Chronic subdural hematoma (CSDH) is one of the most
common neurosurgical conditions occurring mostly in elderly and ideally treated
with surgical drainage. Many surgical techniques of different degrees of
invasiveness have been proposed for its treatment with controversy about the
best surgical procedure. The study aims to evaluate the efficacy of the minimal
access technique of single burr-hole craniostomy and massive irrigation for
treatment of unilateral CSDH. The study is a prospective descriptive study
involved all patients with symptomatic radiologically proven unilateral CSDH
admitted and treated surgically in department of Neurosurgery, Al-Hussein
University hospital, Al-Azhar University, Cairo, Egypt, over 3 years, from
January 2013 to January 2016. In the results we found that total 64 patients of
CSDH, treated surgically by this procedure. Men formed 72% and women 28%. Age
range was 51 to 82 years; the mean age was 65 years. Clinical presentation was
impaired consciousness in 7%, headache (59%), right hemiparesis in 56% and left
hemiparesis in 37%. CT was done for 91% and MRI 27% patients. The hematoma was
left in 61% and right in 39%. Surgical evacuation utilizing this procedure was
done in all patients. Complete recovery was obtained in 82% of patients and
partial recovery in 11% of patients. Follow up for 4 months was done.
Recurrence was detected in 6% of patients. We concluded that unilateral CSDH
can be treated effectively by single nondependent burr-hole craniostomy and
massive irrigation with excellent outcome.
Matsumoto, K., Akagi, K., Abekura, M., Ryujin, H., Ohkawa, M. and Iwasa, N. (1999) Recurrence Factor for Chronic Subdural Haematomas after Burr-Hole Craniostomy and Closed System Drainage. Neurological Research, 21, 277-280.
Macfarlane, M., Weerakkody, Y. and Kathiravel, Y. (2009) Chronic Subdural Haematomas Are Common on Left Than on the Right. Journal of Clinical Neuroscience, 16, 642-644. https://doi.org/10.1016/j.jocn.2008.07.074
Baechli, H., Nordmann, A., Bucher, H. and Gratzl, O. (2004) Demographics and Prevalent Risk Factors of Chronic Subdural Haematoma: Results of a Large Single-Center Cohort Study. Neurosurgical Review, 27, 263-266.
Markwalder, T., Steinsiepe, K., Rohner, M., Reichenbach, W. and Markwalder, H. (1981) The Course of Chronic Subdural Hematomas after Burr-Hole Craniostomy and Closed-System Drainage. Journal of Neurosurgery, 55, 390-396.
Lee, J., Ebel, H., Ernestus, R. and Klug, N. (2004) Various Surgical Treatments of Chronic Subdural Hematoma and Outcome in 172 Patients: Is Membranectomy Necessary? Surgical Neurology, 61, 523-528.
Belkhair, S. and Pickett, G. (2013) One versus Double Burr Holes for Treating Chronic Subdural Hematoma Meta-Analysis. Canadian Journal of Neurological Sciences, 40, 56-60. https://doi.org/10.1017/S0317167100012956
Tripathy, S., Mishra, S., Mahapatra, A., Panda, R., Majhi, H. and Mishra, J. (2013) Role of “Single Burr-Hole and Saline Lavage” in Chronic Subdural Hematoma (csdh): The Need of Another Clinical Prospective Epidemiological Study. Journal of Neurology and Neuroscience, 6, 51.
Sanjay, K. and Atul, J. (2014) Comparative Study of Evacuation of Chronic Subdural Haematoma by Two Burr Holes Technique versus Single Burr Hole with Partial Excision of Membrane Technique. International Journal of Medical Science and Education, 1, 107-112.
Jeong, S., Kim, S. and Won, Y. (2014) Clinical Analysis of Risk Factors for Recurrence in Patients with Chronic Subdural Hematoma Undergoing Burr Hole Trephination. Korean Journal of Neurotrauma, 10, 15-21.
Kansal, R., Nadkarni, T. and Goel, A. (2010) Single versus Double Burr Hole Drainage of Chronic Subdural Hematomas. A Study of 267 Cases. Journal of Clinical Neuroscience, 17, 428-429. https://doi.org/10.1016/j.jocn.2009.07.109