Efficacy of Closed-System Drainage in Treating Chronic Subdural Hematoma: A Prospective Comparative Study

Wakai, Susumu; Hashimoto, Kazuyoshi; Watanabe, Naofumi; Inoh, Satoshi; Ochiai, Chikayuki; Nagai, Masakatsu

doi:10.1227/00006123-199005000-00006

Cited by 167 publications

(87 citation statements)

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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.…”

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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“…One burr hole evacuation and irrigation of the subdural hematoma with or without closed-system drainage has been widely accepted as the optimum method for treating CSDH for the last two decades. 3,4,9,10,14,18,19) The most important advantages of this method is that diagnosis requires minimal examination and that a relatively noninvasive procedure results in a satisfactory outcome even for older or high-risk patients. However, all neurosurgeons have experienced some recurrent cases of this disease after treatment with this method, with an incidence as variable as 3% to 20%.…”

Section: Introductionmentioning

confidence: 99%

Clinical Factors of Recurrent Chronic Subdural Hematoma.

Oishi

Toyama

Tamatani

et al. 2001

Neurol. Med. Chir.(Tokyo)

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109

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The clinical, radiological, and operative factors of recurrent chronic subdural hematoma (CSDH) were retrospectively analyzed in 116 patients with CSDH in 134 hemispheres, treated by one burr hole surgery. The correlation of recurrence was evaluated with personal and clinical factors such as age, sex, history of head injury, and interval from onset of initial symptoms to hospitalization; laboratory findings such as bleeding tendency and liver function; computed tomography (CT) findings such as hematoma density and brain atrophy; and operative findings such as additional procedures and postoperative residual air. The recurrence group (RG) included 10 hemispheres (7.5%) in 10 patients (8.6%). The interval from onset of symptoms to hospitalization was significantly shorter in the RG than in the nonrecurrence group (NRG). Headache was more frequently seen in the RG than in the NRG. Density of hematoma on CT was classified into five types: Low, iso, and high density, niveau, and mixed, and the incidence of recurrence was 0%, 2.3%, 17.2%, 12.5%, and 6.5%, respectively. Larger amounts of residual air in the postoperative hematoma cavity were associated with recurrence of CSDH. CSDH that progresses rapidly in the acute stage and appears as high density on preoperative CT is associated with a high incidence of recurrence. Intraoperative air invasion to the hematoma cavity should be avoided to prevent recurrence.

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“…Surgical intervention has been shown to be the most effective way in treating this entity; however, the incidence of recurrence ranges from 9.2-26.5%. 1,2,[5][6][7] The recurrence can also remain silent with delay in diagnosis and associated morbidity and mortality.…”

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confidence: 99%

Chronic Subdural Haematoma: Systematic Review Highlighting Risk Factors for Recurrent Bleeds

Abdelsadg¹,

Kanodia²,

Abbas³

et al. 2017

Neuro – Open Journal

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Citation Systematic ReviewPage 16 ABSTRACTIntroduction: Chronic subdural haematoma (CSDH) is one of the commonest forms of intracranial haemorrhage. Surgical drainage of CSDH is a routine operation in the modern neurosurgical practice which has shown to be the most effective way in treating this entity; however, the incidence of recurrence of the haematoma post operatively remains as high as 26.5%. The risk factors for CSDH recurrence remains an area of ongoing research. Objective: We have conducted a systematic review to evaluate the available literature addressing the risk factors for CSDH recurrence, aiming to minimise or at least identify patients at higher risk of recurrence in order to decrease associated morbidity. Methods: Ovid via Medline, PubMed, and Google scholar databases were searched for eligible studies, search results were then limited to studies in English language, Humans and studies published within the last 5 years. The included studies were critically appraised using the Critical Appraisal Skills Programme (CASP) tool, and each study has then been ranked using the Harbour and Miller hierarchy of ranking.Results: Based on available evidence, we classified the risk factors associated with recurrence to patients', radiological, and surgical factors. Patient factors include history of seizures, trauma, alcoholism, brain atrophy, and presence of CSF shunts, while the role of diabetes in relation to the recurrence is controversial. Radiologically the presence of air in the subdural space post-operatively, the width of the haematoma, and the presence of bilateral CSDHs are associated with increased risk of recurrence. While the predictive value of multiple membranes in the CSDH remains controversial. Surgically, the risk of recurrence was noted to be higher in patients with parietal or occipital compared to those who had frontal burr hole drainage, also placing a subdural drain decreases the chance of recurrence and some evidence showed better outcomes for frontally placed drains. The role of anti-inflammatory agents (including steroids) remains an area of ongoing debate. Conclusions: Risk factors for CSDH can be divided into patients', radiological, and surgical factors. We encourage health care providers to minimize if not prevent potentially avoidable factors. Patients with increased risks for recurrence should be identified early by the treating team and when possible should be informed about their higher than usual risk of recurrence. Moreover this review highlights the general lack of a sufficiently powered class I evidence addressing this topic and that further research is required in this topic.

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Efficacy of Closed-System Drainage in Treating Chronic Subdural Hematoma: A Prospective Comparative Study

Cited by 167 publications

References 0 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

Clinical Factors of Recurrent Chronic Subdural Hematoma.

Chronic Subdural Haematoma: Systematic Review Highlighting Risk Factors for Recurrent Bleeds

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