Chronic subdural hematoma: surgical management in 133 patients

Robinson, R. G.

doi:10.3171/jns.1984.61.2.0263

Cited by 179 publications

(116 citation statements)

References 28 publications

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“…16,22) During surgery, the internal capsule, which adheres to the cerebral tissue, should not be removed. 4,16) In our series, during burr hole trepanation procedures, the burr holes were slightly widened once drilled since the trephine diameter was usually too small. It is recommended that burr hole diameter should be larger than 2.5 cm.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Operative Treatment of a Series of 100 Patients With Subdural Hematoma

Godlewski

Pawełczyk

et al. 2013

Neurol. Med. Chir.(Tokyo)

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This retrospective study of medical records, surgical protocols, patient observation cards, and imaging files of 100 patients treated for subdural hematoma analyzed the type of hematoma, patient age and sex, operative technique, neurological status, cause of injury, duration of hospital stay, mortality rate, and the number of and reasons for reoperations to determine the effects on treatment outcomes. The time between the head injury and onset of neurological symptoms was analyzed versus the type of hematoma determined from computed tomography (CT) scans. Acute hematomas accounted for 38% of the cases, with subacute hematomas representing 20%, and chronic ones accounting for 42%. In trauma patients, the mean time interval between the injury and onset of neurological symptoms was 0.38 days for acute hematomas, 13.8 days for subacute hematomas, and 23.75 days for chronic hematomas. Repeat surgery was carried out in 26% of the cases. Improvement was obtained in 44% of cases, deterioration in 20%, and no change in neurological status in 36%. Timing of the operations was between 15:00 and 23:00 in 45%, between 23:00 and 7:00 in 33%, and between 7:00 and 15:00 in 22%. The classification of hematomas based on CT presentation corresponds to the classification based on the time elapsed between injury and onset of symptoms, and appears to be appropriate and useful in everyday practice. No preceding injury was identified in 31.6% of acute hematomas, 50% of subacute hematomas, and 61.9% of chronic hematomas. Analysis of reoperations indicates that trepanation may be superior to craniotomy as primary surgery for subacute and chronic hematomas. Subdural hematoma surgeries take place at all times of the day, with most carried out outside the usual working hours.

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Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Operative Treatment of a Series of 100 Patients With Subdural Hematoma

Godlewski

Pawełczyk

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…10,17) The present patient survived the brain stem hemorrhage that developed after the evacuation of bilateral CSDHs.…”

Section: Discussionmentioning

confidence: 95%

Brain Stem Hemorrhage Following Burr Hole Drainage for Chronic Subdural Hematoma -Case Report-

Park

Kang

Lee

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 76-year-old man presented with brain stem hemorrhage after burr-hole drainage for bilateral chronic subdural hematomas. Neuroimaging demonstrated resolution of the transtentorial herniation but also detected new brain stem hemorrhage, manifesting as gait disturbance. He recovered after conservative treatment. Asymmetrical and rapid decompression, which leads to vascular disruption and/or sudden increase in cerebral blood flow, was probably responsible for the secondary brain stem hemorrhage. Therefore, simultaneous and bilateral decompression with a slow rate of evacuation of massive bilateral chronic subdural hematomas is recommended to prevent serious complications such as secondary intracranial hematoma.

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“…O desenvolvimento e o aumento dos hematomas subdurals crônicos são principalmente atribuídos à contínua hemorragia de vasos sinusoidais da neomembrana 12 . Yamashima e col 19 , confirmam esta teoria para determinar o aumento do hematoma.…”

Section: Discussionunclassified

Hematoma subdural crônico: análise de 35 casos

Araújo

Iafigliola

Balbo

1996

Arq. Neuro-Psiquiatr.

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RESUMO -Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.PALAVRAS-CHAVES: hematoma subdural crônico, craniotomia, trepanação. Chronic subdural hematoma: analysis of 35 casesABSTRACT -Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.KEY WORDS: chronic subdural hematoma, craniotomy, burr-hole evacuation.Os hematomas subdurals crônicos constituem condição neurocirúrgica potencialmente curável através de vários métodos cirúrgicos, mas ainda nos dias atuais com significativos índices de mortalidade, sendo a cura espontânea considerada ra ra 1,5,10,1214 .Uma série de 35 pacientes com diagnóstico de hematoma subdural crônico é apresentada e analisada frente a revisão bibliográfica do assunto. PACIENTES E MÉTODOSTrinta e cinco pacientes com o diagnóstico de hematoma subdural crônico foram tratados no período de janeiro-1988 a março-1995. Destes, 27 pacientes eram do sexo masculino e 8 do sexo feminino. A idade variou entre 19 a 80 anos, em 60% estando acima de 60 anos. O antecedente de traumatismo craniano estava presente em 68% dos casos.

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Chronic subdural hematoma: surgical management in 133 patients

Cited by 179 publications

References 28 publications

Retrospective Analysis of Operative Treatment of a Series of 100 Patients With Subdural Hematoma

Retrospective Analysis of Operative Treatment of a Series of 100 Patients With Subdural Hematoma

Brain Stem Hemorrhage Following Burr Hole Drainage for Chronic Subdural Hematoma -Case Report-

Hematoma subdural crônico: análise de 35 casos

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