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Minimal Access Surgical Evacuation of Unilateral Chronic Subdural Hematoma

DOI: 10.4236/wjns.2018.81007, PP. 82-89

Keywords: Chronic Subdural Hematoma, Burr-Hole Evacuation

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Abstract:

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.

References

[1]  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.
https://doi.org/10.1080/01616412.1999.11740931
[2]  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
[3]  Osborn, A. (1994) Diagnostic Neuroradiology. Mosby, St. Louis, 205-211.
[4]  Senturk, S., Guzel, A., Bilici, A., Takmaz, I., Guzel, E. and Aluclu, U. (2010) CT and MR Imaging of Chronic Subdural Haematomas: A Comparative Study. Swiss Medical Weekly, 140, 335-340.
[5]  Chen, J. and Levy, M. (2000) Causes, Epidemiology, and Risk Factors of Chronic Subdural Hematoma. Neurosurgery Clinics of North America, 11, 399-406.
[6]  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.
https://doi.org/10.1007/s10143-004-0337-6
[7]  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.
https://doi.org/10.3171/jns.1981.55.3.0390
[8]  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.
https://doi.org/10.1016/j.surneu.2003.10.026
[9]  Papacocea, T., Adam, D., Croitoru, R., Rusu, I. and Papacocea, A. (2016) Factors Influencing the Recurrence Rate of Operated Chronic Subdural Hematomas. Romanian Neurosurgery, 2, 162-167.
[10]  Gurunathan, J. (2005) Treatment of Chronic Subdural Hematoma with Burr Hole Craniostomy and Irrigation. Indian Journal of Neurotrauma (IJNT), 2, 127-130.
[11]  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
[12]  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.
[13]  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.
[14]  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.
https://doi.org/10.13004/kjnt.2014.10.1.15
[15]  Asaduzzaman, S., Islam, K. and Hussein, M. (2014) Comparative Study between Single versus Double Burr-Hole Drainage of Unilateral Chronic Subdural Haematoma. Bangladesh Medical Journal, 43, 13-16.
[16]  Nayil, K., Altaf, R., Shoaib, Y., Wani, A., Laharwal, M. and Zahoor, A. (2014) Chronic Subdural Hematomas: Single or Double Burr Hole-Results of a Randomized Study. Turkish Neurosurgery, 24, 246-248.
[17]  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

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