Minimal Access Surgical Evacuation of Unilateral Chronic Subdural Hematoma

Hamdy Mohammed Behairy

doi:10.4236/wjns.2018.81007

Abstract

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions occurring mostly in elderly and ideally treated with surgical drainage. Many surgical techniques of different degrees of invasiveness have been proposed for its treatment with controversy about the best surgical procedure. The study aims to evaluate the efficacy of the minimal access technique of single burr-hole craniostomy and massive irrigation for treatment of unilateral CSDH. The study is a prospective descriptive study involved all patients with symptomatic radiologically proven unilateral CSDH admitted and treated surgically in department of Neurosurgery, Al-Hussein University hospital, Al-Azhar University, Cairo, Egypt, over 3 years, from January 2013 to January 2016. In the results we found that total 64 patients of CSDH, treated surgically by this procedure. Men formed 72% and women 28%. Age range was 51 to 82 years; the mean age was 65 years. Clinical presentation was impaired consciousness in 7%, headache (59%), right hemiparesis in 56% and left hemiparesis in 37%. CT was done for 91% and MRI 27% patients. The hematoma was left in 61% and right in 39%. Surgical evacuation utilizing this procedure was done in all patients. Complete recovery was obtained in 82% of patients and partial recovery in 11% of patients. Follow up for 4 months was done. Recurrence was detected in 6% of patients. We concluded that unilateral CSDH can be treated effectively by single nondependent burr-hole craniostomy and massive irrigation with excellent outcome.

Highlights

The study aims to evaluate the efficacy of the minimal access technique of single burr-hole craniostomy and massive irrigation for treatment of unilateral Chronic subdural hematoma (CSDH)
We concluded that unilateral CSDH can be treated effectively by single nondependent burr-hole craniostomy and massive irrigation with excellent outcome
Risk factors include head trauma which is mostly minor, advanced age due to brain atrophy that leads to widening of subdural space and stretching the bridging fragile subdural veins, more tendency to fall and the usual antiplatelet administration [5]

Summary

Introduction

CSDH is dark altered fluid blood, aged more than 3 weeks [2] and appears as crescentic subdural collection, iso, mixed or hypodense in CT scan and predominantly hyperintense in MRI [3] [4]. Several surgical techniques ranging from just twist drill tapping and aspiration to more invasive procedures including single burr-hole drainage, enlarged burr-hole (small craniectomy), multiple burr-holes drainage, and complex craniotomy (with or without membranectomy) (with or without subgaleal or subdural closed drainage system) were used. An Indian study in 2005 reported success of treatment of CSDH with single burr hole craniostomy and irrigation [10]. The steps included single burr hole craniostomy and sustained irrigation till clear saline get back and no drains was inserted. Air water tightness was obtained by making the burr hole nondependent and the highest point during surgery and temporary plugging it with gel foam after

Methods

Results

Conclusion