Mini craniotomy for chronic subdural haematoma: surgical outcome from a single institution experience and predictors of success

Background: Chronic subdural hematoma (CSDH) is an increasingly common neurological disease in daily neurosurgical practice. Despite the wide prevalence of CSDH, there remains a lack of consensus regarding numerous aspects of its surgical management. The diagnosis and treatment are well established but there are different surgical procedures and outcome related to these procedures are not completely understood.Methods: The study conducted was conducted in department of neurosurgery at Ibrahim cardiac hospital and research institute, Dhaka, Bangladesh between January 2019 to July 2020, 105 patients were treated for chronic subdural haematoma This study evaluated the clinical features, radiological findings and surgical outcome by mini craniotomy assessed by modified Rankin scale (mRS) score and Glasgow outcome scale (GOS) score in a large series of patients treated at single institution.Results: At 6 months follow up, only one patient died (0.95%) because of co-morbidities and not directly related to the chronic subdural haematoma, 15 patients (14.3%) improved to mRS 0, 33.33% showed only mild symptoms without any significant disability-mRS 1, slight disability was observed in 28.5% patients, moderate disability was observed in 17.14% patients-mRS 3, moderately severe disability was observed in 5.7%-mRS 4.Conclusions: GOS score at 6 months follow up which shows majority of the patient improved to GOS score 4 (45.71%) and 5 (38.09%). Based on these results, among various method of surgical management, mini craniotomy provides better outcome.

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Surgical management of the patients with chronic subdural haematoma and contralateral subdural effusion: Operation or no-operation?

Brain Injury ◽

10.3109/02699052.2015.1004560 ◽

2015 ◽

Vol 29 (5) ◽

pp. 618-622

Author(s):

Haifeng Wang ◽

Jingwei Zhao ◽

Ye Li ◽

Yan Feng ◽

Li Bie

Keyword(s):

Surgical Management ◽

Subdural Haematoma ◽

Chronic Subdural Haematoma ◽

Subdural Effusion

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Atorvastatin combined with dexamethasone in chronic subdural haematoma (ATOCH II): study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05871-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rong Cai Jiang ◽

Dong Wang ◽

Shi Guang Zhao ◽

Ren Zhi Wang ◽

De Zhi Kang ◽

...

Keyword(s):

Subdural Haematoma ◽

Low Dose ◽

Controlled Trial ◽

Combined Treatment ◽

Chronic Subdural Hematoma ◽

Chronic Subdural Haematoma ◽

Efficacy And Safety ◽

Double Blind ◽

Link Type ◽

Haematoma Volume

Abstract Background Chronic subdural haematoma (CSDH) is a common condition in the elderly that often requires neurosurgical management. For small CSDH, evidence has emerged that statins may reduce haematoma volume and improve outcomes, presumably by reducing local inflammation and promoting vascular repair. We wish to extend this evidence in a study that aims to determine the efficacy and safety of atorvastatin combined with low-dose dexamethasone in patients with CSDH. Methods The second ATorvastatin On Chronic subdural Hematoma (ATOCH-II) study is a multi-centre, randomized, placebo-controlled, double-blind trial which aims to enrol 240 adult patients with a conservative therapeutic indication for CSDH, randomly allocated to standard treatment with atorvastatin 20 mg combined with low-dose dexamethasone (or matching placebos) daily for 28 days, and with 152 days of follow-up. The primary outcome is a composite good outcome defined by any reduction from baseline in haematoma volume and survival free of surgery at 28 days. Secondary outcomes include functional outcome on the modified Rankin scale (mRS) and modified Barthel Index at 28 days, surgical transition and reduction in haematoma volumes at 14, 28 and 90 days. Discussion This multi-centre clinical trial aims to provide high-quality evidence on the efficacy and safety of the combined treatment of atorvastatin and low-dose dexamethasone to reduce inflammation and enhance angiogenesis in CSDH. Trial registration ChiCTR, ChiCTR1900021659. Registered on 3 March 2019, http://www.chictr.org.cn/showproj.aspx?proj=36157.

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Surgical management of chronic subdural haematoma: One hole or two?

