Chronic Subdural Hematomas : A Comparative Study of Three Types of Operative Procedures

Lee, Joon Kook; Choi, Jong Hun; Kim, Chang‐Hyun; Lee, Ho Kook; Moon, Jae Gon

doi:10.3340/jkns.2009.46.3.210

Cited by 52 publications

(64 citation statements)

References 16 publications

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“…Therefore, they initially performed small craniotomies, and achieved more favorable results and a significantly shortened hospital stay. Lee et al 10) reported a reoperation rate of 6.7% in 30 cases of small craniotomies used as initial treatment. Rocchi et al 21) reported that MRI detection of thick and extensive membranes or solid clots with mass effect required an immediate large craniotomy to remove the CSDH.…”

Section: Resultsmentioning

confidence: 99%

“…Although CSDH is well known as a curable disease in the elderly and can be adequately managed with burrholes with drainage, the initial treatment of CSDH can be ineffective; this results in a reoperation rate between 3 and 37% 2,10,13,16,17) . The causes of treatment failure include the presence of nonliquefied hematomas with various bleeding foci 14) ; multilayer loculations within the hematoma, which produce noncommunicating compartments 22) ; and excessive formation of a solid membranes 5) .…”

Section: Discussionmentioning

confidence: 99%

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Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

Kim

Kang

Kim

et al. 2011

J Korean Neurosurg Soc

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mostly liquefied CSDH. Conversely, craniotomy is generally accepted as the optimal approach for reaccumulation of a CSDH, existence of a solid hematoma, failure of brain reexpansion, or marked swelling subjacent to the hematoma 5,14) . The purpose of this study was to analyze the efficacy of small or large craniotomy with membranectomy as the initial treatment for CSDH. MATERIALS AND METHODSA retrospective study was performed using the medical records retained by our hospital. computed tomography (CT) scans were the primary imaging method for the evaluation of CSDH in all patients. The technique of a burr-hole with closed system drainage for 24 to 72 hours was chosen for cases of nonseptated and mostly liquefied CSDH. However, on the basis of CT and/or magnetic resonance imaging (MRI) findings, cases of CSDH demonstrating either mixed density or hyperdense lesions ( Fig. 1), intrahematomal membranes or web-like structures (Fig. 2), or an organized/calcified CSDHs (Fig. 3) were selected for craniotomy. We classified 317 patients with CSDH into three groups according to the extent of surgery required : group I, burr hole with drainage (n=259); group II, small crani- INTRODUCTIONChronic subdural hematoma (CSDH) represents one of the most frequent intracranial hemorrhages encountered in neurosurgical department, with elderly citizens being more frequently affected. The reasons why this type of hematoma occurs frequently among the elderly include an increase in antithrombotic medications, venous fragility, augmentation of the subdural space, and an increased exposure to traumatic injury resulting from frequent falls 1) . For the initial management of CSDH, numerous surgical treatments have been proposed 5,14,15,18,21) . However, the extent of surgical treatment required for CSDH is still controversial 2,24) , and the optimal treatment for CSDH is not well defined 16) . The choice of surgical technique for CSDH must be dictated by the degrees of organization of the hematoma. Burr-hole with drainage is mandatory for non-septated and Department of Neurosurgery, Seoul Medical Center, Seoul, KoreaObjective : There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods : Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results : The mean ages were 69.4±12.1 a...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

Kim

Kang

Kim

et al. 2011

J Korean Neurosurg Soc

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“…Mean duration of the operation was 20.1 ± 2.8 minutes for one side (n ＝ 20) and 40.5 ± 8.0 minutes for two sides (n ＝ 6), less than half of the time reported previously. 6) The radiological findings of the surgical procedure are shown in Table 2. The four recurring CSDHs were treated from 7 to 64 days after the initial procedure (14.8%).…”

Section: Resultsmentioning

confidence: 99%

“…6) The postoperative rate of recurrence was almost equal to those reported. 6,14,15,18,23) The Monro-Kellie doctrine holds that the skull is a rigid compartment housing three components, the brain, blood, and CSF, and if the volume of one component becomes decreased, the volumes of the other components must enlarge accordingly. 9) In the closed condition of surgery for CSDH, the intracranial components are the brain, circulating blood, CSF, and old hematoma (modified elements of the Monro-Kellie doctrine).…”

Section: Discussionmentioning

confidence: 99%

“…7,21,23) Craniotomy is generally not performed because of the invasiveness of the procedure. Craniostomy is the main method of surgical treatment, 23) and is performed by twist drill craniostomy (diameter less than 5 mm), 6,7,13,19,23) one burr-hole craniostomy (8-15 mm), 5,7,18,20) and two burr-hole craniostomy. 15,21) Twist drill craniostomy was introduced as a less invasive method for the treatment of CSDH, and is used worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Tosaka

Sakamoto²,

Watanabe³

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The``closed condition'' represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The``open condition'' includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the``open condition,'' shortens the operation time, and achieves good irrigation of the hematoma.

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Chronic Subdural Hematoma and Intracranial Arachnoid Cysts

et al. 2021

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Chronic Subdural Hematomas : A Comparative Study of Three Types of Operative Procedures

Cited by 52 publications

References 16 publications

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Chronic Subdural Hematoma and Intracranial Arachnoid Cysts

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