Avoidable factors that contribute to complications in the surgical treatment of chronic subdural haematoma

Choudhury, A. R.

doi:10.1007/bf01400867

Cited by 22 publications

(6 citation statements)

References 24 publications

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“…This is particularly relevant to the elderly patients who constitute the majority of patients treated for cSDH, as these patients are more susceptible to complications of immobility such as pneumonia and venous thrombosis. Despite the theoretical benefits of early mobilization, some investigators favor delayed mobilization following a period of recumbency with continuous closed system drainage, in the hopes of promoting brain expansion and thus prevent recurrence of cSDH [1,11]. Previous literature on this topic has reached mixed conclusions about the influence of patient mobilization on cSDH recurrence.…”

Section: Mobilization Of Patients Following Csdh Drainagementioning

confidence: 94%

The surgical management of chronic subdural hematoma

et al. 2011

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Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

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Section: Mobilization Of Patients Following Csdh Drainagementioning

confidence: 94%

The surgical management of chronic subdural hematoma

et al. 2011

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“…Mobilization following surgical treatment of cSDH is an important aspect of postoperative care, especially since most patients are older and more susceptible to complications of immobility such as pneumonia, deep venous thrombosis and pulmonary embolism [1]. On the other hand, delayed mobilization might promote brain expansion and thus prevent recurrence of cSDH [82,83]. Studies on this topic have reached mixed conclusions about the influence of patient mobilization on cSDH recurrence.…”

Section: Mobilization Of Patients Following Bhcmentioning

confidence: 99%

Evidence-Based Treatment of Chronic Subdural Hematoma

Soleman¹,

Taussky²,

Fandiño³

et al. 2014

Traumatic Brain Injury

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Addi"ional informa"ion is available a" "he end of "he chap"er h""p://dx.doi.org/10.5772/57336 . IntroductionChronic subdural hematoma cSDH is one of the most frequent neurosurgical entities caused by head trauma. Since cSDH affects mainly elderly patients and the population continues to age, it has become a common neurosurgical disease seen by both general and specialized health-care practitioners. Despite the increasing prevalence of cSDH, class I studies, and evidence regarding the management of this disease is lacking. We provide an overview of the epidemiology, pathophysiology and etiology of cSDH and discuss several controversial aspects of its management including indication and timing of surgery, steroid treatment, the effectiveness of anti-epileptic prophylaxis, comparative effectiveness of various techniques for surgical evacuation, the timing of postoperative resumption of anticoagulant medication, and protocols for mobilization following evacuation of cSDH. Complications of surgical evacuation such as recurrent hematoma, postoperative epilepsy, brain injury and/or iatrogenic intracerebral bleeding due to hematoma evacuation, drainage insertion or irrigation, and ways to avoid them are also discussed. "s the incidence of cSDH is expected to increase and most treatment aspects lack clear consensus, further large prospective studies are needed. For this reason, a randomized, prospective study evaluating one aspect of the management of cSDH is currently in progress at our institution.. Definition " chronic subdural hematoma cSDH is defined as chronic ≥ weeks intracranial bleeding between the dura mater which adheres to the skull , and the arachnoid mater which envelops © 2014 Soleman e" al.; licensee InTech. This is a paper dis"rib""ed "nder "he "erms of "he Crea"ive Commons A""rib""ion License (h""p://crea"ivecommons.org/licenses/by/3.0), which permi"s "nres"ric"ed "se, dis"rib""ion, and reprod"c"ion in any medi"m, provided "he original work is properly ci"ed. the brain . The underlying cause of cSDH is usually traumatic tearing of the bridging veins which connect the brain surface with the dura mater.[ ]. . EpidemiologyThe incidence of cSDH is estimated at . -per ' people, rising up to per ' people in patients above the age of [ -]. The average age of patients with cSDH is approximately years old [ ]. "s the population continues to mature, incidence is expected to double by the year [ , ]. " large demographic study found the prevalence of cSDH in patients older than to be significantly higher % vs. % [ ]. In addition, men are more frequently affected than women % vs. % . In % of the cases, the patient has suffered a fall in the past and % of the patients were either treated with oral anticoagulants or platelet aggregation inhibitors. The reported recurrence rates range from . % to % [ -]. The most common risk factors are advanced age, alcohol abuse, seizures, cerebrospinal fluid CSF shunts, coagulopathies, blood thinners, and patients at risk for falling e.g. hemiplegia . In -% of the cases, cSDHs are b...

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“…Although recent evaluation of the role of open craniotomy in the treatment of chronic subdural haematoma (CSDH) has indicated no disadvantages in carrying out this procedure [6], nowadays the vast majority of neurosurgeons prefer to use a variety of less invasive surgical methods offering burr-hole craniotomy (BHC) or twist-drill trephination (TDT) regimen with single evacuation or continuous closedsystem drainage of CSDH [3,4,7,9,12,13,16]. Other surgeons propose additional peri-operative lumbar intrathecal injection of Ringer's lactate solution after CSDH evacuation [5] or replacement of haematoma with oxygen after subdural tapping [1,2].…”

Section: Introductionmentioning

confidence: 99%

Chronic subdural haematoma ? a comparison of two different treatment modalities

1997

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Burr-hole craniotomy (BHC) and closed-system drainage undoubtedly is currently the most accepted treatment offered in chronic subdural haematoma (CSDH). Although twist-drill trephination (TDT) techniques have been available for years, now a special subdural catheter kit has been launched for treatment of CSDH. In a prospective study, 33 patients with 36 CSDH were treated with a 5-mm TDT regimen and insertion of a CORDIS subdural catheter (CORDIS Corp., Miami, USA). The results are compared with a consecutive series of 33 patients treated previously with an 11-mm BHC and closed-system drainage for 40 CSDH: Recurrence and persistence rate of CSDH treated with TDT necessitating a second intervention was 18.1%, no further surgical intervention was necessary. In BHC treated patients, 33.3% of haematomas had to be reoperated on, another 6.0% had to be re-operated on a third time. Infection rate in BHC treated patients was 18.1% as compared with a 0% infection rate in patients treated with the TDT technique. Mortality rate for the BHC method was 9.0% as compared with 6.0% in the TDT treatment regimen. Significantly better clinical results are achieved using the TDT technique with insertion of a special subdural catheter, making this procedure superior to the BHC regimen.

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Avoidable factors that contribute to complications in the surgical treatment of chronic subdural haematoma

Cited by 22 publications

References 24 publications

The surgical management of chronic subdural hematoma

The surgical management of chronic subdural hematoma

Evidence-Based Treatment of Chronic Subdural Hematoma

Chronic subdural haematoma ? a comparison of two different treatment modalities

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