Surgical Outcome of Craniotomy and Membranectomy for Organised Chronic Subdural Haematoma.

Abstract

Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical condition in elderly population that a neurosurgeon comes across in his neurosurgical practice. There are more than one treatment options for this condition .In recurrent cases craniotomy and membranectomy is more suitable treatment strategy. The purpose of the study is to find out the best possible surgical treatment option for the organised chronic subdural hematoma. Study Design: Retrospectively study. Setting: Neurosurgery Department, Hayatabadad Medical Complex, Peshawar. Period: 15 March 2009 to 14 March 2017. Patients and Methods: All patients with OCSDH irrespective of their ages and gender being previously operated twice for CSDH via two burholes or single boreholes aspirations, were enrolled in the study. Those patient who refused to be enrolled into the study or those with coagulopathies or with moribund comorbid were not considered for this study as these confounders may bias the study results. The OCSDH was diagnosed on CT scan brain. Their data were stored in semi structured porforma and analysed in SPSS. Frequency and percentage were calculated for variables like age, sex, mechanism of trauma, clinical features, CT scan findings, complications and postoperative outcome. Results: Total 17 patients were operated, there were 13 men and 4 women, and the mean age was 66 years (61 ± 12.1), with a range of 28–87 years. The commonest presentation of our study population was persistent headache followed by altered consciousness. Per operatively we noted Age related brain atrophy in 8 (61.54%) patients. Three patients (23.07%) with recurrence were also having evidence of some pneumocephalous. We noted bony calcified membrane in 4 patients (23.53%). Thick membrane with straw coloured sludge and debris was found in 13 patients (76.47). The commonest post complication in our study population was postop seizure which was noted in 4(23.53%) patients. One patients who also had Basal ganglion bleed died due to status epileticus. Wound infection was was seen in one patient (7.70%). Conclusion: Craniotomy with membranectomy produce very good results in patients with organised CSDH. However the surgeon should be ready to aggressively treat the post complication like seizures which may lead to dreadful con sequences if not treated appropriately and well in time.