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

Abstract

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.

Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases

“…On the other hand, early diagnosis and surgical drainage allow complete recovery in most cases 7 . Most patients are in the third decade or older, with the highest incidence between the fifth and sixth decades 8 , as was found in our series, average 59.3 years, which was lower than that found in cases of review studies 1,9,10 . In all series men were more commonly affected than women, corroborating our findings.…”

Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases

“…In our series the rates of superficial and deep infections were 1.05% and 0.5%, respectively. The rate of superficial infections ranged from 0.2% to 1.5% in literature (27,33,36,56,57), while the rate of deep infections varied from 0.7% to 5.5% (4,12,35,41,56,(58)(59)(60)(61)(62). Deep infections can be life-threatening as it was the case in our series.…”

“…Although CSH is frequently observed, there is no gold standard for treatment. The most surgical techniques used are craniostomy by burr hole or twist drill with or without irrigation, and with or without drainage (2,4,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). Drainage seems to be a must for several authors (42,(44)(45)(46)(47)(48)(49)(50)(51)(52).…”

A Study on Chronic Subdural Haematoma Observed in Neurosurgery, Especially in Elderly Patients

“…[5] Despite the high incidence of CSDHs to date relatively few authors have under taken a systemic analysis of the result attained following burrhole craniectomy and system drainage. Factors that did not have a significant on their outcome included whether the SDH formation was bilateral or unilateral, the extent of neomembrane organization of the haematoma and the amount of primary cerebral expansion following decompression.. [6] The common occurance of CSDHs in older patient raises some diagnostic and therapeutic difficulties. Despite general agreement about the indication of Operation, the extent of surgery is still controversial.…”