Clinical Evaluation of Bilateral Chronic Subdural Hematoma: Characteristic Findings and Significance of Postoperative Drainage Amount

2005 ◽  
Vol 1 (1) ◽  
pp. 46 ◽  
Author(s):  
Jong-Hyun Kim ◽  
Taek-Hyun Kwon ◽  
Suk Han ◽  
Joo-Han Kim ◽  
Youn-Kwan Park ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Drainage ◽  
Bilateral Chronic Subdural Hematoma

Bilateral chronic subdural hematoma: unilateral or bilateral drainage?

2016 ◽  
Vol 126 (6) ◽  
pp. 1905-1911 ◽  
Author(s):  
Nina Christine Andersen-Ranberg ◽  
Frantz Rom Poulsen ◽  
Bo Bergholt ◽  
Torben Hundsholt ◽  
Kåre Fugleholm
Keyword(s):  
Subdural Hematoma ◽  
Multivariate Analyses ◽  
Chronic Subdural Hematoma ◽  
High Rate ◽  
National Database ◽  
Bilateral Surgery ◽  
Postoperative Drainage ◽  
Retreatment Rate ◽  
The Relationship ◽  
Bilateral Chronic Subdural Hematoma

OBJECTIVEBilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors are associated with the retreatment of bCSDH with a focus on surgical laterality.METHODSIn a national database of CSDHs (Danish Chronic Subdural Hematoma Study) the authors retrospectively identified all bCSDHs treated in the 4 Danish neurosurgical departments over the 3-year period from 2010 to 2012. Univariate and multivariate analyses were performed to determine the relationship between retreatment of bCSDH and clinical, radiological, and surgical variables.RESULTSTwo hundred ninety-one patients with bCSDH were identified, and 264 of them underwent unilateral (136 patients) or bilateral (128 patients) surgery. The overall retreatment rate was 21.6% (57 of 264 patients). Cases treated with unilateral surgery had twice the risk of retreatment compared with cases undergoing bilateral surgery (28.7% vs 14.1%, respectively, p = 0.002). In accordance with previous studies, the data also showed that a separated hematoma density and the absence of postoperative drainage were independent predictors of retreatment.CONCLUSIONSIn bCSDHs bilateral surgical intervention significantly lowers the risk of retreatment compared with unilateral intervention and should be considered when choosing a surgical procedure.

scholarly journals Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

2014 ◽  
Vol 121 (3) ◽  
pp. 665-673 ◽  
Author(s):  
Weiming Liu ◽  
Nicolaas A. Bakker ◽  
Rob J. M. Groen
Keyword(s):  
Outcome Measures ◽  
Surgical Procedures ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Twist Drill ◽  
Recurrence Rates ◽  
Postoperative Drainage

Object In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T2 (tau-squared), I2, and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Results Of the 297 studies identified, 19 RCTs were included. Of them, 7 studies evaluated the use of postoperative drainage, of which the meta-analysis showed a pooled OR of 0.36 (95% CI 0.21–0.60; p < 0.001) in favor of drainage. Four studies compared twist drill and bur hole procedures. No significant differences between the 2 methods were present, but heterogeneity was considered to be significant. Three studies directly compared the use of irrigation before drainage. A fixed-effects meta-analysis showed a pooled OR of 0.49 (95% CI 0.21–1.14; p = 0.10) in favor of irrigation. Two studies evaluated postoperative posture. The available data did not reveal a significant advantage in favor of the postoperative supine posture. Regarding positioning of the catheter used for drainage, it was shown that a frontal catheter led to a better outcome. One study compared duration of drainage, showing that 48 hours of drainage was as effective as 96 hours of drainage. Conclusions Postoperative drainage has the advantage of reducing recurrence without increasing complications. The use of a bur hole or twist drill does not seem to make any significant difference in recurrence rates or other outcome measures. It seems that irrigation may lead to a better outcome. These results may lead to more standardized procedures.

Subdural-peritoneal shunt: Treatment for bilateral chronic subdural hematoma

1996 ◽  
Vol 46 (4) ◽  
pp. 378-383 ◽  
Author(s):  
Mukesh Misra ◽  
Jose L. Salazar ◽  
Donna M. Bloom
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Shunt Treatment ◽  
Bilateral Chronic Subdural Hematoma

scholarly journals A Case of Bilateral Chronic Subdural Hematoma Associated with Spontaneous Intracranial Hypotension.

