Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature

Abstract

Objective-Chronic subdural hematoma has an increasing incidence and results in high morbidity and mortality. We review here the ten-year experience of a single institution and the literature regarding the treatment and major associations of chronic subdural hematoma (cSDH).Methods-We retrospectively reviewed all cSDHs surgically treated from 2000 to 2010 at our institution to evaluate duration from admission to treatment, type of treatment, length of stay in critical care, length of stay in the hospital and recurrence. The literature was reviewed with regards to incidence, associations and treatment of cSDH. [2000][2001][2002][2003][2004][2005][2006][2007][2008]44 patients were treated with burr holes. From 2008 to 2010, 29 patients were treated with twist drill evacuation (SEPS). 4 patients from each group were readmitted for reoperation (9% vs. 14%; p=.53). The average time to intervention for SEPS (11.2±15.3 hrs) was faster than for burr holes (40.3±69.1 hrs) (p=.02). The total hospital LOS was shorter for SEPS (9.3±6.8 days) versus burr holes (13.4±10.2 days) (p=.04); both were significantly longer than for a brain tumor patient undergoing craniotomy (7.0±0.5 days, n=94, P<. 01). Results-FromConclusion-Despite decreasing lengths of stay over time as treatment for cSDH evolved from burr holes to SEPS, the length of stay for a cSDH is still greater than that of a patient undergoing craniotomy for brain tumor. We noted 11% recurrence in our series of patients, which included individuals who recurred as late as 3 years after initial diagnosis.

Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma

“…10 The study by Balser et al was the only study to examine the logistical and economic implications and concluded that the new minimally invasive techniques have many benefits over BHC including shorter time to intervention, length of hospital stay, and overall cost of treatment. 2 These findings highlight the many benefits of SEPS/ hollow screw over traditional techniques. First, the minimally invasive nature of these techniques means that they can be performed after administration of a local anesthetic at the bedside.…”

“…2 All studies concluded that the new techniques are safe and effective procedures and should be considered in the treatment of CSDH, while 2 studies concluded that they should be first-line techniques. 9,12 The 3 case-control studies all concluded that while minimally invasive hollow screw techniques were an established alternative, superiority had not been proven and more evidence was needed to establish these techniques as superior to traditional ones.…”

“…1,6 It has also been suggested that this novel technique can shorten the length of stay, leading to cost savings. 2 The aim of this systematic review is to collate the current experience with these novel hollow screw systems and evaluate their safety and efficacy in comparison with the other surgical treatment methods.…”

Coleções subdurais crônicas não infecciosas: Aspectos epidemiológicos e resultados em 581 pacientes consecutivos submetidos a tratamento cirúrgico

“…Os HSDCr constituem apresentação comum de hemorragia intracraniana. Estão associados comumente a traumatismos cranioencefálicos prévios, geralmente de leve intensidade, com taxas de morbidade e mortalidade relativamente altas (1)(2) , ocorrendo principalmente em idosos. Outra lesão que se assemelha ao HSDCr é o Higroma Subdural, sendo que a distinção entre ambos permanece controversa.…”

“…Haja vista o progressivo envelhecimento da população mundial observa-se, atualmente, aumento na incidência das coleções subdurais crônicas. Isso promove maior impacto na qualidade de vida do indivíduo, refletindo em custos tanto sociais quanto econômicos para as populações envolvidas (2) . O processo de atrofia cerebral constitui fator de risco significativo associado principalmente aos idosos e etilistas crônicos.…”