International Journal of Surgery ◽

10.1016/j.ijsu.2012.08.005 ◽

2012 ◽

Vol 10 (9) ◽

pp. 450-452 ◽

Cited By ~ 16

Author(s):

Matthew D. Smith ◽

Lyudmila Kishikova ◽

Joseph M. Norris

Keyword(s):

Surgical Management ◽

Subdural Haematoma ◽

Chronic Subdural Haematoma

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Comparative study between single versus double burr-hole drainage of unilateral chronic subdural haematoma

Bangladesh Medical Journal ◽

10.3329/bmj.v43i1.21370 ◽

2014 ◽

Vol 43 (1) ◽

pp. 13-16 ◽

Cited By ~ 1

Author(s):

SM Asaduzzaman ◽

KM Tarikul Islam ◽

Mohammad Nazrul Hossain ◽

Md Ruhul Amin ◽

Md Jahangir Alam ◽

...

Keyword(s):

Clinical Outcome ◽

Subdural Haematoma ◽

The Elderly ◽

Chronic Subdural Haematoma ◽

Burr Hole ◽

Limb Weakness ◽

Group A ◽

Grading Scale ◽

Group B

Chronic subdural haematoma (CSDH) is defined as the haematoma in the subdural space which tend to occur in the elderly several weeks after head injury. The incidence of CSDH varied from 1.72 per 100,000 inhabitants per year in Finland to 13.1 per 100,000 inhabitants per year in Japan with a peak incidence in the sixth and seventh decade of life. CSDH is a common treatable cause of dementia. The principal techniques used in the treatment of CSDHs are presently burr hole, twist drill craniostomy, craniectomy and craniotomy. The aim of this study was to assess clinical outcome in unilateral chronic subdural haematoma psatients treated by single or double burr-hole drainage. This clinical trial was carried out at the department of neurosurgery, BSMMU from June 2010 to November 2011. A total of 40 consecutive patients with their age ranged from 50 to 70 years with GCS 9 to 13 & haematoma volume greater than 30cc were included in this study and randomly divided into two groups. In group A, patients with chronic subdural haematoma (CSDH) were managed with double burr-hole drainage. In group B, patients were managed with single burr-hole drainage. Clinical outcome was measured on the 1st post operative day, 3rd post operative day and at the time of discharge (usually on the 7th post operative day) and at 1 month follow-up by measuring Glassgow coma scale (GCS), improvement of limb weakness and Markwalder grading scale. In this study double burr-hole drainage and single burr-hole drainage surgery shows equal success in the management of CSDHs. DOI: http://dx.doi.org/10.3329/bmj.v43i1.21370 Bangladesh Med J. 2014 January; 43 (1): 13-16

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Atorvastatin combined with dexamethasone in chronic subdural haematoma (ATOCH II): study protocol for a randomised controlled trial

10.21203/rs.3.rs-64849/v1 ◽

2020 ◽

Author(s):

Rong Cai Jiang ◽

Dong Wang ◽

Shi Guang Zhao ◽

Ren Zhi Wang ◽

De Zhi Kang ◽

...

Keyword(s):

Subdural Haematoma ◽

Low Dose ◽

Controlled Trial ◽

Combined Treatment ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Chronic Subdural Haematoma ◽

Efficacy And Safety ◽

Double Blind ◽

Haematoma Volume

Abstract Background Chronic subdural haematoma (CSDH) is a common condition in the elderly that often requires neurosurgical management. For small CSDH, evidence has emerged that statins may reduce haematoma volume and improve outcomes, presumably by reducing local inflammation and promoting vascular repair. We wish to extend this evidence in a study that aims to determine the efficacy and safety of atorvastatin combined with low-dose dexamethasone in patients with CSDH. Methods The second ATorvastatin On Chronic subdural Hematoma (ATOCH-II) study is a multi-center, randomized, placebo-controlled, double blind trial which aims to enroll 240 adult patients with a conservative therapeutic indication for CSDH, randomly allocated to standard treatment with atorvastatin 20 mg combined with low-dose dexamethasone (or matching placebos) daily for 28 days, and with 152 days of follow-up. The primary outcome is a composite good outcome defined by any reduction from baseline in haematoma volume and survival free of surgery at 28 days. Secondary outcomes include functional outcome on the modified Rankin scale (mRS) and modified Barthel Index at 28 days, surgical transition, and reduction in haematoma volumes at 14, 28 and 90 days. Discussion This multi-centre clinical trial aims to provide high-quality evidence on the efficacy and safety of the combined treatment of atorvastatin and low-dose dexamethasone to reduce inflammation and enhance angiogenesis in CSDH. Trial registration: ChiCTR, ChiCTR1900021659. Registered 3 March 2019, http://www.chictr.org.cn/showproj.aspx?proj=36157

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