Treatment of chronic subdural hematoma: 5-year clinical experience: Kronik subdural hematom tedavisi: 5 yıllık klinik deneyim

Kadir Oktay; Semih Kıvanç Olguner; Mustafa Emre Saraç; Kerem Mazhar Özsay; Nuri Eralp Çetinalp; Yurda Gezercan; Şakir Berat Vural

doi:10.5152/EurJTher.2016.002

Authors

Kadir Oktay Clinic of Neurosurgery, Mehmet Akif Inan Training and Research Hospital, Sanliurfa
Semih Kıvanç Olguner Clinic of Neurosurgery, Mehmet Akif Inan Training and Research Hospital, Sanliurfa
Mustafa Emre Saraç Clinic of Neurosurgery, Ceyhan State Hospital, Adana
Kerem Mazhar Özsay Department of Neurosurgery, Faculty of Medicine, Cukurova University, Adana
Nuri Eralp Çetinalp Department of Neurosurgery, Faculty of Medicine, Cukurova University, Adana
Yurda Gezercan Clinic of Neurosurgery, Adana Numune Training and Research Hospital, Adana
Şakir Berat Vural Clinic of Neurosurgery, Adana Numune Training and Research Hospital, Adana

DOI:

https://doi.org/10.5152/EurJTher.2016.002

Keywords:

Chronic subdural hematoma, burr-hole craniostomy, craniotomy

Abstract

Introduction: Chronic subdural hematoma is one of the most common types of intracranial hemorrhage, especially in the elderly. Multiple standart surgical techniques exist for the evacuation of chronic subdural hematoma. We compared the results of treatment with burr-hole craniostomy and craniotomy techniques.
Materials and Methods: A retrospective study was performed on 93 patients who underwent surgical treatment with chronic subdural hematoma. Two surgical procedures were performed; burr-hole craniostomy with membranectomy (Group A) and craniotomy with extensive membranectomy (Group B).
Results: The general outcome of the patients was good. Overall, the rate of reoperation was 11%. Individual reoperation rates of the groups were 14% and 5%, respectively. Coagulopathy was the most common cause of rebleeding in the reoperated patients’ group (80%) and the remaining patients had cerebral atrophy which was preventing re-expansion of the brain. In 76 patients, neurologic status improved significantly in the postoperative period and the operative mortality rate was found 4%.
Conclusion: Both surgical techniques seem to be effective for the treatment of chronic subdural hemtaoma. Coagulopathy and brain atrophy are defined as two major risk factors for recurrence.

Metrics

Metrics Loading ...

References

Aydin IH, Aydin Y, Akdemir D, Erdem H, Iyigün I, Yilikoglu Y. Chronic subdural hematomas (clinical analysis). Zentralbl Neurochir 1987;48(4):308-11.

Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 2004;27:263-6.

Chen JC, Levy ML. Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 2000;11:399-406.

Fogelholm R, Waltimo O. Epidemiology of chronic subdural hematoma. Acta Neurochir 1975;32:247.

Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, MartinezRumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005;107:223-9.

Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H. A comparative study of the treatment of chronic subdural hematoma burr hole drainage versus burr hole irrigation. Surg Neurol 2002;57:405-9;discussion 410.

Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003;74:937-43.

Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S. Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a lo¬gistic regression model. J Neurosurg 2003;98:1217-21.

Benzel EC, Bridges RM Jr, Hadden TA, Orrison WW. The single burr hole technique for the evacuation of non-acute subdural hematomas. J Trauma 1994;36(2):190-4.

Gurelik M, Aslan A, Gurelik B, Ozum U, Karadag O, Kars HZ. A safe and effective method for treatment of chronic subdural haematoma. Can J Neurol Sci 2007;34:84-7.

Harders A, Eggert HR, Weigel K. Treatment of chronic subdural haematoma by closed external drainage. Neurochirurgia (Stuttg) 1982;25(5):147-52.

Kotwica Z, Brzezinski J. Chronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients. Br J Neurosurg 1991;5(5):461-5.

Kwon TH, Park YK, Lim DJ, Cho TH, Chung YG, Chung HS, et al. Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume. J Neurosurg 2000;93(5):796-9.

Lee JY, Ebel H, Ernestus RI, Klug N. Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary? Surg Neurol 2004;61:523-7;discussion 527-8.

Markwalder TM, Seiler RW. Chronic subdural hematomas: to drain or not to drain? Neurosurgery 1985;16(2):185-8.

Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 1981;55(3):390-6.

Matsumoto K, Akagi K, Abekura M, Ryujin H, Ohkawa M, Iwasa N, et al. Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage. Neurol Res 1999;21(3):277-80.

Nakaguchi H, Tanishima T, Yoshimasu N. Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage. J Neurosurg 2000;93(5):791-5.

Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg 1984;61(2):263-8.

Rohde V, Graf G, Hassler W. Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev 2002;25(1- 2):89-94.

Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M. Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurgery 1990;26(5):771-3.

Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg 1986;65(2):183-7.

Carlton CK, Saunders RL. Twist drill craniostomy and closed system drainage of chronic and subacute subdural hematomas. Neurosurgery 1983;13(2):153-9.

Gökmen M, Sucu HK, Ergin A, Gökmen A, Bezircioglu H. Randomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas. Zentralbl Neurochir 2008;69:129-33.

Muzii VF, Bistazzoni S, Zalaffi A, Carangelo B, Mariottini A, Palma L. Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study. J Neurosurg Sci 2005;49:41-7.

Rychlicki F, Recchioni MA, Burchianti M, Marcolini P, Messori A, Papo I. Percutaneous twist-drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 1991;113(1- 2):38-41.

Santos-Ditto RA, Santos-Franco JA, Pinos-Gavilanes MW, MoraBenítez H, Saavedra T, Martínez-Gonzáles V. Management of chronic subdural hematoma with twist-drill craniostomy. Report of 213 patients. Gac Med Mex 2007;143:203-8.