Carbon dioxide insufflation for chronic subdural haematoma: a simple addition to burr-hole irrigation and closed-system drainage

Background: Chronic subdural haematoma (CSDH), is a common neurosurgical disorder that is associated with morbidity and mortality affecting the ageing population. The aim is to present the treatment experience of CSDH patients treated with a technique that combines the classical single burr-hole irrigation and the continuous closed system drainage: The closed system irrigation & drainage (CSID) technique. Methods: The cases undergoing CSDH evacuation with the CSID method were captured over a 4-year period at a tertiary neurosurgical centre. The authors describe the performance of this methods with respect to post-operative clinical and radiological features, including recurrence rates, complications, and length of stay. Results: A total of 36 cases undergoing 42 CSID procedures (30 unilateral and 6 bilateral CSDHs) were performed, in cases ranging between 55-95 years old (median age 79 years). The rate of recurrence or significant ruminant blood in the subdural space on post-operative imaging was 11% (n=4). No cases of pneumocephalus were observed in this series (n=0). The mean (SD) skin-to-skin time for this procedure was 13.4 (4.4) minutes, with a mean (SD) length of stay of 4 (1.9) days. Conclusion: We conclude that the one burr-hole closed system irrigation and drainage technique with a sub-periosteal drain seems to be a simple, effective and safe procedure for treatment of CSDH. It’s well tolerated under local anaesthesia for patients with high co-morbidities and these preliminary results indicated it may potentially be a better option for treatment of CSDH with a lower rate of post-operative complications.

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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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Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery: Optimal management of patients on antiplatelet therapy

British Journal of Neurosurgery ◽

10.3109/02688697.2013.829563 ◽

2013 ◽

Vol 28 (2) ◽

pp. 204-208 ◽

Cited By ~ 32

Author(s):

Atsushi Okano ◽

Soichi Oya ◽

Naoaki Fujisawa ◽

Tsukasa Tsuchiya ◽

Masahiro Indo ◽

...

Keyword(s):

Risk Factors ◽

Antiplatelet Therapy ◽

Subdural Haematoma ◽

Chronic Subdural Haematoma ◽

Burr Hole ◽

Optimal Management

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Life threatening hyponatraemia following evacuation of spontaneous chronic subdural haematoma

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184903720 ◽

2014 ◽

Vol 96 (6) ◽

pp. e26-e27

Author(s):

R Johnson ◽

T Ibrahim

Keyword(s):

Antidiuretic Hormone ◽

Subdural Haematoma ◽

Chronic Subdural Haematoma ◽

Burr Hole ◽

Pituitary Stalk ◽

Brain Shift ◽

First Report ◽

Inappropriate Secretion ◽

Life Threatening

We report the case of a 43-year-old woman who developed life threatening hyponatraemia 4 days following burr hole drainage of a spontaneous chronic subdural haematoma (CSDH). Syndrome of inappropriate secretion of antidiuretic hormone was confirmed. This is the first report of delayed life threatening hyponatraemia developing postoperatively in CSDH. The mechanism remains unclear but may involve brain shift on the pituitary stalk following subdural evacuation.

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Neurenteric Cysts Found on the Outer Membrane of a Subdural Haematoma

Case Reports in Neurological Medicine ◽

10.1155/2013/130597 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Satoshi Takahashi ◽

Yoshio Tanizaki ◽

Kazunori Akaji ◽

Tadashige Kano ◽

Ban Mihara ◽

...

Keyword(s):

Epithelial Cells ◽

Outer Membrane ◽

Subdural Haematoma ◽

Chronic Subdural Haematoma ◽

Burr Hole ◽

Pathologic Examination ◽

First Report ◽

Underlying Causes ◽

Ciliated Epithelial Cells

We report on a patient initially diagnosed with a chronic subdural haematoma that was resistant to treatment. After the second burr hole craniostomy within a half month failed to resolve the subdural haematoma (SDH), we performed a craniotomy to identify the point of bleeding. Macroscopic evaluation showed that most of the outer membrane of the SDH was transparent; however, further examination revealed the presence of multiple white regions. Pathologic examination showed that the white regions were fluid filled and surrounded by columnar ciliated epithelial cells. These lesions were pathologically diagnosed as neurenteric cysts. To our knowledge, this is the first report on a patient with neurenteric cysts found on the outer membrane of a CSDH. We agree that a craniotomy is a treatment of last resort for recurrent CSDHs; however, sometimes this procedure can be very useful for identifying underlying causes of obstinate SDHs as well as for their treatment.

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