scholarly journals Single Burr Hole and Drainage in Chronic Subdural Hematoma: Outcome in Consecutive 333 Cases

2016 ◽  
Vol 13 (1) ◽  
pp. 35-42
Author(s):  
Yam B Roka ◽  
Afjal Firoj ◽  
Jha Alok ◽  
Lohani Biprav
Keyword(s):  
Subdural Hematoma ◽  
Vascular Malformations ◽  
Chronic Subdural Hematoma ◽  
Chronic Alcoholism ◽  
Neurological Deficits ◽  
P Value ◽  
Common Symptom ◽  
Age Group ◽  
Bowel And Bladder Dysfunction ◽  
Group Sex

Chronic subdural hematoma (CSDH) is a common neurosurgical disease with incidence 3 in 100,000 in general population. Recorded or trivial head injury is the most common cause of CSDH with several predisposing factors like alcoholism, coagulopathy, seizure disorder, cerebrospinal fluid shunts, metastases and vascular malformations. Bilateral CSDH are common in infants and interhemispheric subdural hematomas are often associated with child abuse. Coagulopathy and intracranial tumors have been associated with spontaneous CSDH. 86 % were males with 47% of CSDH on left followed by 35% in right and 61 cases (18%) were bilateral. The most common age group was 61 to 80 years (45%) followed by the 41 to 60 year group. During admission headache was the most common symptom followed by neurological deficits that include, loss of speech (65%), mono or hemiparesis (20%), quadreparesis (5%), bowel and bladder dysfunction and loss of memory or altered sensorium. Statistical analysis did not show any significant p value between the Age group, Sex, Side of CSDH or chronic alcoholism as independent variables affecting outcome. GCS at admission was the only factor that had significant p value in terms of outcome prediction. Although there are multiple comorbidities associated with CSDH this study found that except GCS there was no relation to age, side, sex, alcoholism, hypertension or diabetes in the outcome after surgery. Meticulous care to remove all the CSDH followed by use of drain is the most efficient way to manage CSDH.Nepal Journal of Neuroscience 13:35-42, 2016  

scholarly journals Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients

2020 ◽  
Vol 17 (02) ◽  
pp. 110-120
Author(s):  
Ramesh Chandra Vemula ◽  
B. C.M. Prasad ◽  
Venkat Koyalmantham ◽  
Kunal Kumar
Keyword(s):  
Ct Scan ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
P Value ◽  
First Choice ◽  
Significant Difference ◽  
Preoperative Ct

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.

Chronic subdural hematoma in infancy

1990 ◽  
Vol 73 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Treatment Protocol ◽  
Chronic Subdural Hematoma ◽  
Neurological Deficits ◽  
Acute Subdural Hematoma ◽  
Hemorrhagic Diathesis ◽  
Content Type ◽  
Fine Print ◽  
Subdural Tapping

✓ The cases of 30 infants with chronic subdural hematoma treated surgically between 1978 and 1987 (after the introduction of computerized tomography) were reviewed. This series was limited to infants presenting with increased intracranial pressure, neurological deficits, or developmental retardation. Nineteen patients were male and 11 were female, ranging in age from 1 to 14 months (average 6.1 months). The surgical treatment was initiated with percutaneous subdural tapping which was repeated periodically, if indicated, for 2 weeks. If the patients failed to respond to subdural tapping, subdural-peritoneal shunting was installed. The follow-up periods were from 3 months to 9 years 8 months (average 4 years 10 months). Computerized tomography at that time disclosed disappearance or minimal collection of subdural fluid in 28 cases (93%) and a significant collection (> 5 mm) in two (7%). Neurological examination revealed that the patients were “normal” in 17 cases (57%), “mildly or moderately disabled” in nine (30%), and “severely disabled” in four (13%). The majority of disabled patients had lesions secondary to infantile acute subdural hematoma, child abuse, or hemorrhagic diathesis. These results indicate that the treatment protocol in the present series is acceptable for the elimination of subdural hematoma. Together, early diagnosis and treatment of the etiological conditions causing the lesion are indispensable for obtaining a satisfactory neurological outcome.

scholarly journals Role of outer membrane histopathology and comparison of clinico-radiological aspects of chronic subdural hematoma in different age groups: a retrospective study

2017 ◽  
Vol 4 (7) ◽  
pp. 2164
Author(s):  
Nilesh Vishnu Potdar ◽  
Suresh Kumar S. ◽  
Bhavadasan Kaplinghat
Keyword(s):  
Outer Membrane ◽  
Old Age ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Young Age ◽  
Histopathological Study ◽  
Age Group ◽  
Group Patient ◽  
Membrane Type

