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.

Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume

2000 ◽  
Vol 93 (5) ◽  
pp. 796-799 ◽  
Author(s):  
Taek-Hyun Kwon ◽  
Youn-Kwan Park ◽  
Dong-Jun Lim ◽  
Tai-Hyoung Cho ◽  
Yong-Gu Chung ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Closed System ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Low Density ◽  
Content Type ◽  
Drainage Volume ◽  
Postoperative Drainage ◽  
Fine Print

Object. A wide variation in postoperative drainage volumes is observed during treatment of chronic subdural hematoma (CSDH) with twist-drill or burr-hole craniostomy and closed-system drainage. In this study the authors investigate the causes of the variation, the clinical significance thereof, and its influence on treatment outcome.Methods. A total of 175 cases were investigated between January 1991 and December 1997. Of these, 145 patients had surgery for CSDH, of whom 30 had bilateral lesions. The cases of CSDH were divided into five subtypes (low-density, isodense, high-density, mixed-density, and layering types) on the basis of the brain computerized tomography (CT) findings. Burr-hole craniostomies with closed-system drainage were performed in all patients and the drainage was maintained for 5 days, during which daily amounts of fluid were measured. The mean drainage volume over 5 days was 320 ml, with the largest volume (413 ml) seen in the low-density type and the smallest (151 ml) in the mixed-density type of CSDH. There were recurrences in six patients (seven instances, 4%). The mixed-density type had the highest recurrence rate (8.6%), whereas there was no recurrence for the low-density type. There were no recurrences in 81 patients in whom the total drainage volumes for 5 days were more than 200 ml, but there were recurrences in six (seven instances) of 94 patients in whom the total drainage volume was less than 200 ml.Conclusions. The postoperative drainage volumes varied greatly because of differences in the outer membrane permeability of CSDH, and such variation seems to be related to the findings on the CT scans obtained preoperatively. Patients with CSDH in whom there is less postoperative drainage than expected should be carefully observed, with special attention paid to the possibility of recurrence.

Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage

2000 ◽  
Vol 93 (5) ◽  
pp. 791-795 ◽  
Author(s):  
Hiroshi Nakaguchi ◽  
Takeo Tanishima ◽  
Norio Yoshimasu
Keyword(s):  
Recurrence Rate ◽  
Closed System ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Ct Scans ◽  
Subdural Space ◽  
Content Type ◽  
Drainage Catheter ◽  
Fine Print

Object. This study was conducted to determine the best position for the subdural drainage catheter to achieve a low recurrence rate after burr-hole irrigation and closed-system drainage of chronic subdural hematoma (CSDH).Methods. The authors studied 63 patients with CSDH in whom the drainage catheter tip was randomly placed and precisely determined on postoperative computerized tomography (CT) scans and 104 patients with CSDH in whom CT scans were obtained 7 days postsurgery. The location of the subdural drainage catheter, the maximum postoperative width of the subdural space, and the percentage of the ipsilateral subdural space occupied by air postoperatively were determined and compared with the postoperative recurrence and reoperation rates.Patients with parietal or occipital drainage had a higher rate of CSDH recurrence and much more subdural air than those with frontal drainage. In addition, patients with residual subdural air demonstrated on CT scans obtained 7 days postsurgery also had a higher recurrence rate than those without subdural air collections. Furthermore, patients with a subdural space wider than 10 mm on CT scans obtained 7 days postsurgery had a higher recurrence rate than those with a space measuring 10 mm or less.Conclusions. The incidence of postoperative fluid reaccumulation seems to be reduced by placing the tip of the drainage catheter in the frontal convexity and by removing subdural air during or after surgery.

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.

The role of craniectomy in the treatment of chronic subdural hematomas

1980 ◽  
Vol 52 (6) ◽  
pp. 776-781 ◽  
Author(s):  
George Tyson ◽  
W. Ellis Strachan ◽  
Peter Newman ◽  
H. Richard Winn ◽  
Albert Butler ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Chronic Subdural Hematoma ◽  
Neurological Deterioration ◽  
Neurological Dysfunction ◽  
Consecutive Series ◽  
Content Type ◽  
Significant Clinical Improvement ◽  
Acute Neurological Deterioration ◽  
Fine Print

✓ A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.

