scholarly journals Chronic Subdural Hematoma - A Dilemma to Put Drain

2019 ◽  
Vol 9 (1) ◽  
pp. 26-32
Author(s):  
Md Amir Ali ◽  
Md Aminul Islam ◽  
RU Chowdhury ◽  
Ahmed Mursalin ◽  
Md Al Amin Salek ◽  
...  
Keyword(s):  
Closed System ◽  
Subdural Hematoma ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Burr Hole ◽  
Air Entrapment ◽  
Number Of Patients ◽  
Group A

Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain. Objectives: our study is to compare the clinical outcome of CSDH with or without drain. Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS. Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %). Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone. Bang. J Neurosurgery 2019; 9(1): 26-32

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 POSTOPERATIVE PATIENT POSTURE IN THE RECURRENCE OF TRAUMATIC CHRONIC SUBDURAL HEMATOMA AFTER BURR-HOLE SURGERY

Neurosurgery ◽  
2007 ◽  
Vol 61 (4) ◽  
pp. 794-797 ◽  
Author(s):  
Mehdi Abouzari ◽  
Armin Rashidi ◽  
Jalal Rezaii ◽  
Khalil Esfandiari ◽  
Marjan Asadollahi ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Burr Hole ◽  
Upright Posture ◽  
Postoperative Patient ◽  
Repeat Surgery ◽  
Group A

Abstract OBJECTIVE Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, especially in the elderly, with a significant recurrence rate ranging from 9.2 to 26.5%. The role of postoperative patient posture in the recurrence of CSDH has not been studied sufficiently. METHODS A total of 84 consecutive patients with unilateral traumatic CSDH without known risk factors of CSDH recurrence were prospectively enrolled in this study. All patients underwent burr-hole surgery with closed system drainage and were then allocated randomly to either of two groups: Group A (n = 42) patients were kept in a supine position for 3 days after the operation, whereas Group B (n = 42) patients assumed a sitting position in bed, with the head of the bed elevated to 30 to 40 degrees, for the same duration as Group A. After 3 days, there was no restriction in patients' activities in both groups. All patients were followed-up for at least 3 months after surgery. RESULTS The groups were not significantly different in age, sex, presence of brain atrophy or hydrocephalus, preoperative hematoma width, and postsurgery subdural space width. The recurrence rate in Groups A and B were 2.3 and 19.0% (necessitating repeat surgery in one patient), respectively (P = 0.02). Other complications in Groups A and B, respectively, were atelectasis (10 versus seven; P = 0.41), pneumonia (five versus four; P = 0.72), decubitus ulcer (three versus two; P = 0.64), and deep vein thrombosis (zero versus one; P = 0.31). CONCLUSION Assuming an upright posture soon after burr-hole surgery was associated with a significantly increased incidence of CSDH recurrence but not with a significant change in other position-related postsurgical complications. According to this result, it is not recommended that elderly patients assume an upright posture soon after burr-hole surgery to prevent postoperative atelectasis and dementia, as these might significantly increase the risk of CSDH recurrence.

scholarly journals Single versus Double Burr Holes for Treating Chronic Subdural Hematoma

2020 ◽  
Vol 9 (2) ◽  
pp. 99-104
Author(s):  
Uzzal Kumer Sadhu Khan ◽  
Asit Chandra Sarker ◽  
Md Mahamudul Haq Morshed ◽  
Md Motasimul Hasan ◽  
Saiful Hoque ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Cerebral Atrophy ◽  
The Elderly ◽  
Burr Hole ◽  
Group A ◽  
Group B ◽  
Burr Holes ◽  
Better Than

