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.

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.

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

2008 ◽  
Vol 108 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Rudolf A. Kristof ◽  
Jochen M. Grimm ◽  
Birgit Stoffel-Wagner
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Cerebrospinal Fluid Leakage ◽  
Subdural Space ◽  
Subdural Hygroma ◽  
Fluid Leakage ◽  
Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

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.

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.

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.

Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model

2003 ◽  
Vol 98 (6) ◽  
pp. 1217-1221 ◽  
Author(s):  
Hiromichi Yamamoto ◽  
Yutaka Hirashima ◽  
Hideo Hamada ◽  
Nakamasa Hayashi ◽  
Hideki Origasa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Multivariate Analysis ◽  
Subdural Hematoma ◽  
Logistic Regression Model ◽  
Multivariate Analyses ◽  
Chronic Subdural Hematoma ◽  
Ct Scans ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The authors attempted to determine independent predictors that contribute to the recurrence of chronic subdural hematoma (CSDH). Methods. A total of 105 consecutive patients who underwent surgery for CSDH were included in this study. Eleven patients underwent a repeated operation because the CSDH recurred. Univariate and multivariate analyses were performed to assess the relationships among various variables and CSDH recurrence. Finally, four variables were found to be independently associated with the recurrence of CSDH: 1) absence of a multiplicity of hematoma cavities on CT scans; 2) presence of a history of seizure; 3) width of the hematoma; and 4) absence of a history of diabetes mellitus (DM). Conclusions. As previously reported, the width of the hematoma is related to the incidence of CSDH recurrence. In this study, the lack of a multiplicity of hematoma cavities was the favorite predictor of CSDH recurrence. In addition, histories of seizure and no past DM are closely related to the incidence of CSDH recurrence.

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.

Sedimentation level in chronic subdural hematoma visible on computerized tomography

1983 ◽  
Vol 58 (2) ◽  
pp. 246-251 ◽  
Author(s):  
Ming-Chien Kao
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Clinical Manifestations ◽  
Chronic Subdural Hematoma ◽  
Ct Scans ◽  
Content Type ◽  
Ct Examination ◽  
History Of ◽  
Chronic Hematoma ◽  
Fine Print

✓ A clear interface dividing subdural hematoma into an upper hypodense and a lower hyperdense part was seen on computerized tomography (CT) scan in seven of 140 patients with chronic subdural hematoma. All except one of the seven patients had a definite history of head trauma more than 1 month before they developed acute disturbances of consciousness and pronounced hemiparesis. Consequently, they remained bed-ridden until they underwent drainage of the subdural hematoma. This group was compared to seven chronic subdural hematoma patients with mild clinical manifestations who were selected and intentionally confined to bed for a period before CT examination and craniotomy. The CT scans in this latter group did not show the clear interface in the subdural hematoma seen in the first group. Based on this study, it is hypothesized that this sedimentation level occurred as a result of rebleeding into a chronic hematoma that was sufficiently old to result in its contents being homogenous prior to the rebleed. In cases of rebleeding, a sufficient period of bed confinement in the brow-up position before CT examination allows development of a gravitational sedimentation in the hematoma. This clear level of sedimentation is seen in only a small portion of patients, but this finding may be specific for a significant amount of rebleeding and may herald acute deterioration.

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.

Sign in / Sign up

Export Citation Format

Share Document