Use of Automated Irrigating Drainage System in Six Patients With Chronic Subdural Hematoma: A Single-Center Experience

Abstract Background Organized chronic subdural hematoma (CSDH) is a special type of CSDH. However, the optimal surgical procedure has not been established. We present our experience here to discuss the surgical procedure in treatment of organized CSDH. Methods Thirty-three patients with organized CSDH were admitted between January 1, 2008 and January 1, 2018. Age, gender, clinical symptoms, imaging data, type of surgical procedure, Barthel index (BI), and postoperative complications were collected and retrospectively analyzed. The BI was assessed both pre and postoperatively (1 week and 1 month after surgery). Results Overall, 14 patients underwent large craniotomy and 19 patients underwent small craniotomy. No significant differences in gender, age, initial clinical symptoms, and preoperative BI were found between the groups (p > 0.05). Among the 14 patients who underwent large craniotomy, 2 patients developed epilepsy after the operation, while 1 patient had postoperative aphasia. None of the patients had recurrence in 6 months postoperatively. Among the 19 patients who underwent small craniotomy, 1 patient developed an acute subdural hematoma and 1 patient developed aphasia. No obvious complications were found in the remaining 18 patients and none of the 19 patients had recurrence in 6 months postoperatively. BI scores of the small craniotomy group were significantly better than those of the large craniotomy group at 1 week postoperatively (p < 0.05). However, there was no significant difference in the 1-month results (p > 0.05). Conclusion According to our single-center experience, a small craniotomy for treating organized CSDH can be considered as an alternative to a larger craniotomy.

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Morbidity and Mortality After Burr Hole Craniostomy Versus Craniotomy for Chronic Subdural Hematoma Evacuation: A Single-Center Experience

World Neurosurgery ◽

10.1016/j.wneu.2019.10.023 ◽

2020 ◽

Vol 134 ◽

pp. e196-e203 ◽

Cited By ~ 1

Author(s):

Alankrita Raghavan ◽

Gabriel Smith ◽

Louisa Onyewadume ◽

Matthew R. Peck ◽

Eric Herring ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Morbidity And Mortality ◽

Single Center ◽

Hematoma Evacuation ◽

Single Center Experience

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O-030 Super-selective middle meningeal artery embolization for chronic subdural hematoma using n-BCA with the sugar push technique: single center experience of 61 consecutive patients

10.1136/neurintsurg-2021-snis.30 ◽

2021 ◽

Author(s):

S Majidi ◽

S Matsoukas ◽

R De Leacy ◽

P Morgenstern ◽

R Soni ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Single Center ◽

Artery Embolization ◽

Single Center Experience ◽

Meningeal Artery

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Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015005003 ◽

2015 ◽

Vol 42 (5) ◽

pp. 283-287 ◽

Cited By ~ 7

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.

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Chronic Subdural Hematomas: To Drain or Not to Drain?

Neurosurgery ◽

10.1227/00006123-198502000-00010 ◽

1985 ◽

Vol 16 (2) ◽

pp. 185-188 ◽

Cited By ~ 76

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.

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Chronic Subdural Hematoma - A Dilemma to Put Drain

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i1.42921 ◽

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

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Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016552 ◽

2020 ◽

pp. neurintsurg-2020-016552

Author(s):

Joshua S Catapano ◽

Andrew F Ducruet ◽

Candice L Nguyen ◽

Jacob F Baranoski ◽

Tyler S Cole ◽

...

Keyword(s):

Subdural Hematoma ◽

Complete Resolution ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Embolic Material ◽

Ethylene Vinyl Alcohol ◽

Single Center Experience ◽

Meningeal Artery ◽

Single Branch

BackgroundRecently, middle meningeal artery (MMA) embolization has emerged as a potentially safe and effective method of treating chronic subdural hematoma (cSDH).ObjectiveTo report a single-center experience with MMA embolization and examines the type of embolic material used, the extent of penetration, and the number of MMA branches embolized.MethodsA retrospective analysis of all patients with MMA embolization from 2018 through 2019 was performed. A failed outcome was defined as either surgical rescue and/or greater than 10 mm of hematoma residual or reaccumulation following embolization.ResultsOf 35 patients, surgery had failed for 9 (26%) and initial conservative treatment had failed for 6 (17%). Of 41 MMA embolizations, including those in six patients with bilateral cSDH who underwent bilateral MMA embolization, 29 (72%) were performed using ethylene vinyl alcohol copolymer (Onyx), 7 (17%) using particles, and 5 (12%) using n-butyl cyanoacrylate. Both the anterior and posterior MMA divisions were embolized in 29 cases (71%); distal penetration of these branches was achieved in 25 embolizations (61%). Twenty-six (63%) cSDHs completely resolved. Complete resolution was seen in 22 of 29 hematomas (76%) in which both anterior and posterior MMA branches were occluded versus 4 of 12 (33%) following single-branch embolization (p=0.014). Embolization of one cSDH (2%) failed.ConclusionMMA embolization of cSDHs appears to be both safe and efficacious. Furthermore, embolization of both the anterior and posterior MMA branches may be associated with increased odds of complete resolution.

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