Outcome Of Chronic Subdural Hematoma Research Articles

Assessment of Surgical Treatment and Outcome of Chronic Subdural Hematoma at University of Gondar Comprehensive Specialized Hospital, a one Year Prospective Study

IntroductionChronic subdural hematomas are a relatively common condition defined as an abnormal collection of blood and its break down products in the subdural space, usually accompanied by a history of preceding mild head trauma. Surgical management remains the mainstay of treatment. The objective of this study was to assess the surgical treatment outcome of patients operated on for chronic subdural hematoma at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. This comprehensive novel study serves as a benchmark for assessing therapeutic outcomes among patients with chronic subdural hematoma in the context of Ethiopia. MethodInstitution-based prospective observational study was conducted among patients operated on for symptomatic chronic subdural hematoma at University of Gondar Comprehensive Specialized Hospital from January 1, 2023, to December 31, 2023 G.C. ResultA total of 107 patients (70 males (65.4%) and 37 females (34.6%) with a male to female ration of 1.9:1 and mean age of 62.4 and a standard deviation of 13.7 (range from 23 to 92) were studied. 51 (47.7%) of the patients had a history of antecedent trauma. In terms of clinical symptoms, 86 (80.4%) patients had weakness as the chief complaint, followed by headache in 81 (75.7%). Among complications, recurrence is the most common, which was seen in 16 (15%) patients, followed by altered mental status (confusion, delirium) in 18 (16.8%) patients. The mean duration of the hospital stay was 6 days, with a standard deviation of 4 days. The majority of the patients had a good recovery with the resumption of normal life: 92 (86%), 10 (9.3%) patients had moderate disability, were disabled but independent, 2 (1.8%) patients had severe disability, were dependent on daily support, and 3 (2.8%) patients died. ConclusionChronic subdural hematomas are a relatively common condition characterized by an abnormal collection of blood. Antecedent trauma is the usual risk factor. Complication can happen following surgical intervention; however, patients with chronic subdural hematoma generally have a good prognosis.

A Linear Regression Equation for Predicting the Residual Volume of Chronic Subdural Hematoma 1 Week After Surgery.

The outcome of chronic subdural hematoma (CSDH) is influenced not only by the choice of treatment but also by various baseline characteristics. The main objective of this study is to identify the risk factors that can affect the prognosis of CSDH and develop a regression equation based on these risk factors. A total of 212 patients with CSDH were included in the study. We collected clinical data including age, gender, and so on, and radiological data including preoperative hematoma volume (V1), effusion volume 1 day after surgery (V2), gas volume 1 day after surgery (V3), and so on. These were considered independent variables, while residual volume 1 week after surgery (V4) was the dependent variable. Univariate linear regression analysis was performed to identify factors that were significantly related. Subsequently, multivariate linear regression analysis was conducted to determine the relationship between each independent variable and the dependent variable. Multiple linear regression analysis was used to obtain a regression equation predicting V4. We have found that age (t = 3.109, P = 0.002), aspirin (t = 2.762, P = 0.006), hemostatic agents (haemocoagulase, t = 3.731, P < 0.001; vitamin K, t = 2.824, P = 0.005 < 0.05), V2 (t = 8.73, P < 0.001), and V3 (t = 5.968, P < 0.001) are significantly associated with V4. Furthermore, we have developed a regression equation that can predict this volume with CSDH. The fit of the model is robust with an R-squared value of 65.2% > 50%. Age, aspirin, hemostatic agent, V2, and V3 are significantly associated with V4. We developed a regression equation to predict this volume with CSDH.

Effect of long-term anticoagulant therapy on the outcome of chronic subdural hematoma: a propensity score-matched analysis.

