Behandlung des chronischen Subduralhämatoms mit externer geschlossener Drainage - Bericht über 100 konsekutive Fälle

Härders, A.; Hr, Eggert; Weigel, K.

doi:10.1055/s-2008-1053981

Cited by 11 publications

(4 citation statements)

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“…23 A m uch sm aller variance was found in a review of m ore recent studies, however, where m ortality rates between 1.5 and 6.6% were reported. 14 The results of the present study con® rm the observation, which has already been m ade in earlier studies, 8,14,22,23,33 that this treatm ent m ethod results in a very low rate of com plications if the postoperative course is m onitored closely. For this reason, the prognosis for patients with chronic SD H , who are usually older, is determ ined m ainly by their condition at adm ission, 17,34 their general condition, and the accom panying diseases 6,14,34,35 which are frequently presented.…”

Section: Surgical Techniquesupporting

confidence: 87%

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Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage*

Krupp

Jans

1995

British Journal of Neurosurgery

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Despite the high incidence of chronic subdural haematoma (SDH), to date relatively few authors have undertaken a systematic analysis of the results attained following burr-hole craniostomy and closed-system drainage on the basis of a study involving a large patient population defined according to clear-cut criteria. Between 1980 and 1993, surgery was performed on 212 patients with a chronic SDH. In a retrospective study, the condition of each patient was assessed at the time of admission on the basis of the Bender Scale and the results 4 weeks after discharge were classified according to the Glasgow Outcome Scale (GOS). At admission, 165 patients (78%) were in a satisfactory condition (Stage 1 or 2); 47 (22%) were at Stage 3 or 4, i.e. stuporous or comatose. Nine (4%) of the patients died; none of these deaths was attributable to the operation. In addition to significant extracerebral disease (2.4%), CT revealed ischaemic cerebral infarctions in three patients (1.4%) after removal of the SDH. The operative morbidity was 4.2%. In 22% of the patients, surgical intervention was required to remove a recurring SDH. In 90% of the patients, the results achieved could be graded as 'very good' or 'good' (GOS 1 or 2). The results were related to the condition at admission (p < 0.001) and the patient's age (p < 0.05). Factors that did not have a significant effect on the outcome included whether the SDH formation was bilateral or unilateral, the extent of neomembranous organization of the haematoma, and the amount of primary cerebral expansion following decompression. We were able to confirm the results of previous studies that the method used is a highly effective treatment, with a low incidence of complications.

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Section: Surgical Techniquesupporting

confidence: 87%

“…This positive observation presupposes that th e post-operative course is m onitored carefully in patients with th is apparently harm less syndrom e in order to recognize clinical deterioration prom ptly and perform the reoperation without delay if th e clinical picture is veri® ed by the C T or M RI. 8,10,14 …”

Section: Recurrencementioning

confidence: 99%

Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage*

Krupp

Jans

1995

British Journal of Neurosurgery

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“…One significant technical aspect in BHC-treatment consists in rinsing the haematoma cavity to evacuate possible haematoma clots [3,7,12,19]. Introducing a 5-ram TDT technique with bedside insertion of a special catheter into the haematoma cavity [16], besides adding an even less invasive treatment mode, also changed the previous usual practice of additional rinsing by simply evacuating it slowly.…”

Section: Discussionmentioning

confidence: 98%

“…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

Choudhury

1994

Acta neurochir

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The results of a personal series of 44 consecutive patients undergoing burrhole evacuation and closed system suction drainage for chronic subdural haematoma are presented. 43 patients made a complete recovery and one was left with moderate disability. Contralateral weakness in one patient, recurrence of haematoma in another, and a new contralateral haematoma in a third were the only complications. The operative procedures responsible for the rather low complication rate in this series are described. It is concluded that to avoid complications following surgical treatment of chronic subdural haematoma, attention must be paid to the following factors: evacuation of the haematoma through two burrholes overlying the subdural collection; attention to ensure free communication through the subdural space between the two burrholes; identification and opening of additional loculations overlying the cortex; irrigation of the subdural space to ensure as complete an evacuation of the subdural collection as possible and the use of closed system suction drainage, nursing the patient flat, and intravenous hydration of the patient for three days. In addition, in patients with coagulopathy, correction of these disorders before surgery is most essential.

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Behandlung des chronischen Subduralhämatoms mit externer geschlossener Drainage - Bericht über 100 konsekutive Fälle

Cited by 11 publications

References 0 publications

Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage*

Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage*

Chronic subdural haematoma ? a comparison of two different treatment modalities

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

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