Single Parietal Burr-hole Craniostomy with Irrigation and Drainage for Unilateral Chronic Subdural Hematoma in Young Adults <40 Years: A Rationale behind the Procedure

Abstract

Background:Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. It is mostly a disease of elderly population with very little data about the young patients. There is also the debate regarding treatment strategies. We decided to determine the overall efficacy of the single burr-hole craniostomy (SBHC) for unilateral CSDH in young adults <40 years.Subjects and Methods:We performed a retrospective study of young patients undergoing SBHC for unilateral CSDH between January 2013 and June 2016 at our institution. Medical records were assessed based on patient characteristics in the form of sex of the patient, etiology, presenting symptoms, comorbidities, and signs including Glasgow Coma Scale, computed tomography (CT) brain findings (site and thickness of SDH with midline shift), and intraoperative presence of chronic/subacute component.Results:Mean age of the patient was 33.69 years (range 18–40 years), mean thickness of SDH was 15.47 mm, and mean midline shift was 11.26 mm. 61.54% patients were male, trauma being the most common etiology (92.31%) with most common presenting complaint being headache (90.38% patients). 69.23% patients presented within 1 day of onset of symptoms. On CT scan, most of the patients were having SDH thickness between 11 and 20 mm (67.31%) with midline shift of 6–10 mm (53.85%). Right-sided SDH was present in 53.85%. Intraoperatively, 63.46% patients had subacute SDH whereas 34.61% had chronic component. There were total 2 recurrences (3.85%).Conclusions:Young adults who present with unilateral CSDH usually have a history of trauma. They have shorter duration of symptoms and present mainly with the features of raised intracranial pressure such as headache and vomiting. SBHC with irrigation and drainage has excellent result for unilateral CSDH in young adults compared to other methods of drainage and should be considered treatment of choice unless contraindicated.

Recurrence rate of chronic subdural hematoma after evacuating it by two large burr holes, irrigation, and subgaleal low-pressure suction drainage

“…[14] Most of the studies found the value of irrigation in reducing the RR of CSDH after burr-hole evacuation. [18,25,26] To the best of my knowledge, the present study is the first study that found 0% RR after surgical evacuation of CSDH within a relatively long follow-up period of at least 12 months. This study tried to emphasize that we have to perform certain combined operative steps to get better results in the surgical management of CSDH.…”

“…Most of the studies found the value of irrigation in reducing the RR of CSDH after burr-hole evacuation. [182526]…”

“…Although CSDH is a common neurosurgical condition, still there is no consensus on the best surgical steps among different neurosurgical centers and among neurosurgeons of the same center such as the number of burr holes or their size, [18,19] the use of irrigation, [20] the type of the irrigating fluid, [21] and the site of the drain whether subdural or subgaleal.…”

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

“…Although CSDH is a common neurosurgical condition, still, there is no consensus on the best surgical steps among different neurosurgical centers and among neurosurgeons of the same center such as the number of burr holes or their size [22,23], the use of irrigation [24], the site of the drain whether subdural or subgaleal, and the opening of the hematomas' inner membrane.…”