Production of clinical form of chronic subdural hematoma in experimental animals

1972 ◽  
Vol 37 (5) ◽  
pp. 552-561 ◽  
Author(s):  
Satoru Watanabe ◽  
Hironobu Shimada ◽  
Shozo Ishii
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Subdural Space ◽  
Clinical Form ◽  
Content Type ◽  
Experimental Animals ◽  
Fine Print

✓ A method for producing a clinical form of experimental chronic subdural hematoma is reported. When blood is mixed with cerebrospinal fluid and incubated, a peculiar clot is formed which, when inoculated into the subdural space of dogs or monkeys, grows gradually. Histologically the capsule of the hematoma is comparable to that seen in human chronic subdural hematoma. In some animals progressive hemiparesis develops.

Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage

1977 ◽  
Vol 46 (2) ◽  
pp. 220-226 ◽  
Author(s):  
Kamran Tabaddor ◽  
Kenneth Shulman
Keyword(s):  
Closed System ◽  
Subdural Hematoma ◽  
Patient Population ◽  
Chronic Subdural Hematoma ◽  
Definitive Treatment ◽  
Twist Drill ◽  
Simple Method ◽  
Content Type ◽  
Theoretical Considerations ◽  
Fine Print

✓ A simple method of bedside twist-drill craniostomy and closed-system drainage for evacuation of chronic and subacute subdural hematoma is introduced. The principles and theoretical considerations that form the basis for this technique are discussed. The technique was used in 21 patients with chronic or subacute subdural hematoma; it has produced results superior to those of the conventional methods used in our patient population. Possible mechanisms responsible for the better results with the simple twist-drill closed-system drainage are described.

The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma

1997 ◽  
Vol 87 (6) ◽  
pp. 870-875 ◽  
Author(s):  
Kazuo Tsutsumi ◽  
Keiichirou Maeda ◽  
Akira Iijima ◽  
Masaaki Usui ◽  
Yoshihumi Okada ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Recurrence Rate ◽  
Closed System ◽  
Subdural Hematoma ◽  
High Intensity ◽  
Chronic Subdural Hematoma ◽  
Content Type ◽  
Preoperative Magnetic Resonance ◽  
The Relationship ◽  
Fine Print

✓ Although chronic subdural hematoma (CSDH) is a well-known entity, its recurrence rate has remained uncertain. There is little knowledge concerning whether the results of radiological imaging can be used to predict CSDH recurrence or whether surgical methods can influence this rate. The first aim of this study is to evaluate the relationship between the recurrence rate of CSDHs and their appearance on preoperative magnetic resonance (MR) or computerized tomography images. The second aim is to evaluate by means of a prospective randomized method the usefulness of closed-system drainage. From January 1988 through June 1996, the authors surgically treated 257 consecutive adult patients with CSDHs. Data obtained in 199 patients who were evaluated preoperatively by MR imaging were analyzed. Thirty-one of these patients underwent bilateral operations and thus 230 operative sites of CSDH were included in the analyses. The cases of CSDH were separated into high- and nonhigh-intensity groups on the basis of the appearance on T1-weighted MR images. From July 1992 to June 1996, the authors conducted a prospective randomized study on the recurrence rate of CSDH in patients undergoing burr-hole irrigation with or without closed system drainage. The recurrence rate of 3.4% in the high-intensity group was significantly lower than the 11.6% rate found in the nonhigh-intensity group (p < 0.05). The recurrence rates following irrigation with and without closed system drainage were significantly different (p < 0.025): 3.1% with closed system drainage and 17% following burr-hole irrigation alone. The surgical procedures were correlated with the MR findings. In the high-intensity group, 1.1% of CSDHs recurred in patients in whom closed system drainage was used and 11.1% in patients without closed system drainage. In the nonhigh-intensity group, 8.1% of CSDHs recurred in patients in whom drainage was used and 23.1% in patients without closed system drainage. Magnetic resonance T1-weighted imaging was useful in predicting the propensity of CSDHs to recur. Closed system drainage significantly reduced the recurrence rate of CSDHs regardless of MR findings.

Role of local hyperfibrinolysis in the etiology of chronic subdural hematoma

1976 ◽  
Vol 45 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Haruhide Ito ◽  
Shinjiro Yamamoto ◽  
Toshio Komai ◽  
Hidetaka Mizukoshi
Keyword(s):  
Subdural Hematoma ◽  
Degradation Products ◽  
Chronic Subdural Hematoma ◽  
Subdural Space ◽  
Human Fibrinogen ◽  
Content Type ◽  
The Mean ◽  
Continuous Bleeding ◽  
Fine Print