Background: The incidence of chronic subdural hematoma (CSDH) has been found to increasing in younger patients. This study was aimed to evaluate the role of outer membrane histopathology and comparison with the clinic-radiological aspects of chronic subdural hematoma in different age groups.Methods: Cases of CSDH admitted to the Neurosurgery department during January 2014 and December 2016 were included in the study. They were analyzed clinically, radiologically like site, size, thickness in computed tomography, the attenuation value and midline shift. Histopathological features were also recorded. Cases of acute and chronic sub dural hematoma which were managed conservatively irrespective of age and sex were excluded from the study.Results: Total 196 patients were included with median age of 66 yrs. The most common histopathological type of membrane was the scar inflammatory membrane (Type IV) in 43% of cases followed by hemorrhagic inflammatory membrane (Type III) in 31% of cases while the scar inflammatory type of membrane (Type II) was in 26% of cases. Young age group patient having less thickness of hematoma (<2cm) and having hyper density on CT scan. Old age group had more thickness(3.2cm) and mixed density with multiple layering.Conclusions: Young age group patient having less thickness of hematoma and hyper density compared to old age group. Recurrence and bilateral disease were more common in old age group associated with brain atrophy. Histopathological study completes the spectrum of CSDH in terms of severity of disease and overall prognosis of patient.

scholarly journals Functional recovery following surgery for chronic subdural hematoma

2020 ◽  
Vol 11 ◽  
pp. 450
Author(s):  
Sarah A. Merrill ◽  
Daniel Khan ◽  
Alexandra E. Richards ◽  
Maziyar A. Kalani ◽  
Naresh P. Patel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Physical Therapy ◽  
Functional Recovery ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Deficits ◽  
Presenting Symptoms

Background: Among the elderly, chronic subdural hematoma is a relatively common neurosurgical condition. Presenting symptoms range from headache and focal neurological deficits to seizure and coma depending on location and extent of brain compression. Functional recovery following surgery for chronic subdural hematoma is central to quality of life and ongoing health for elderly patients; however, there is a paucity of data regarding functional recovery in this population. Methods: In this study, the physical activity of patients who underwent surgical evacuation of chronic subdural hematoma was surveyed, as well as participation in physical therapy following surgery. In total, 38 patients completed the survey. Results: Of the 30 patients who exercised regularly before surgery, 28 (90.3%) returned to exercise within 1 year after surgery. Of 13 patients who reported playing hobby sports before surgery, 9 (69.2%) returned to those sports. 17/38 (44.7%) patients participated in physical therapy after surgery. 35/38 (92.1%) of patients reported that the surgery improved their quality of life. Conclusion: The majority of patients who underwent surgery for chronic subdural hematoma were able to return to exercise within 1 year. Participation in physical therapy was associated with return to exercise and sports. Further study is needed to determine which factors contribute to a return to baseline levels of physical activity following surgery for chronic subdural hematoma.

scholarly journals Clinico Pathological Review of Adnexal Masses in Children and Adolescents at a University Hospital

2021 ◽  
Keyword(s):  
Abdominal Pain ◽  
Mucinous Cystadenoma ◽  
University Hospital ◽  
P Value ◽  
Common Symptom ◽  
Age Group ◽  
Study Objective ◽  
Adnexal Masses ◽  
Children And Adolescent ◽  
Follicular Cyst

Background & Objective: The study objective was to review the clinic-pathological characteristics of adnexal masses in the children and adolescent population in our institution. Methods: Retrospective analysis of 178 adolescent patients including neonates, presenting with adnexal masses between January 2000-December 2012, was performed. Results: Records of a total of 178 patients were analyzed. The mean age was 14 years. The most common symptom was abdominal pain noted in 146(82%) patients followed by nausea and vomiting in 28(15.7%) and incidental findings in 19(10.7%). The majority of the ovarian masses were benign. The follicular cyst was the most common histopathological type in 66 patients (37.1%) followed by a hemorrhagic cyst in 40(22.5%), benign teratoma in 21(11.8%), benign serous cyst in 20 patients (11.2%), endometrioma and mucinous cystadenoma in 13 patients (7.3%). The average tumor size observed in the present study was 7.84cms. However, the size varied in different age groups such as 4.27 cm size in neonates, and 7.1 cm in 1-14 years age group, and 8.61 cm in 15-19 years age group with a P-value of 0.009. Out of a total of 178 patients, 46(25.8%) were managed conservatively. However, 90(50.6%) patients underwent ovarian cystectomy, 26(14.6%) were managed by unilateral salpingo-oophorectomy, 10(5.6%) by unilateral oophorectomy. Aspiration and biopsy were done in 6(3.4%) patients. Conclusion: Incidence of adnexal masses increases with age with maximum cases between age 14 and above. Adolescent girls with adnexal masses can have variable presentations however abdominal pain is the most common symptom. Mostly these are benign masses therefore conservative approach for treatment should be adopted.

scholarly journals Bedside Percutaneous Twist Drill Craniostomy of Chronic Subdural Hematoma—A Single-Center Study

