Abstract
BackgroundSymptomatic chronic subdural hematomas (CSDH) remain one of the most encountered forms of intracranial hemorrhages particularly in the elder patients, yet fortunately implies a good surgical prognosis. Burr hole evacuation under general anesthesia is the most commonly used neurosurgical technique for the management of CSDH. Clinical disagreement between many studies regarding the number of burr holes required to achieve the optimal surgical and clinical outcome has long existed. The objective of this study is to evaluate the prognosis and clinical outcome following the use of single-burr hole craniostomy technique in the aim of surgical evacuation of CSDH.ResultsThis is a retrospective study of 30 patients, with symptomatic unilateral or bilateral CSDH managed by the authors strictly by single-burr hole evacuation with closed-system drainage on the corresponding site of the hematoma. Clinical outcome was then assessed at 1, 7, and 30 days after surgery using the Glasgow Coma Scale (GCS) and by comparing the Markwalder grade scale before surgery to 1 month following surgery; the pre- and post-operative radiological data, clinical neurological progress and the possible incidence of complications postoperatively were also recorded. Study duration was from August 2019 to October 2020. Our study included 18 (60%) male patients and 12 (40%) female patients. The main presenting symptom was altered level of consciousness noted in 29 (96.7%) patients; a history of a relevant head trauma was recorded in 11 patients (36.7%). The GCS showed a statistically highly significant improvement comparing the preoperative to the postoperative values throughout the follow-up intervals (p = 0.001); similarly, the Markwalder score significantly improved 1 month after surgery, where 17 (63%) patients were Markwalder grade 0, 9(33.3%) patients were grade 1, a single patient (3.7%) was grade 2, and none were Markwalder grade 3.ConclusionOur study concluded that single-burr hole craniostomy with closed-system drainage for the management of symptomatic CSDH would be a sufficient approach to achieve a good surgical outcome with a low complication rate. Larger series and further studies would be yet considered with longer follow-up periods.
Highlights
Symptomatic chronic subdural hematomas (CSDH) remain one of the most encountered forms of intracranial hemorrhages in the elder patients, yet implies a good surgical prognosis
*Correspondence: omarelfarouk@hotmail.com Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt. It is described as a dark adjusted liquefied blood located between the dura mater and the arachnoid layer of the brain that appears as a crescentic subdural collection on the computed tomography (CT) scan images mostly hypodense and essentially hyperintense in magnetic resonance imaging (MRI) [10, 17]
Burr hole craniostomy (BHC), twist-drill craniostomy (TDC), and craniotomy have been the most commonly used surgical techniques for years. All these three techniques have approximately the same mortality rate (2%– 4%), both craniotomy and TDC account for a significantly higher morbidity rate and a higher recurrence rate, respectively [22], suggesting that BHC is the preferred technique taking into consideration the simplicity of procedure, its efficacy and its operative risks, while craniotomy is more considered for symptomatic recurrences [24]
Summary
Symptomatic chronic subdural hematomas (CSDH) remain one of the most encountered forms of intracranial hemorrhages in the elder patients, yet implies a good surgical prognosis. Burr hole evacuation under general anesthesia is the most commonly used neurosurgical technique for the management of CSDH. The objective of this study is to evaluate the prognosis and clinical outcome following the use of single-burr hole craniostomy technique in the aim of surgical evacuation of CSDH. Chronic subdural hematoma (CSDH) remains one of the most common types of traumatic intracranial hematomas, taking place often in the elderly [5, 22] with an incidence of 8.2/100,000/year after the age of 70 years [1]. Definite indication considering number of burr holes is not yet agreed upon and it mostly relies upon neurosurgeon’s preference
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