✓ The authors describe studies performed on material aspirated from chronic subdural hematomas. Patients were given 51Cr-labeled red cells prior to aspiration, and it was possible to demonstrate that the mean daily hemorrhage into the hematoma space amounted to 10.2% of its volume. Immunoelectrophoresis of the aspirated hematoma fluid by monospecific anti-human fibrinogen revealed the presence of fibrin and fibrinogen degradation products that, measured by hemagglutination-inhibition immunoassay techniques, varied between 5.0 and 10,500 µg/ml with an average of 2604 µg/ml in 18 cases. The tissue activator was demonstrated by Todd's histological localization in the outer membrane of the chronic subdural hematoma in 11 cases, but not in the inner membrane. These results indicate that if a clot in the subdural space causes the formation of neomembrane, and excessive fibrinolysis occurs, the subdural clot would not only liquefy, but also enlarge by continuous hemorrhage from the neomembrane. Therefore, local hyperfibrinolysis and continuous bleeding are important in the etiology of the chronic subdural hematoma.

Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains

2003 ◽  
Vol 99 (1) ◽  
pp. 44-46 ◽  
Author(s):  
Christopher R. P. Lind ◽  
Christina J. Lind ◽  
Edward W. Mee
Keyword(s):  
Demographic Data ◽  
Burr Hole ◽  
Content Type ◽  
Subdural Hematomas ◽  
Subdural Drain ◽  
Burr Hole Evacuation ◽  
Brain Expansion ◽  
Burr Holes ◽  
Fine Print ◽  
Auckland Hospital

Object. The aim of this study was to determine the influence of closed-system subdural drainage on repeated operation rates after burr hole evacuation of subacute and chronic subdural hematomas (SDHs). Methods. Five hundred consecutive operations for the treatment of SDH via burr holes were performed between January 1, 1996, and April 15, 2002, at the Auckland Hospital. Hospital records were used to ascertain demographic data, operation, and repeated operation details. Rates of repeated surgeries were compared in patients with and without subdural drains. Repeated operations were performed less frequently in patients with subdural drains, occurring in 31 (10%) of 310 cases involving drains and in 35 (19%) of 188 cases without drains (p < 0.01). Demographics between the two groups were not significantly different except for mean patient age, which was higher among patients with a subdural drain. A lower rate of repeated operation was observed in patients who had undergone drain placement, regardless of whether there was visible evidence of brain reexpansion. Conclusions. Patients have lower rates of repeated surgeries if subdural drains are placed following evacuation of an SDH via a burr hole. To reach high clinical significance, 12 patients must undergo this simple intervention. If technically feasible, subdural drains should be inserted regardless of any occurrence of brain expansion during surgery.

Plasmin-α2-plasmin inhibitor complex and α2-plasmin inhibitor in chronic subdural hematoma

1989 ◽  
Vol 70 (1) ◽  
pp. 68-72 ◽  
Author(s):  
Kenichi Saito ◽  
Haruhide Ito ◽  
Takeshi Hasegawa ◽  
Shinjiro Yamamoto
Keyword(s):  
Chronic Subdural Hematoma ◽  
Enzyme Linked Immunosorbent Assay ◽  
Subdural Space ◽  
Normal Range ◽  
Content Type ◽  
Inhibitor Complex ◽  
Low Concentrations ◽  
High Concentrations ◽  
Plasmin Inhibitor ◽  
Fine Print

✓ Levels of the plasmin-α2-plasmin inhibitor complex (PLN-A2PI complex) and α2-plasmin inhibitor (A2PI) were determined by enzyme-linked immunosorbent assay (ELISA) with monoclonal antibodies in 59 patients with 66 chronic subdural hematomas (SDH's). Normal concentrations of the PLN-A2PI complex and A2PI in plasma are below 0.8 µg/ml and 60.5 ± 16.1 µg/ml, respectively (mean ± 2 standard deviations). The hematoma fluid contained high concentrations of the PLN-A2PI complex (4.58 ± 2.60 µg/ml) and low concentrations of A2PI (10.32 ± 4.81 µg/ml), while both values in the plasma of 12 patients with chronic SDH's were within the normal range. This represents local hyperfibrinolytic activity in the hematoma. Stuporous or comatose patients had higher PLN-A2PI complex levels than did the alert and the drowsy or disoriented patients. The layering type of hematoma as seen on computerized tomography scans showed the highest PLN-A2PI complex levels among five types of hematoma. In the fluid drained postoperatively from the subdural cavities of chronic SDH's, both the PLN-A2PI complex and A2PI levels decreased gradually in healing cases. In two patients with hematoma reaccumulation after surgery, both levels increased. The postoperative increase of the PLN-A2PI complex represents the recurrence of intermittent cycles of fibrinolysis, bleeding, coagulation, and hemostasis in the subdural space.

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