1999 ◽  
Vol 49 (6) ◽  
pp. 455-459
Author(s):  
Masahiko Tosaka ◽  
Shin Takatama ◽  
Kazuya Sakamoto ◽  
Yumi Yanai ◽  
Kimio Onoda
Keyword(s):  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Chronic Subdural Hematoma ◽  
Bilateral Chronic Subdural Hematoma

scholarly journals Bilateral Chronic Subdural Hematoma in the Posterior Fossa Treated with a Burr Hole Irrigation: A Case Report and Review of the Literature

2019 ◽  
Vol 11 (1) ◽  
pp. 87-93
Author(s):  
Takuro Inoue ◽  
Hisao Hirai ◽  
Ayako Shima ◽  
Fumio Suzuki ◽  
Masayuki Matsuda
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Posterior Fossa ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Ventricular Drainage ◽  
Review Of The Literature ◽  
Bilateral Chronic Subdural Hematoma ◽  
Radiological Examinations

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare. The surgical strategy is still controversial. We report a case of bilateral CSH in the posterior fossa successfully treated with a single-burr hole surgery. A 74-year-old man under anticoagulation and antiplatelet therapy developed headache and nausea during observation for an asymptomatic supratentorial CSH. Radiological examinations revealed appearance of bilateral CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient’s consciousness, an urgent treatment was required. A burr hole was made near the transverse-sigmoid junction on the left side to access the hematoma. No ventricular drainage was placed as his consciousness improved during the decompression of the hematoma. Postoperative computed tomography showed that bilateral CSH and hydrocephalus had been successfully treated. In bilateral CSH in the posterior fossa, there may be a connection between each side. CSH in the posterior fossa, when urgent, can be treated under local anesthesia with a unilateral burr hole irrigation.

Generalized Chorea Associated with Bilateral Chronic Subdural Hematoma

2004 ◽  
Vol 51 (4) ◽  
pp. 227-230 ◽  
Author(s):  
Yueh-Feng Sung ◽  
Hsin-I. Ma ◽  
Yaw-Don Hsu
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Bilateral Chronic Subdural Hematoma

scholarly journals Unilateral Oculomotor Nerve Palsy as an Initial Presentation of Bilateral Chronic Subdural Hematoma: Case Report

2013 ◽  
Vol 53 (9) ◽  
pp. 616-619 ◽  
Author(s):  
Ryosuke MATSUDA ◽  
Yasuo HIRONAKA ◽  
Hisashi KAWAI ◽  
Young-Su PARK ◽  
Toshiaki TAOKA ◽  
...  
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Nerve Palsy ◽  
Chronic Subdural Hematoma ◽  
Oculomotor Nerve ◽  
Initial Presentation ◽  
Oculomotor Nerve Palsy ◽  
Bilateral Chronic Subdural Hematoma

scholarly journals The question is whether hemiparesis is more common in unilateral than bilateral chronic subdural hematoma

2014 ◽  
Vol 67 (9-10) ◽  
pp. 277-281 ◽  
Author(s):  
Mirela Jukovic ◽  
Kosta Petrovic ◽  
Viktor Till
Keyword(s):  
Subdural Hematoma ◽  
Clinical Symptoms ◽  
Great Influence ◽  
Chronic Subdural Hematoma ◽  
Functional Condition ◽  
Neurological Symptoms ◽  
Special Focus ◽  
Subdural Hematomas ◽  
Time Required ◽  
Bilateral Chronic Subdural Hematoma

Introduction. Chronic subdural hematoma is an intracranial hemorrhagic lesion that illustrates various expressions in clinical and radiological practice. The aim of this study was to emphasize the correlation between the brain site of chronic subdural hematoma and clinical symptoms/signs of disease. Furthermore, the study denotes the significance of hemiparesis occurrence in the patients with unilateral chronic subdural hematomas more than in those with bilateral ones, associated with time required to diagnose hematoma. Material and Methods: A three-year study included 72 patients with chronic subdural hematoma. According to their clinical and neurological symptoms on hospital admission, all patients underwent non-contrast brain computed tomography scan, which confirmed the diagnosis. The radiological parameters, inlcuding the site of chronic subdural hematoma, a hematoma width and midline shift were recorded to give precise data about the correlation with neurological symptoms. A special focus was put on the lag time between the onset of symptoms and signs to diagnosis of chronic subdural hematoma. Results. The study proved that the patients with unilateral chronic subdural hematoma had more frequent occurrence of hemiparesis than the patients with bilateral chronic subdural hematoma. It took the left-sided chronic subdural hematomas less time (about 200 hours earlier) than the rightsided ones to present its symptoms although the average hematoma diameter value was almost the same. Conclusion. The site and the form of intracranial lesion-chronic subdural hematoma could have a great influence on neurological and functional condition in a patient. Although the length of time required for making diagnosis as well as clinical symptoms greatly differ and the latter are not always so clear, physicians should maintain a high level of suspicion for this disease and thus contribute to prompt diagnosis and better clinical outcome of patients.

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