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.

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.

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.

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.

Middle meningeal artery embolization for refractory chronic subdural hematoma

2000 ◽  
Vol 93 (4) ◽  
pp. 686-688 ◽  
Author(s):  
Shinya Mandai ◽  
Masaru Sakurai ◽  
Yuzo Matsumoto
Keyword(s):  
Liver Cirrhosis ◽  
Subdural Hematoma ◽  
Therapeutic Approach ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Content Type ◽  
Meningeal Artery ◽  
Fine Print

✓ The authors present a case of refractory chronic subdural hematoma (CSH) in a 59-year-old man with coagulopathy due to liver cirrhosis. The patient was successfully treated by embolization of the middle meningeal artery after several drainage procedures. This new therapeutic approach to recurrent CSH is discussed.

Chronic subdural hematoma simulating transient cerebral ischemic attacks

1975 ◽  
Vol 42 (1) ◽  
pp. 101-103 ◽  
Author(s):  
Eldad Melamed ◽  
Slvan Law ◽  
Avinoam Reches ◽  
Abraham Sahar
Keyword(s):  
Subdural Hematoma ◽  
Clinical Picture ◽  
Chronic Subdural Hematoma ◽  
Sensory Deficit ◽  
Transient Ischemic Attacks ◽  
Neurological Manifestations ◽  
Content Type ◽  
Pathophysiological Mechanisms ◽  
Cerebral Ischemic ◽  
Fine Print

✓ A patient is presented in whom chronic subdural hematoma simulated transient ischemic attacks. The neurological manifestations were those of recurrent, transient episodes of expressive dysphasia preceded by focal sensory deficit. Various pathophysiological mechanisms which could have caused the unusual clinical picture are briefly considered.

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.

Brain scans and echoencephalography in the diagnosis of chronic subdural hematoma

1974 ◽  
Vol 40 (3) ◽  
pp. 347-350 ◽  
Author(s):  
Sheldon R. Hurwitz ◽  
Samuel E. Halpern ◽  
George Leopold
Keyword(s):  
Cerebral Angiography ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Content Type ◽  
Brain Scans ◽  
Subdural Hematomas ◽  
Fine Print

✓ Eighteen patients with chronic subdural hematomas were studied by both brain scans and echoencephalography. All cases were verified by cerebral angiography. Brain scanning was accurate in predicting hematomas in 93% of the cases, and echoencephalography in 44%. When hematomas were bilateral or when frontal clots caused no shift in the diencephalic midline, the routine echoencephalogram often was negative. The two procedures are complementary, and serial studies may be helpful in the study of changing clinical situations.

Chronic subdural hematoma presenting as spontaneous subarachnoid hemorrhage

1985 ◽  
Vol 63 (5) ◽  
pp. 691-692 ◽  
Author(s):  
Zbigniew Kotwica ◽  
Jerzy Brzeziński
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Clinical Findings ◽  
Content Type ◽  
Acute Subarachnoid Hemorrhage ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Fine Print

✓ Six cases of chronic subdural hematoma presenting with the clinical findings of acute subarachnoid hemorrhage are reported. No systemic or focal cause for the bleeding was found, and possible mechanisms are discussed.

Experimental chronic subdural hematoma in mice

1987 ◽  
Vol 67 (5) ◽  
pp. 710-716 ◽  
Author(s):  
Hisashi Aikawa ◽  
Kinuko Suzuki
Keyword(s):  
Body Weight ◽  
Blood Vessels ◽  
Subdural Hematoma ◽  
Intraperitoneal Injection ◽  
Intraventricular Hemorrhage ◽  
Chronic Subdural Hematoma ◽  
Content Type ◽  
Single Intraperitoneal Injection ◽  
Thin Walled ◽  
Fine Print

✓ A new experimental model of chronic subdural hematoma in mice is described. A single intraperitoneal injection of 6-aminonicotinamide (25 mg/kg body weight) on the 5th postnatal day induced hydrocephalus in mice with almost 100% success. Approximately 60% of the mice spontaneously developed intracranial hemorrhage 20 days after the injection. About 1 week after the hemorrhage, a lens-shaped or spherical subdural hematoma was observed, accompanied by marked dilatation of the lateral ventricles and intraventricular hemorrhage. Histological examination revealed that the hematoma contained well-organized outer and inner membranes. Fresh hemorrhage surrounded by many hemosiderin-laden macrophages was seen at the margin of the hematoma adjacent to the organizing outer membrane, in which many fibroblasts and blood vessels were noted. The inner membrane of the hematoma was made up of several tiers of flattened cells with thin-walled blood vessels. The gross morphology and histology of these hematomas closely resembled those of human chronic subdural hematoma.

Chronic subdural hematoma in adults

1975 ◽  
Vol 42 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Rainer Fogelholm ◽  
Olli Heiskanen ◽  
Olli Waltimo
Keyword(s):  
Subdural Hematoma ◽  
Pyramidal Tract ◽  
Young Patients ◽  
Chronic Subdural Hematoma ◽  
Pathological Findings ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Mental Deterioration ◽  
Relationship Of ◽  
The Relationship

✓The relationship of age to clinical and pathological findings was analyzed in 109 adult patients operated on because of chronic subdural hematoma. A well-formed membrane on the inner and outer surface of the hematoma was used as the criterion for chronicity of the hematoma. Younger patients had more evidence of increased intracranial pressure; older patients had more evidence of mental deterioration and pyramidal tract lesions. The interval from trauma to operation was shorter in the young patients. The thickness of the hematoma as measured from angiograms increased with the age of the patient. The cause of this difference is discussed.

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