A subdural hematoma is a collection of blood below the inner layer of the dura but external to the bran and arachnoid membrane.Chronic subdural hematoma is commonly associated with cerebral atrophy, occur in the elderly after apparently insignificant head trauma. The incidence of Chronic subdural hematoma increases with age and after 70 years of age. Surgical evacuation of hematoma is indicated in patients who are clinically deteriorate or do not improve. Surgery can bring a rapid clinical improvement with a favorable outcome in over 80% of patient. Methods: This study was a prospective intervention study. Results: It was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B in GOS scoring on the 7th POD. The alive patients were again divided into 4 sub groups, as shown in the table. Among total 60 patients, in Group A 1(3.4%) died and 3 (10.0%) died in Group B. After 3 months follow up, it was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B. The alive patients were again divided into 4 sub groups, as shown in the table. Persistent vegetative and severe disability was not improved in Group B. Conclusion: In my study it was observed that the surgical outcome in single burr hole craniotomy is better than double burr hole craniotomy for treating of chronic subdural hematoma. Bang. J Neurosurgery 2020; 9(2): 99-104

Efficacy of Closed-System Drainage in Treating Chronic Subdural Hematoma: A Prospective Comparative Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 771-773 ◽  
Author(s):  
Susumu Wakai ◽  
Kazuyoshi Hashimoto ◽  
Naofumi Watanabe ◽  
Satoshi Inoh ◽  
Chikayuki Ochiai ◽  
...  
Keyword(s):  
Comparative Study ◽  
Recurrence Rate ◽  
Closed System ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Treatment Modalities ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B

Abstract The authors conducted a prospective comparative study on the recurrence rate of chronic subdural hematoma after the use of two different treatment modalities: burr-hole irrigation of the hematoma cavity with (Group A) and without closed-system drainage (Group B). Thirty-eight patients were studied. Patients were assigned to groups sequentially upon admission. There were no significant differences between the two groups for age, sex, preoperative hematoma volume, and density on computed tomographic scan. One patient in Group A (5%) suffered a recurrence as opposed to 6 in Group B (33%). The difference in recurrence rate between the two groups was statistically significant (p < 0.05). The authors conclude that closed-system drainage after burr-hole irrigation reduces the recurrence rate of chronic subdural hematoma.

scholarly journals Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases

2015 ◽  
Vol 42 (5) ◽  
pp. 283-287 ◽  
Author(s):  
JAMIL FARHAT NETO ◽  
João Luiz Vitorino Araujo ◽  
Vinícius Ricieri Ferraz ◽  
Luciano Haddad ◽  
José Carlos Esteves Veiga
Keyword(s):  
Subdural Hematoma ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Prognostic Indicators ◽  
Altered Consciousness ◽  
Prognostic Analysis ◽  
Motor Abnormalities ◽  
The Right ◽  
Change Of Consciousness

Objective : To characterize patients with chronic subdural hematoma undergoing surgery and to identify prognostic indicators. Methods : We conducted a retrospective analysis of patients diagnosed with chronic subdural hematoma (CSDH) undergoing surgical treatment. We analyzed: age, period from trauma to diagnostic imaging, pre and postoperative Glasgow coma scale, type of surgery, associated comorbidities, use of postoperative drainage and outpatient treatment. Results : The sample consisted of 176 patients, 126 male and 50 female patients (ratio 2.5 : 1), ages ranged from six months to 97 years, with an average of 59.3 years. CSDH was caused by trauma in 52% of patients, with the time from trauma to imaging averaging 25.05 days; 37.7% were hypertensive patients and 20% had a neurological disease. Eighty-five (48.3%) patients were elderly and altered consciousness was present in 63% of cases. Of the 91 (51.7%) non-elderly patients, 44% presented with headache, altered consciousness occurred in 40% and motor abnormalities in 27.5%. The CSDH was located on the right in 41%, left in 43% and bilaterally in 16% of patients. Conclusion : the change of consciousness was the most common clinical alteration in the elderly and headache in non-elderly. The most associated comorbidity was the arterial hypertension and the most frequent cause, head trauma. The trepanation with two oriffices associated with a closed drainage system was the most used operating, with high efficacy and low complication rate.

scholarly journals A Rare Complication of Chronic Subdural Hematoma Evacuation: Brain Stem Hemorrhage: A Case Report

2018 ◽  
Vol 32 (3) ◽  
pp. 462-465 ◽  
Author(s):  
Ghassen Gader ◽  
Mouna Rkhami ◽  
Maher Ben Salem ◽  
Mohamed Badri ◽  
Kamel Bahri ◽  
...  
Keyword(s):  
Brain Stem ◽  
Subdural Hematoma ◽  
Rare Complication ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Burr Hole ◽  
Sudden Increase ◽  
Vascular Disruption ◽  
Rapid Decompression ◽  
Surgical Modality