2019 ◽  
Vol 11 (01) ◽  
pp. 084-088 ◽  
Author(s):  
Geo Senil Kidangan ◽  
Binoy Damodar Thavara ◽  
Bijukrishnan Rajagopalawarrier
Keyword(s):  
Statistical Analysis ◽  
Ct Scan ◽  
Clinical Improvement ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Common Symptom ◽  
Twist Drill ◽  
Duration Of Symptoms ◽  
The Mean

Abstract Background Chronic subdural hematoma (CSDH) is predominantly a disease of the elderly. Objectives This article studies the clinical and radiological outcomes in patients with CSDH who had undergone bedside percutaneous twist drill craniostomy (TDC). Patients and Methods A retrospective study was conducted in 80 patients who had undergone percutaneous TDC for CSDH between January 2017 and December 2018. Patients between 18 and 90 years of age were selected. CSDH showing computed tomography (CT) scan findings of homogeneous hypodensity, homogeneous isodensity, mixed density, and CSDH with hyperdense gravity-dependent fluid level were selected. CT evidence of multiple septations, recurrent CSDH, bilateral CSDH, and acute on CSDH were excluded. The presence of midline shift (MLS) was measured as any deviation of the septum pellucidum from the midline. The mass effect was determined by the effacement of the sulci, Sylvian fissure obscuration, or compression of lateral ventricles. Postoperative decrease in the signs and symptoms were considered as the postoperative clinical improvement. Improvement in the postoperative CT scan was determined by the decrease in the thickness of CSDH and absence of MLS with decrease in the mass effect. The presence of the CSDH with mass effect and MLS was considered as the significant residue in the postoperative CT scan. Statistical Analysis Statistical analysis is done using Epi Info software. Results The mean age range was 67.78 years ± 12.03 standard deviation (SD). There were 49 (61.25%) males and 31 (38.75%) females. Thirty-eight (47.5%) CSDHs were on the right side and 42 (52.5%) on the left side. The locations were in the frontotemporoparietal region in 91.25% patients and in the frontoparietal region in 8.75% patients. The mean duration of symptoms was 4.62 days ± 5.20 SD. History of trauma was present in 58.75% patients. The mean duration of trauma was 45.78 days ± 28.32 SD. The most common symptoms were weakness of the limbs (68.75%), altered sensorium or decreased memory (52.5%), and headache (32.5%). The preoperative Glasgow Coma Scale (GCS) score ranged from 4 to 15 (mean 12.86 ± 2.98 SD). Limb motor weakness was noted in 75% patients. The maximum thickness of the CSDH (in millimeter) in axial CT scan was 8 to 32 (mean 23.22 ± 4.87 SD). All of the 80 patients had MLS. Postoperative GCS ranged from 3 to 15 (mean 14.1 ± 2.78 SD). Postoperative power was improved in 95% of affected limbs. Postoperative power was deteriorated (including patients of complications and death) in 5% patients. Clinical improvement was noted in 93.75% patients. Postoperative CT scan improvement was noted in 95% patients. Two patients (2.5%) had significant residue which required reoperation. Two patients (2.5%) developed extradural hematoma which was operated. Five (6.25%) patients developed complications, among which 4 (5%) patients died. The mean duration of stay in the hospital was 6.82 days ± 4.16 SD. Conclusions CSDH is a disease of elderly population. CSDH is more common in male population. The most common symptom is weakness of the limbs. High clinical and radiological improvement can be achieved with TDC. TDC should be considered as a safe and effective alternative to burr hole craniostomy.

Chronic subdural hematoma with transient neurological deficits: A review of 15 cases

1983 ◽  
Vol 14 (5) ◽  
pp. 539-542 ◽  
Author(s):  
Mark L. Moster ◽  
David E. Johnston ◽  
Oscar M. Reinmuth
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Neurological Deficits

scholarly journals Microvascular proliferation in the clots: The key finding of acute subdural hematoma transforming into chronic subdural hematoma?

2021 ◽  
Vol 12 ◽  
pp. 601
Author(s):  
Aito Watanabe ◽  
Satoshi Tsutsumi ◽  
Senshu Nonaka ◽  
Hisato Ishii
Keyword(s):  
Outer Membrane ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Nodular Lesion ◽  
Neurological Deficits ◽  
Cranial Computed Tomography ◽  
Acute Subdural Hematoma ◽  
Partial Removal ◽  
Cerebral Magnetic Resonance Imaging ◽  
Microvascular Proliferation

