Chronic Subdural Hematomas: To Drain or Not to Drain?

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 185-188 ◽  
Author(s):  
Thomas Marc Markwalder ◽  
Rolf W. Seiler
Keyword(s):  
Clinical Improvement ◽  
Closed System ◽  
Subdural Hematoma ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Postoperative Phase ◽  
Consecutive Series ◽  
Neurological Improvement ◽  
Burr Hole Evacuation

Abstract A consecutive series of 21 adult patients with chronic subdural hematoma was studied in respect to postoperative resolution of subdural collections and clinical improvement after burr hole evacuation without subdural drainage. This series was compared to a previously studied series of patients with chronic subdural hematoma in whom postoperative closed system drainage had been installed. Using the identical protocol for treatment and postoperative follow-up, we obtained identical results with respect to time-related neurological improvement and persistence of subdural collections in the undrained and drained series, except that the steadily progressive clinical improvement during the early postoperative phase (24 hours) in all cases of the drained series was not universal in the undrained cases. Our study suggests that, to avoid the possibility of early postoperative clinical deterioration, burr hole craniostomy and closed system drainage is advisable. We think that subdural drainage is not necessary when the installation of the drainage system seems to be technically difficult, as it may be in cases with considerable perioperative cortical expansion.

scholarly journals Chronic Subdural Hematoma - A Dilemma to Put Drain

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

The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage

1981 ◽  
Vol 55 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Thomas-Marc Markwalder ◽  
Klaus F. Steinsiepe ◽  
Matthias Rohner ◽  
Walter Reichenbach ◽  
Hans Markwalder
Keyword(s):  
Ct Scan ◽  
Closed System ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Consecutive Series ◽  
Subdural Space ◽  
Significant Morbidity ◽  
Content Type ◽  
Brain Expansion ◽  
Fine Print

✓ A consecutive series of 32 adult patients with chronic subdural hematoma was studied in respect to postoperative cerebral reexpansion (reduction in diameter of the subdural space) after burr-hole craniostomy and closed-system drainage. Patients with high subdural pressure showed the most rapid brain expansion and clinical improvement during the first 2 days. Nevertheless, a computerized tomography (CT) scan performed on the 10th day after surgery demonstrated persisting subdural fluid in 78% of cases. After 40 days, the CT scan was normal in 27 of the 32 patients. There was no mortality and no significant morbidity. Our study suggests that well developed subdural neomembranes are the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10 to 20 days. However, blood vessel dysfunction and impairment of cerebral blood flow may participate in delay of brain reexpansion. It may be argued that additional surgical procedures, such as repeated tapping of the subdural fluid, craniotomy, and membranectomy or even craniectomy, should not be evaluated earlier than 20 days after the initial surgical procedure unless the patient has deteriorated markedly.

A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma

2014 ◽  
Vol 62 (2) ◽  
pp. 169 ◽  
Author(s):  
Bhaskar Suryanarayanan ◽  
Ajay Choudhary ◽  
LaxmiNarayan Gupta ◽  
Akhila Prasad ◽  
AmitKumar Singh ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Randomized Study ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Prospective Randomized Study ◽  
Burr Hole Evacuation

scholarly journals Outcome of Chronic Subdural Hematoma Treated with Single Burr Hole Under Local Anesthesia

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
Abebe Mersha ◽  
Sahlu Abat ◽  
Tsegaye Temesgen ◽  
Abebe Nebyou
Keyword(s):  
Hospital Stay ◽  
Local Anesthesia ◽  
Subdural Hematoma ◽  
Addis Ababa ◽  
Chronic Subdural Hematoma ◽  
Postoperative Outcome ◽  
The Elderly ◽  
Burr Hole ◽  
Cross Sectional ◽  
Burr Hole Evacuation

BACKGROUND: Chronic subdural hematoma (CSDH) is a common condition encountered in daily neurosurgical practice usually affecting the elderly population. Various surgical procedures have been used for the evacuation of hematoma in patients with CSDH. The objective of this paper was to study the postoperative outcome of patients who were operated for CSDH and to describe the easy, safest and effective procedure that can be performed at primary level hospitals.METHODS: Institutional based cross-sectional retrospective study was conducted among patients operated for CSDH from January 1, 2012 to December 31, 2015 at Teklehaymanot General Hospital, a private hospital in Addis Ababa, Ethiopia. Descriptive statistics, using SPSS version 20, was used to determine the postoperative outcomes including hospital stay, complications and recurrence rate.RESULTS: Of the 195 charts reviewed, 70.3% were of males, with M: F ratio of 2.4:1. 68.2% of patients being above the age of 55 years with a mean age at presentation of 57.63. The most common presenting symptom was headache followed by extremity weakness. The diagnosis of CSDH was made with either head CT scan or MRI. Forty one percent of patients had a left side hematoma and 48(24.6%) patients had bilateral CSDH. All patients were operated with a single burr hole evacuation under local anesthesia and postoperative subdural closed system drainage by a single neurosurgeon. The mean hospital stay was 3.68±2.6 days. The postoperative outcome was assessed using the Glasgow Outcome Score, and 95.9% of the patients reported good recovery. Thirteen (6.6%) patients were operated twice for recurrence, and there were four deaths.CONCLUSIONS: Single burr hole craniostomy is an easy, safe and effective technique for the treatment of CSDH.

scholarly journals Organized Subdural Hematoma with Thick Membrane in Chronic Subdural Hematoma

2012 ◽  
Vol 52 (185) ◽  
Author(s):  
P Shrestha ◽  
B Panta ◽  
P Shrestha ◽  
P Rajbhandari
Keyword(s):  
Subdural Hematoma ◽  
Analytical Study ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Membrane Formation ◽  
Burr Hole Evacuation

Introduction: Chronic subdural hematoma (CSDH) may occasionally contain organized hematoma which can lead to recurrence and other complications after surgery. There is no exact study and data about OHTMF in Nepal so far. The main objective of this study is to study its prevalence and complications. Methods: This is a multicentric retrospective analytical study being carried out at Norvic International Hospital and Annapurna Neurological Institute. We retrospectively analyzed one hundred cases of CSDH between early 2006 to 2010 August. We focused our study mainly on OHTMF. Results: Of 100 cases, majority of the patients were male ranging from 4 to 85 years of age. Bilateral subdural hematoma was found in about 9% of cases. Majority of cases were treated in usual fashion with single burr hole and drain. OHTMF was found in 3 cases (3%) for which craniotomy with radical membranectomy was performed. In 2 cases membrane formation was noticed during surgery, craniotomy with total membranectomy was performed immediately. In one case there was recurrence of CSDH within 10 days of single burr hole evacuation. Craniotomy with membranectomy was performed in 2nd surgery. There was no recurrence after membranectomy. One case developed seizure post operatively. Conclusions: OHTMF is one of the important causes of CSDH recurrence. It has to be treated radically. Different hypthotheses have been postulated regarding thick membrane formation in CSDH. We have tried to discuss these hypotheses. Keywords: burr hole evacuation, craniotomy, CSDH, OHTMF.

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