BackgroundChronic subdural hematomas (CSDHs) are common in neurosurgical practice. There are no publications that report large series of the epidemiological characteristics of this pathology in Brazil. The purpose is to describe a large series of surgical cases and analyze the epidemiological and clinical characteristics.MethodsWe retrospectively analyzed patients with CSDH admitted into Neurosurgical Services at the Hospital de Base do Distrito Federal, Brasília, Brazil from 2006 to 2011. Age, sex, clinical feature, etiology, surgical procedure, side, clinical outcome, and recurrence were reviewed. Statistical tests were used to analyze data, and P < 0.05 was considered statistically significant.ResultsThe series included 778 patients. There were 643 (82.6%) male patients with a mean age of 64.3 ± 15.9 (range, 14–93) years. The principal symptom was headache (58.9%). The most frequent origin was a fall (282 cases, 36.2%), but the origin remained unclear in 281 (36.1%) patients. Mild head injury occurred in 540 (69.4%) cases. Burr holes with drainage were used as the surgical procedure in 96.5% patients, and 687 (88.3%) patients had a positive outcome. Mortality was 0%. Recurrence was observed in 42 cases.ConclusionsThe occurrence of CSDHs is more common in elderly men. Treatment with burr holes and drainage is a simple and safe method for treatment. In our experience, CSDH presents decreased morbidity and mortality.

SummaryWe have analysed our experiences in a Spinal Cord Unit in Brasilia, Brazil in the last 5 years (1982)(1983)(1984)(1985)(1986). There were 738 outpatients and 243 inpatients.One hundred and six patients were operated on by the neurosurgical staff, and the indications for operation are discussed. Some patients showed neurological recovery with surgery and some without surgery. Patients with a complete neuro logical deficit on admission did not show any improvement, and those with a severe but incomplete deficit showed improvement with surgery (18%), which was better than those without an operation. We conclude that a surgical proce dure seems to be indicated in those with a comminuted, or with an unstable fracture, if there is an incomplete neurological deficit with an unreduced spinal deformity. There was a possibility of recovery of some nerve root function. The goal of surgical treatment is to restore and maintain the anatomical relationships between the spinal canal, spinal cord and nerve roots with the simplest possible surgical procedure, returning the patient as soon as possible to his functional capacity and social life.

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Palavras-Chave IntroduçãoA coluna cervical pode ser dividida em alta (côndilos C1 e C2) e subaxial ou baixa (vértebras C3 a C7). 1A coluna cervical alta apresenta características anatômi-cas diferentes das demais vértebras da coluna cervical: não existe disco intervertebral, e a estabilidade é fornecida por um complexo sistema ligamentar que conecta o atlas e o áxis à base do occipital. As lesões cervicais altas são infrequentes, e a sua exata incidência não é bem conhecida devido à sua ocorrência em vítimas fatais dos acidentes de trânsito. As lesões neurológicas são raras devido ao maior diâmetro do canal raquidiano em relação à medula espinhal. No entanto, as lesões neurológicas neste nível podem ser fatais. 1As fraturas da coluna cervical subaxial correspondem a um grande espectro de lesões. Grande porcentagem destas não tem sido diagnosticada no atendimento inicial dos pacientes, enfatizando a necessidade de um exame clínico detalhado e da visualização de toda a extensão da coluna cervical nos exames de imagem dos pacientes com potencial lesão deste segmento.