Chronic Subdural Hematoma Surgical Evacuation with Burr-Hole Drainage: An Institutional Experience

Abstract

Abstract Background Chronic SDH (CSDH) is one of the most common clinical entities in neurosurgery with most favorable prognosis commonly encountered in elderly patients with history of minor trauma and surgery is gold standard treatment. Objectives This study was done to evaluate the clinical presentation, radiologic findings, complications, and management of patients with CSDH who were treated surgically with burr-hole evacuation. Materials and Methods This prospective study was done in Department of Neuro-surgery, SMS Medical College, Jaipur, India, from September 2015 to April 2016. The sample size was 55. Results In this study out of 55 patients, 39 (71%) patients were male and 16 (29%) were female. The most common age group in which CSDH observed was between 61 and 70 years. Most common presenting symptom was headache present in 30 (54.55%) patients followed by weakness. Midline shift more than 5 mm was seen in 43 (78%) patients. The most common complication was recurrence of CSDH (5.4%) in our study. Recurrence after single burr hole was 16.6% and 4.1% after double burr holes. Simple pneumocephalus was present in almost all cases and tension pneumocephalus was found in one (1.8%) patient. Conclusion Complete evacuation of unilateral CSDH by two burr holes at highest point of hematoma is sufficient. Factors affecting recurrence rate include old age, gross midline shift, and single burr hole. Postoperative simple pneumocephalus is a common radiologic finding that requires no treatment and it does not affect ultimate outcome. Tension pneumocephalus is a serious complication requiring emergent treatment.