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.

Multiple burr-hole operation for adult moyamoya disease

1996 ◽  
Vol 84 (3) ◽  
pp. 468-476 ◽  
Author(s):  
Tetsuro Kawaguchi ◽  
Shigekiyo Fujita ◽  
Kohkichi Hosoda ◽  
Yoshiteru Shose ◽  
Seiji Hamano ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Burr Hole ◽  
Subdural Effusion ◽  
Content Type ◽  
Burr Holes ◽  
Adult Moyamoya Disease ◽  
Fine Print

✓ Excellent results from multiple burr-hole operations for adult moyamoya disease are reported in this study. Ten patients had between one and four burr holes (mean 2.1) drilled in each hemisphere. In four patients new burr holes were added on the opposite side after depression of cerebral blood flow (CBF) was detected by follow-up single-photon emission computerized tomography imaging of the brain with N-isopropyl-p-[123I]iodoamphetamine. The postoperative follow-up period ranged from 6 to 62 months (mean 34.7 months). Beginning at 6 months postsurgery, angiograms disclosed rich neovascularization at 41 of 43 burr holes, first from the middle meningeal artery, then from the superficial temporal artery. Neovascularization did not occur at two burr holes at which there was subdural effusion and local cerebral atrophy, respectively. Progression of stenosis of the major vessels was seen in six patients. Moyamoya vessels were decreased at six sites in four patients. The CBF study revealed that the reactivity to acetazolamide improved in all six patients tested. Transient ischemic attacks disappeared in all six patients presenting with this symptom, and preoperative symptoms improved in both of the patients who presented with cerebral infarction and in both patients with intraventricular hemorrhage. There was no mortality or morbidity, and no new neurological deficits or rebleeding developed during the follow-up period. The authors strongly recommend the multiple burr-hole operation as the surgical treatment of choice for adult moyamoya disease because of its safety and effectiveness.

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.

Superimposed chronic subdural hygromas

1975 ◽  
Vol 43 (5) ◽  
pp. 623-626 ◽  
Author(s):  
Robert S. Maurice-Williams
Keyword(s):  
Cerebral Hemisphere ◽  
Burr Hole ◽  
Content Type ◽  
Burr Hole Evacuation ◽  
Fine Print

✓ Two cases are reported of separate but superimposed chronic subdural collections occurring over one cerebral hemisphere convexity. It is suggested that this phenomenon may account for some apparent recurrences of chronic subdural collections after simple burr-hole evacuation.

Acute subdural hematomas

1975 ◽  
Vol 42 (1) ◽  
pp. 37-42 ◽  
Author(s):  
David A. Fell ◽  
Sean Fitzgerald ◽  
Richard H. Moiel ◽  
Pedro Caram
Keyword(s):  
Nursing Home ◽  
Head Injury ◽  
Mortality Rate ◽  
Closed Head Injury ◽  
Nursing Home Care ◽  
Content Type ◽  
Subdural Hematomas ◽  
Closed Head ◽  
Burr Holes ◽  
Fine Print

✓ The authors report 144 cases in which acute subdural hematomas resulting from closed head injury were surgically treated. The mortality rate was 48% for those treated within 24 hours of injury and 45% for those treated within 72 hours. Patients under 10 years of age had a 33% mortality, while 69% of those over 60 years died. In the first 6 years of the series, 75% of the patients were treated by multiple burr holes and a subtemporal craniectomy, with a mortality of 41%; in the last 6 years, 92% of the patients had large craniotomies with a 45% mortality. Of the 32 survivors among the last 60 patients treated, nine require full nursing home care, eight have returned to their own homes, 12 are able to care for themselves but not work, and three have returned to work.

scholarly journals Surgical management of chronic subdural hematomas through single-burr hole craniostomy: is it sufficient?

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Omar El Farouk Ahmed ◽  
Ahmad El Sawy ◽  
Shafik El Molla
Keyword(s):  
Clinical Outcome ◽  
Closed System ◽  
Burr Hole ◽  
Altered Level ◽  
Subdural Hematomas ◽  
Elder Patients ◽  
Grade Scale ◽  
Burr Hole Evacuation ◽  
Burr Holes

Abstract Background Symptomatic chronic subdural hematomas (CSDH) remain one of the most encountered forms of intracranial hemorrhages particularly in the elder patients, yet fortunately implies a good surgical prognosis. Burr hole evacuation under general anesthesia is the most commonly used neurosurgical technique for the management of CSDH. Clinical disagreement between many studies regarding the number of burr holes required to achieve the optimal surgical and clinical outcome has long existed. The objective of this study is to evaluate the prognosis and clinical outcome following the use of single-burr hole craniostomy technique in the aim of surgical evacuation of CSDH. Results This is a retrospective study of 30 patients, with symptomatic unilateral or bilateral CSDH managed by the authors strictly by single-burr hole evacuation with closed-system drainage on the corresponding site of the hematoma. Clinical outcome was then assessed at 1, 7, and 30 days after surgery using the Glasgow Coma Scale (GCS) and by comparing the Markwalder grade scale before surgery to 1 month following surgery; the pre- and post-operative radiological data, clinical neurological progress and the possible incidence of complications postoperatively were also recorded. Study duration was from August 2019 to October 2020. Our study included 18 (60%) male patients and 12 (40%) female patients. The main presenting symptom was altered level of consciousness noted in 29 (96.7%) patients; a history of a relevant head trauma was recorded in 11 patients (36.7%). The GCS showed a statistically highly significant improvement comparing the preoperative to the postoperative values throughout the follow-up intervals (p = 0.001); similarly, the Markwalder score significantly improved 1 month after surgery, where 17 (63%) patients were Markwalder grade 0, 9(33.3%) patients were grade 1, a single patient (3.7%) was grade 2, and none were Markwalder grade 3. Conclusion Our study concluded that single-burr hole craniostomy with closed-system drainage for the management of symptomatic CSDH would be a sufficient approach to achieve a good surgical outcome with a low complication rate. Larger series and further studies would be yet considered with longer follow-up periods.