Abstract Chronic subdural hematoma (CSDH), which commonly affects the elderly, is one of the most frequent, but also benign neurosurgical pathologies. Burr hole drainage is the standard surgical modality for evacuation of a CSDH. This technique is known to be safe, with low morbidity and mortality rates. However, postoperative complications have occasionally been reported. We report the case of a 70-year-old man who presented a fatal brain stem hemorrhage after burr-hole drainage for unilateral chronic subdural hematoma. Asymmetrical and rapid decompression were thought to be leading to vascular disruption or sudden increase in cerebral blood flow, was probably responsible for the secondary brain stem bleeding. Therefore, a slow rate of evacuation of chronic subdural hematomas, as well as rigorous postoperative reanimation, are recommended in order to prevent serious complications.

scholarly journals Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

2020 ◽  
Vol 2 (1) ◽  
pp. 30-34
Author(s):  
Suresh Sapkota ◽  
Kiran Niraula ◽  
Subash Lohani ◽  
Shikher Shrestha ◽  
Bibhusan Shrestha ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Subdural Hematoma ◽  
Surgical Outcome ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Midline Shift ◽  
External Drainage ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Significant Difference

Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

Factors Favoring the Development of Chronic Subdural Hematoma After Traumatic Acute Subdural Hematoma in the Elderly

2021 ◽  
pp. 000313482110562
Author(s):  
Tarik Wasfie ◽  
Nicholas Fitzpatrick ◽  
Mursal Niasan ◽  
Jennifer L. Hille ◽  
Raquel Yapchai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Subdural Hematoma ◽  
Significant Risk ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Acute Subdural Hematoma ◽  
Mortality Data ◽  
Group A

Introduction Traumatic acute subdural hematoma (TASDH) is by far the most common traumatic brain injury in elderly patients presented to the emergency department, and a number of those treated conservatively will develop chronic subdural hematoma (CSDH). The factors contributing to chronicity were not well studied in the elderly; therefore, we retrospectively analyzed our elderly patients with acute subdural hematomas to identify the risk factors which might contribute to the development of subsequent CSDH. Methods A retrospective analysis of 254 patients with TASDH admitted between 2012 and 2016 to our level 2 trauma department in a community hospital was collected. Data include age, sex, comorbid conditions, CT findings, anticoagulant therapy, surgical interventions, disposition after discharge, and mortality. Data on those readmitted within the first 2 months with the diagnosis of CSDH were also studied (group A), and compared to those not readmitted (group B). Multiple logistic regression was used to determine the risk factors associated with readmission at P ≤ .05. Institutional review board approval was obtained for this study. Results There were 254 patients who were admitted with TASDH, 144 male (56.7%) and 110 female (43.3%), with the mean age of 71.4 (SD ± 19.38) years. Only 37 patients (14.6%) went for surgery in their initial admission. A total of 14 patients (5.6%) were readmitted subsequently with the diagnosis of CSDH within two months of initial discharge (group A). Only four patients (28.5%) were on anticoagulant therapy and these patients went for emergency craniotomy for evacuation of hematoma. All 14 patients had a history of coronary artery disease and hypertension and only 5 (35.7%) were diabetic. Review of head CT on initial admission of those patients revealed 4 patients (28.5%) had multiple lesions and 4 (28.5%) had tentorial/falax bleeding and 4 (28.5%) had a shift. The initial size and thickness of the bleeding was 1.4-5 mm. The adjusted model identified diabetes, race, and initial disposition as significant risk factors ( P < .05). Conclusion Risk associated with the transformation of TASDH to CSDH is difficult to assess in those group of elderly patients because of the small number; however, diabetes, race, and initial disposition to home pointed toward a risk for future development of CSDH and those patients should be followed clinically and radiographically over the next few months after discharge, particularly those on anticoagulant therapy.

scholarly journals Comparative study between single versus double burr-hole drainage of unilateral chronic subdural haematoma

