Effect of Inner Membrane Tearing in the Treatment of Adult Chronic Subdural Hematoma: A Comparative Study

Abstract

The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. The study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. In the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 ± 0.2 mm, and for Group 2, 14.3 ± 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p < 0.05). The means were 6.6 ± 0.2 mm for Group 1 and 10.3 ± 0.5 mm for Group 2 on the seventh day (p < 0.05). Recurrence rate was 8.3% in Group 2 and 0 in Group 1. This difference was statistically significant (p = 0001). The length of hospital stay was 7.0 ± 0.1 days for the Group 1 and 8.8 ± 0.2 days for Group 2 and this difference was significant (p < 0.05). These results indicate that the CTIM technique is preferable because it results in earlier re-expansion, lower recurrence, less subdural effusion and pneumocephalus, and shorter hospital stays.

Inner membrane opening during the burr-hole evacuation of a chronic subdural hematoma: risk-adding or recurrence-preventing?

“…From the results of the current study and the two articles that discussed the opening of the inner membrane during a burr-hole evacuation of a CSDH [17,18], it can be proposed that this operative step was not a riskadding but, apparently, a recurrence-preventing one. A prospective randomized controlled study is recommended to establish this finding.…”

“…Kayaci et al [18] in their retrospective study found that the recurrence rate was zero in the 144 patients who underwent incision of the inner membrane during the burr-hole evacuation of their CSDH, but they did not mention the follow-up period.…”

“…Inner membrane opening was discussed during craniotomy for CSDH in many studies [10][11][12][13][14][15][16], but only a few studies had mentioned the opening of the inner membrane during the burr-hole evacuation of a CSDH [17,18].…”

Prevention of Cerebral Herniation by Decompressive Craniotomy in a Child with Acute Peritentorial Subdural Hematoma and Brain Edema: A Case Report

“…We were thinking that this method for a bleeding in peritentorial localization can be applied. ma and damage, decompressive craniectomy may be the decision [3][4][5][6][7]. It may also be the decision in uncal or trans-tentorial herniation situations with a Glasgow Coma Score higher than 3, diffuse cerebral edema and midline shift on brain CT images, an intra-cerebral pressure of over 40 mmHg within the first 48 hours of trauma [3][4][5].…”

“…The relaxation of temporal base has resulted in the dispersion of the peritentorial blood. It has been reported in a very limited number of studies in the literature that removal or reduction of the pressure on the temporal base has resulted in a motion in the subarachnoid space, together with the increased intracranial pressure, and that the cerebrospinal fluid has washed the blood on the tentorial surface and led to its distribution [7,8]. The blood on the tentorium may have migrated downward after being collected around the free edges of tentorium in the medial side [8].…”