Management of Chronic Subdural Hematoma: A National Survey and Literature Review

Cenic, Aleksa; Bhandari, Mohit; Reddy, Kesava

doi:10.1017/s0317167100004510

Cited by 152 publications

(126 citation statements)

References 19 publications

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“…Surgery is generally recommended when chronic subdural hematomas become symptomatic. The optimal surgical procedure, the use of a closeddrainage system, and modalities of post-operative management are under ongoing debate (1,3,9,12,14,25,34,37). Complications of surgery mainly include infection, acute hemorrhage, post-operative seizure, symptomatic hygroma, and symptomatic pneumocephalus (16,22,29).…”

Section: Introductionmentioning

confidence: 99%

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

et al. 2009

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OBJECTIVE Most symptomatic chronic subdural hematomas are treated by subdural drainage. However, a subperiostal (i.e., extracranial) passive closed-drainage system in combination with double burr hole trepanation is used at our institution. Therefore, we wanted to analyze our results and compare them with the alternate treatment strategies reported in the current literature. METHODS In a retrospective single-center study, we analyzed the data of all patients undergoing double burr hole trepanation with a subperiostal passive closed-drainage system. Data analysis included general patient data, complications, postoperative seizure rate, and outcome. RESULTS One hundred forty-seven patients underwent surgery for 183 symptomatic chronic subdural hematomas. The perioperative mortality rate was 3.4%. Hematoma persistence or recurrence occurred in 13.1% of the cases. The postoperative seizure rate was 6.6%, and the infection rate was 1.6%, including 3 cases of superficial wound infection and 1 case with deep infection. The reintervention rate was 9.3%, including trepanation in 8.2% of the patients and craniotomy in 1.1%. The overall complication rate was 10.9%. CONCLUSION Double burr hole trepanation combined with a subperiostal passive closed-drainage system is a technically easy, highly effective, safe, and cost-efficient treatment strategy for symptomatic chronic subdural hematomas. The absence of a drain in direct contact with the hematoma capsule may moderate the risk of postoperative seizure and limit the secondary spread of infection to intracranial compartments.

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Section: Introductionmentioning

confidence: 99%

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

et al. 2009

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“…5,15,19 Overall, BHC seems to be the most widely practiced technique, as it balances a lower recurrence rate (in comparison with TDC) with a lower morbidity rate (in comparison with craniotomy). 3,5,15,16,19 Nevertheless, continuing refinement and evaluation of existing surgical techniques is essential for improving the care and outcomes of patients with CSDH. More recently, a novel technique involving a hollow screw, which is threaded through a twist-drill hole in the cranium and is then connected to a closed drainage system, has been increasing in its popularity and use.…”

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confidence: 99%

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

Chari

Kolias

Santarius

et al. 2014

JNS

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Object. The incidence of chronic subdural hematoma (CSDH) is expected to increase substantially over the next 25 years. Continuing refinement of techniques for surgical evacuation is essential for optimizing patient outcomes. A novel technique involving a hollow screw, which is threaded through a twist-drill hole in the cranium and then connected to a closed drainage system, has been increasing in popularity. The aim of this systematic review is to collate and analyze the published experience with this novel technique and to evaluate its efficacy in comparison with the other surgical treatment methods.Methods. This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and has been registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42013003544). MEDLINE, Web of Knowledge, EMBASE, and the Cochrane Database of Systematic Reviews were searched for published series involving more than 10 patients treated with these new techniques.Results. Nine eligible studies were found (6 case series and 3 case-control studies) comprising 796 patients treated with these new techniques. Pooled analysis showed a "success rate" of 77.6% (95% CI 74.6%-80.4%), recurrence rate of 22.4%, and in-hospital mortality of 1.4%.Conclusions. This systematic review adds further evidence to the pool of data assessing the safety and efficacy of the use of this novel, minimally invasive technique for the treatment for CSDH. Overall, twist-drill craniostomy with hollow screws appears to be safe and effective. Class I evidence is necessary to optimize the surgical management of patients with CSDH. (http://thejns.org/doi/abs/10.3171/2014.4.JNS131212) Key worDs • chronic subdural hematoma • minimally invasive • hollow screw • subdural evacuating port system • systematic review • surgical technique Abbreviations used in this paper: BHC = bur hole craniostomy; CSDH = chronic SDH; SDH = subdural hematoma; SEPS = Subdural Evacuating Port System; TDC = twist-drill craniostomy.