2014 ◽  
Vol 43 (1) ◽  
pp. 13-16 ◽  
Author(s):  
SM Asaduzzaman ◽  
KM Tarikul Islam ◽  
Mohammad Nazrul Hossain ◽  
Md Ruhul Amin ◽  
Md Jahangir Alam ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Subdural Haematoma ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Burr Hole ◽  
Limb Weakness ◽  
Group A ◽  
Grading Scale ◽  
Group B

Chronic subdural haematoma (CSDH) is defined as the haematoma in the subdural space which tend to occur in the elderly several weeks after head injury. The incidence of CSDH varied from 1.72 per 100,000 inhabitants per year in Finland to 13.1 per 100,000 inhabitants per year in Japan with a peak incidence in the sixth and seventh decade of life. CSDH is a common treatable cause of dementia. The principal techniques used in the treatment of CSDHs are presently burr hole, twist drill craniostomy, craniectomy and craniotomy. The aim of this study was to assess clinical outcome in unilateral chronic subdural haematoma psatients treated by single or double burr-hole drainage. This clinical trial was carried out at the department of neurosurgery, BSMMU from June 2010 to November 2011. A total of 40 consecutive patients with their age ranged from 50 to 70 years with GCS 9 to 13 & haematoma volume greater than 30cc were included in this study and randomly divided into two groups. In group A, patients with chronic subdural haematoma (CSDH) were managed with double burr-hole drainage. In group B, patients were managed with single burr-hole drainage. Clinical outcome was measured on the 1st post operative day, 3rd post operative day and at the time of discharge (usually on the 7th post operative day) and at 1 month follow-up by measuring Glassgow coma scale (GCS), improvement of limb weakness and Markwalder grading scale. In this study double burr-hole drainage and single burr-hole drainage surgery shows equal success in the management of CSDHs. DOI: http://dx.doi.org/10.3329/bmj.v43i1.21370 Bangladesh Med J. 2014 January; 43 (1): 13-16

scholarly journals Outcome of Chronic Subdural Hematoma Treated with Single Burr Hole Under Local Anesthesia

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
Abebe Mersha ◽  
Sahlu Abat ◽  
Tsegaye Temesgen ◽  
Abebe Nebyou
Keyword(s):  
Hospital Stay ◽  
Local Anesthesia ◽  
Subdural Hematoma ◽  
Addis Ababa ◽  
Chronic Subdural Hematoma ◽  
Postoperative Outcome ◽  
The Elderly ◽  
Burr Hole ◽  
Cross Sectional ◽  
Burr Hole Evacuation

BACKGROUND: Chronic subdural hematoma (CSDH) is a common condition encountered in daily neurosurgical practice usually affecting the elderly population. Various surgical procedures have been used for the evacuation of hematoma in patients with CSDH. The objective of this paper was to study the postoperative outcome of patients who were operated for CSDH and to describe the easy, safest and effective procedure that can be performed at primary level hospitals.METHODS: Institutional based cross-sectional retrospective study was conducted among patients operated for CSDH from January 1, 2012 to December 31, 2015 at Teklehaymanot General Hospital, a private hospital in Addis Ababa, Ethiopia. Descriptive statistics, using SPSS version 20, was used to determine the postoperative outcomes including hospital stay, complications and recurrence rate.RESULTS: Of the 195 charts reviewed, 70.3% were of males, with M: F ratio of 2.4:1. 68.2% of patients being above the age of 55 years with a mean age at presentation of 57.63. The most common presenting symptom was headache followed by extremity weakness. The diagnosis of CSDH was made with either head CT scan or MRI. Forty one percent of patients had a left side hematoma and 48(24.6%) patients had bilateral CSDH. All patients were operated with a single burr hole evacuation under local anesthesia and postoperative subdural closed system drainage by a single neurosurgeon. The mean hospital stay was 3.68±2.6 days. The postoperative outcome was assessed using the Glasgow Outcome Score, and 95.9% of the patients reported good recovery. Thirteen (6.6%) patients were operated twice for recurrence, and there were four deaths.CONCLUSIONS: Single burr hole craniostomy is an easy, safe and effective technique for the treatment of CSDH.

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