scholarly journals The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

2017 ◽  
Vol 75 (11) ◽  
pp. 809-812 ◽  
Author(s):  
Lindolfo Carlos Heringer ◽  
Ulysses de Oliveira Sousa ◽  
Matheus Fernandes de Oliveira ◽  
Aline Silva Nunes ◽  
Katiusa de Abreu Alves ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Burr Hole ◽  
Surgical Results ◽  
Subdural Hematomas ◽  
Burr Hole Evacuation ◽  
Burr Holes

ABSTRACT Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.

Rapid spontaneous resolution of acute extradural and subdural hematomas

1993 ◽  
Vol 78 (1) ◽  
pp. 126-128 ◽  
Author(s):  
Toshihiko Kuroiwa ◽  
Harushi Tanabe ◽  
Hiroyuki Takatsuka ◽  
Motohiro Arai ◽  
Nobuyoshi Sakai ◽  
...  
Keyword(s):  
Spontaneous Resolution ◽  
Content Type ◽  
First Report ◽  
Simultaneous Resolution ◽  
Subdural Hematomas ◽  
Fine Print

✓ The rapid spontaneous resolution of two traumatic acute hematomas, one extradural and one subdural, is reported in a 17-year-old young man. The authors believe that this is the first report of simultaneous resolution of both types of hematoma.

Factors affecting coagulation: fibrinolysis in chronic subdural fluid collections

1983 ◽  
Vol 58 (2) ◽  
pp. 242-245 ◽  
Author(s):  
Bryce Weir ◽  
Philip Gordon
Keyword(s):  
Degradation Products ◽  
Hemoglobin Content ◽  
Fibrin Degradation Product ◽  
Content Type ◽  
Factors Affecting ◽  
Fibrin Degradation Products ◽  
Subdural Hematomas ◽  
Increased Risk ◽  
Fluid Collections ◽  
Fine Print

✓ Plasminogen, alpha2-antiplasmin, fibrinogen, fibrin degradation products (FDP's), and hemoglobin were measured in the supernatant fluid of 25 chronic subdural hematomas and five chronic subdural hygromas. The 30 patients underwent pre- and postoperative computerized tomography. The hematomas were characterized by low fibrinogen and high fibrin degradation product concentrations. The hemoglobin content varied directly with the alpha2-antiplasmin, and inversely with the plasminogen. Four patients underwent reoperation for recurrences. The initial fluid from these cases was characterized by relatively high plasminogen and low alpha2-antiplasmin. The hygromas had no hemoglobin, and low fibrinogen, high FDP's, low alpha2-antiplasmin, and variable plasminogen levels. It is possible that those cases having the greatest capacity to produce plasmin (high plasminogen and low alpha2-antiplasmin) can produce more FDP's which in turn causes more rebleeding and an increased risk of reaccumulation of chronic subdural hematomas.

Extradural and subdural hematomas

1970 ◽  
Vol 33 (6) ◽  
pp. 632-635 ◽  
Author(s):  
Kenneth G. Jamieson
Keyword(s):  
Traffic Accidents ◽  
Head Injuries ◽  
Accident Prevention ◽  
Content Type ◽  
Subdural Hematomas ◽  
Fine Print

✓ The pattern of head injuries due to traffic accidents has changed markedly in Australia in the period since 1935. A review of autopsy cases of extradural and acute subdural hematomas shows a startling shift toward inoperable lesions. The author points out that accident prevention must now be considered the chief means of reversing man's trend toward self-destruction on the highway.

The contrast-enhanced CT scan in the diagnosis of isodense subdural hematoma

1979 ◽  
Vol 50 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Fong Y. Tsai ◽  
James E. Huprich ◽  
Hervey D. Segall ◽  
James S. Teal
Keyword(s):  
Cerebral Cortex ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Correct Diagnosis ◽  
Content Type ◽  
Subdural Hematomas ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Fine Print

✓ The authors review 29 cases of surgically-proven isodense subdural hematomas examined by non-contrast and contrast-enhanced computerized tomography scans. Three types of isodense collections were noted: homogeneous isodense collections, mixed-density collections, and gravitational layering within subdural collections. Contrast enhancement within the cerebral cortex, cortical vessels, and subdural membranes led to the correct diagnosis in each case. Contrast-enhanced scans are essential for the evaluation of isodense subdural hematomas.

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