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“…Lately, twist drill craniostomy has been defined, but it is not frequently used as it is expensive, the related knowledge is not sufficient, and the first studies showed high recurrence rates (33%). 1,2,6 Although burr-hole craniostomy has been shown as a safe treatment method, reported relapse rates are between 9.2% and 26.5%. 7,8 For craniotomy, postoperative mortality rates mount to 11%, and morbidity rates mount to 25%.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of the disease is approximately 1-58/100 000, and the disease is most frequently seen in 70-80-year-old individuals. [1][2][3] Cortical atrophy and enlargement of potential subdural space increase subdural venous tension and create susceptibility to bleeding after trauma in elderly. Enlargement of subdural space also facilitates formation of membranes formed by blood degradation components after bleeding.…”

Section: K Ke Ey Y Wmentioning

confidence: 99%

Minimally Invasive Approaches for Chronic Subdural Hematoma: The Experience of a Education Clinic in Eastern Anatolia

Durdağ¹,

Albayrak²,

Ayden³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : Chronic subdural hematomas typically appear in the elderly and they are the most frequent diseases that make elderly people admit to neurosurgeons. This disease usually requires a neurosurgical operation when symptomatic, and a number of interventions ranging from needle aspiration to draining of hematoma by craniotomy have been described. In this article, we present our interventions for subdural hematomas, and the patients we treated by minimally invasive methods in Elazığ Training and Research Hospital, as a peripheral education clinic. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Patients were basically divided into three groups. In the first group, there were patients who had a burr hole drainage under general anesthesia. In the second group, there were patients who had a mini-craniotomy under general anesthesia. In the third group, there were patients who had burr hole drainage under local anesthesia. The patients were assessed for their age, gender, complaints at presentation, systemic problems, trauma history, use of anticoagulants, radiological features, preferred surgical intervention, type of anesthesia, mortality and morbidity. R Re es su ul lt ts s: : When mortality and morbidity rates were considered, none of the patients had operative morbidity. One patient from the first group and one patient from the second group died in the intensive care unit due to their systemic problems. No surgery-related mortality was seen. One patient in the first group needed revision surgery and one patient in the third group needed two revision surgeries. C Co on nc cl lu us si io on n: : Initial results of our study indicate that minimally invasive surgical methods are effective and safe for the treatment of chronic subdural hematoma. Prospective randomized trials are needed for more precise results. K Ke ey y W Wo or rd ds s: : Hematoma, subdural, chronic; surgical procedures, minimally invasive; craniotomy Ö ÖZ ZE ET T A Am ma aç ç: : Kronik subdural hematom sıklıkla yaşlı popülasyonda görülen ve bu yaş grubunu nö-roşirürjyenlerle en sık karşılaştıran hastalıktır. Semptomatik olduğunda çoğunlukla nöroşirürjikal operasyon gerektiren bu hastalık grubunda, iğne aspirasyonundan, hematomun kraniyotomi ile boşaltılmasına kadar çeşitli girişimler tariflenmiştir. Bu yazımızda bir perifer eğitim kliniği olarak Elazığ Eğitim Araştırma Hastanesindeki subdural hematomlarla ilgili girişimlerimizi ve minimal invaziv metotlarla tedavi ettiğimiz hastaları sunmak istedik. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Hastalar temel olarak üç gruba bölündü. İlk grupta genel anestezi eşliğinde burr hole drenajı uygulanan hastalar, ikinci grupta genel anestezi eşliğinde mini-kraniyotomi uygulanan hastalar, üçüncü grupta ise lokal anestezi eşliğinde burr hole drenajı uygulanan hastalar vardı. Hastalar yaşları, cinsiyetleri, başvuru şikâyetleri, sistemik sorunları, travma hikâyeleri, antikoagülan kullanımları, radyolojik özellikleri, tercih edilen cerrahi giri...

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Management of Chronic Subdural Hematoma: A National Survey and Literature Review

Cited by 152 publications

References 19 publications

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

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

Minimally Invasive Approaches for Chronic Subdural Hematoma: The Experience of a Education Clinic in Eastern Anatolia

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