i1.34 ◽

2018 ◽

Vol 60 (1) ◽

pp. 19-23

Author(s):

Ali K. AL-Shalchy ◽

Wameedh Q. Abdul-hussein ◽

Saif S. AL-Musawy

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Early Recognition ◽

Chronic Subdural Hematoma ◽

Predisposing Factors ◽

Burr Hole ◽

Blood Collection ◽

Age Group ◽

A Prospective Study ◽

Symptoms And Signs

Background: Chronic subdural hematoma is a blood collection in the subdural space for more than 3 weeks from the onset of the bleeding. It is more likely to develop in infancy and after the age of 60 years. The incidence of subdural hematoma is 1- 2 per 100,000 people per year.Objective: To delineate the most common feature aspects of SDH like age, predisposing factors, symptoms and signs and different types of management of the disease.Patients and Methods: A prospective study of 40 patients from the period January 2012 - January 2014, and conducted in Gazi Al-Hariri Hospital of Surgical Specialties, disregarding the age, complaining of chronic subdural hematoma as proved by CT scan. It includes the predisposing factors, the symptoms and signs, the location of hematoma, mode of treatment, complications and the outcome.Results: In this study, the highest incidence of CSDH was above 50 years and the second age group was below 1 year. It was more common in males than females and they were unilateral more than bilateral, as shown by C.T scan which was the most reliable method for diagnosis and assessment.Conclusions: The most suitable treatment was burr hole in the older age group but craniotomy with membranectomy were still performed. In patients below 1 year, subdural peritoneal shunt found to be the method of choice. This study shows that the most common complications are the recurrence and infection. The outcome depends mainly on the early recognition and treatment.Keywords: Chronic subdural hematoma, traumatic brain injury, Burr hole aspiration. ورم دموي تحت الجافية المزمن دراسة مستقبلية د. علي كامل الشالجي د. وميض قيس عبد الحسين د. سيف سعد الموسوي الخلاصه: المقدمة: النزف الدموي تحت الام الجافية المزمن هو تجمع الدم في المجال تحت الام الجافية لأكثر من 3 أسابيع من بداية النزف. من المرجح أن تحصل في مرحلة الطفولة وبعد سن 60 عاما. حدوث الورم الدموي تحت الام الجافية هو 1-2 لكل 100,000 شخص سنويا. الهدف من الدراسة: لتعيين المميزات الأكثر شيوعا في النزف الدموي تحت الام القاسية مثل: العمر، والعوامل المؤهلة والأعراض والعلامات وطرق العلاج. مرضى وطرق: دراسة مستقبلية من 40 مريضا من الفترة يناير 2012 - يناير 2014، وأجريت في مستشفى غازي الحريري للتخصصات الجراحية، بغض النظر عن العمر، والذين يشكون من ورم دموي تحت الام الجافية المزمن مشخص بالاشعة المقطعية. وتشمل العوامل المؤهلة، والأعراض والعلامات، وموقع الورم الدموي، وطريقة العلاج، والمضاعفات والنتيجة. النتائج: في هذه الدراسة كانت أعلى نسبة للمرضى الذين تتجاوز اعمارهم أكثر من 50 سنة، وكانت الفئة العمرية الثانية الاكثر شيوعا هي الأقل من 1 سنة. وكان الذكور أكثر شيوعا من الإناث وكانت في جهة واحدة أكثر من الثنائية، كما هو مبين من قبل الاشعة المقطعية التي كان الأسلوب الأكثر موثوقية للتشخيص والتقييم. الاستنتاجات: وكان العلاج الأنسب تثقيب الجمجمة في الفئة العمرية الأكبر سنا ولكن فتح الجمجمة مع استئصال الغشاء لا تزال تنفذ. في المرضى الذين تقل أعمارهم عن 1 سنة، وجدت تحويلة تحت الجافية بريتونية لتكون الطريقة المفضلة. وتبين هذه الدراسة أن المضاعفات الأكثر شيوعا هي التكرار والعدوى. النتيجة تعتمد أساسا على التشخيص المبكر والعلاج. التوصيات: تثقيب الجمجمة يجب ان تكون النهج الجراحي الرئيسي في العلاج للمرضى مع اعطاء علاج الستيرويد لتقليل إمكانية التكرار. مفتاح الكلمات: ورم دموي تحت الام الجافية المزمن، وإصابات الدماغ الصدامية، بزل ثقوب الجمجمة.

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