Background: Despite extensive investigations, the exact etiology of chronic subdural hematoma (CSDH) remains elusive. Organized CSDHs are a distinct but less-understood type of CSDH. Case Description: A 50-year-old hypertensive woman experienced headache without any previous head injury. At presentation, the patient showed no focal neurological deficits. Cranial computed tomography (CT) revealed a slightly compressive subdural hematoma that spontaneously regressed and no intracranial vascular lesions. Cerebral magnetic resonance imaging identified a non-enhancing nodular lesion in the subdural hematoma. After the patient presented disorientation and aphasia on post hospitalization day 14, CT showed a considerable enlargement of the subdural hematoma. Partial removal of the bi-layered hematoma was performed through a parietal craniotomy. Histological examination revealed microvascular proliferation in both the outer membrane and the nodular lesion. On postoperative day 35, CT demonstrated a remarkable resolution of the residual hematoma. Conclusion: Development of microvascular proliferation in the clots of an acute subdural hematoma may lead to its rapid enlargement as an organized CSDH. Organized CSDH can be managed by partial removal of the outer membrane and hematoma through a craniotomy.

scholarly journals Spreading depolarization may represent a novel mechanism for delayed fluctuating neurological deficit after chronic subdural hematoma evacuation

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Laila M. Mohammad ◽  
Mohammad Abbas ◽  
C. William Shuttleworth ◽  
Rosstin Ahmadian ◽  
Annapoorna Bhat ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Neurological Deficit ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Brain Dysfunction ◽  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Focal Neurological Deficit ◽  
Entire Cohort ◽  
Subdural Electrode

OBJECTIVEMost patients with chronic subdural hematoma (cSDH) recover after surgical evacuation with a straightforward course. There is a subset of patients who develop transient and fluctuating deficits not explained by seizures, stroke, or mass effect after evacuation. The objective of this study was to investigate whether these postoperative neurological deficits may be related to temporary brain dysfunction caused by cortical spreading depolarizations (SDs).METHODSThe authors conducted a prospective observational study of 40 patients who underwent cSDH evacuation. At the time of surgery, a 1 × 6 subdural electrode strip was placed on the cortex parallel to the subdural drain. Clinical outcomes were assessed utilizing the Markwalder Grading Scale, need for clinical EEG for new deficit, and presence of new deficits.RESULTSDefinitive SD was detected in 6 (15%) of 40 patients. Baseline and cSDH characteristics did not differ between patients with and without SD. More patients experienced postoperative neurological deterioration if they had SD (50%) compared to those without SD (8.8%; p = 0.03). Only 2 patients in the entire cohort demonstrated early neurological deterioration, both of whom had SD. One of these cases demonstrated a time-locked new focal neurological deficit (aphasia) at the start of a series of multiple clusters of SD.CONCLUSIONSThis is the first observation of SD occurring after cSDH evacuation. SD occurred at a rate of 15% and was associated with neurological deterioration. This may represent a novel mechanism for otherwise unexplained fluctuating neurological deficit after cSDH evacuation. This could provide a new therapeutic target, and SD-targeted therapies should be evaluated in prospective clinical trials.

Middle Meningeal Artery Embolization of a Pediatric Patient With Progressive Chronic Subdural Hematoma

2021 ◽  
Author(s):  
Tomoyoshi Shigematsu ◽  
Evelyn Dier ◽  
Kurt A Yaeger ◽  
Peter F Morgenstern ◽  
Lauren D Glass ◽  
...  
Keyword(s):  
High Risk ◽  
Heart Transplant ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Left Ventricular ◽  
Neurological Deficits ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Middle Cerebral Artery ◽  
Meningeal Artery

Abstract BACKGROUND AND IMPORTANCE Evidence suggests middle meningeal artery (MMA) embolization benefits adult patients with chronic subdural hematoma (CSDH) at high risk for recurrence or hemorrhagic complications. Yet, there has not been any report discussing MMA embolization in the pediatric population. Thus, we present a case of an infant with CSDH successfully managed with MMA embolization without surgical management. CLINICAL PRESENTATION A 5-mo-old girl with idiopathic dilated cardiomyopathy underwent surgical implantation of a left ventricular assist device for a bridge to heart transplantation. This was complicated by left ventricular thrombus causing stroke. She was placed on dual antiplatelet antithrombotic therapy on top of bivalirudin infusion. She sustained a left middle cerebral artery infarction, but did not have neurological deficits. Subsequent computed tomography scans of the head showed a progressively enlarging asymptomatic CSDH, and the heart transplant was repeatedly postponed. The decision was made to proceed with MMA embolization at the age of 7 mo. Bilateral modified MMA embolization, using warmed, low-concentration n-butyl-cyanoacrylate (n-BCA) from distal microcatheter positioning, allowed the embolic material to close the distal MMA and subdural membranous vasculature. The patient underwent successful heart transplant and the CSDH improved significantly. She remained neurologically asymptomatic and had normal neurological development after the MMA embolization. CONCLUSION MMA embolization may represent a safe and effective minimally invasive option for pediatric CSDH, especially for patients at high risk for surgery or hematoma recurrence.

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