Chronic subdural hematomas (cSDHs) are particularly common in older adults who have increased risk of falls and the conditions that require anticoagulants (ACs). In such cases, clinicians are often left with the dilemma of co-managing the cSDH and the ongoing need for ACs. Patients who underwent surgical management for cSDH at the authors' institution between January 2006 and June 2022 were identified. Propensity score-matched analysis was used to obtain a balance in patients who were on ACs before the procedure versus those who were not, and in patients who were on ACs postprocedure versus those who were not. Length of hospitalization, periprocedural complications, reintervention rate during the same admission, rebleeding risk, and reintervention rates after discharge were compared. In total, 104 patients were on long-term ACs before the procedure, whereas 372 were not. After matching, 55 pairs were included in the analysis. Postprocedure, 74 patients were started on long-term ACs; the rest were not. A total of 49 patients in each group were then included in the analysis after matching. Comparing the preprocedure AC group with the non-AC group, no significant differences were found in length of hospitalization (8.5 ± 6.7 days vs 8.1 ± 7.7 days, p = 0.75), periprocedural complications (7.3% vs 7.3%, p > 0.99), or reintervention during the same admission (1.8% vs 5.5%, p = 0.31). In the comparison of postprocedure AC and non-AC groups, no significant differences were seen in recurrence rate (8.2% vs 14.3%, p = 0.52), reintervention rate after discharge (4.1% vs 14.3%, p = 0.16), or disability (i.e., mRS ≤ 2; 83.7% vs 89.8%, p = 0.55). Being treated with long-term ACs before cSDH procedures does not affect length of hospitalization, periprocedural complications, or reintervention during the same admission. Similarly, administration of long-term ACs after a procedure for cSDH does not increase rebleeding risk or reintervention rate. Patients who are on long-term ACs can have similar interventions to those who are not on ACs. In addition, it is safe to restart patients on AC agents in a 7- to 14-day window after admission for cSDH with or without acute/subacute components.

Institutional analysis of management and outcome of Chronic Subdural Hematoma in elderly population

The elderly population is particularly at risk for developing Chronic Subdural hematomas (CSDH) as a result of trivial trauma. This, along with the inevitable associated medical co-morbidities, manifests as a challenge for surgical management. The outcomes therefore can sometimes be unfavourable, leading to significant burden on the lives of patients, their families as well as the healthcare set-ups around the world. This seemingly innocuous disease entity can cause poor outcomes in terms of morbidity and mortality for this particular population. Despite having multiple treatment options, both surgical and medical, no consensus has been reached regarding optimal management strategies. We present this article to analyse the management and outcomes as well as challenges faced in the elderly population with CSDH reporting to a tertiary care neurosurgical centre.

Surgical treatment and outcome of chronic subdural hematoma: a comparative study between Ethiopia and Norway.

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Here, we studied differences in demographics, treatment, and outcome for CSDH patients in low-income (Ethiopia) and high-income (Norway) countries and assessed potential outcome determinants. We included patients from Addis Ababa University Hospitals (AAUH) and Haukeland University Hospital (HUH) who had surgery for CSDH (2013-2017). Patients were included prospectively in Ethiopia and retrospectively in Norway. We enrolled 314 patients from AAUH and 284 patients from HUH, with a median age of 60 and 75years, respectively. Trauma history was more common in AAUH (72%) than in HUH patients (64.1%). More patients at HUH (45.1%) used anticoagulants/antiplatelets than at AAUH (3.2%). Comorbidities were more frequent in HUH (77.5%) than in AAUH patients (30.3%). Burr hole craniostomy under local anesthesia and postoperative drainage was the standard treatment in both countries. Postoperative CT scanning was more common at HUH (99.3%) than at AAUH (5.2%). Reoperations were more frequent at HUH (10.9%) than at AAUH (6.1%), and in both countries, mostly due to hematoma recurrence. Medical complications were more common at HUH (6.7%) than at AAUH (1.3%). The 1-year mortality rate at HUH was 7% and at AAUH 3.5%. At the end of follow-up (> 3years), the Glasgow Outcome Scale Extended (GOSE) score was 8 in 82.9% of AAUH and 46.8% of HUH patients. The surgical treatment was similar at AAUH and HUH. The poorer outcome in Norway could largely be explained by age, comorbidity, medication, and complication rates.

Postoperative pneumocephalus and recurrence and outcome of chronic subdural hematoma: a systematic review and meta-analysis.

We conducted a meta-analysis to analyze the effects of pneumocephalus after chronic subdural hematoma (CSDH) surgery on hematoma recurrence, mortality, and functional outcomes. In this meta-analysis, following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science online databases were queried using the keywords "pneumocephalus," "pneumoencephalos," "intracranial pneumatocele," "pneumo encephalon," "subdural air," and "chronic subdural hematoma." The results were limited to English-language articles. Through the online database, we identified a total of 276 articles and finally included 14 articles for meta-analysis. The results showed that the recurrence rate in the pneumocephalus group was higher than that in the control group, with a pooled OR of 3.35 (CI: 2.51-4.46, P < 0.001). There was no difference in recurrence rate between the no/few and moderate pneumocephalus groups (OR: 1.27, CI: 0.68-2.37, P = 0.46), but the recurrence rate of the large pneumocephalus group was significantly higher than that of the moderate group, with a pooled OR of 3.29 (CI: 1.71-6.32, P < 0.001). This study failed to show higher mortality and worse outcomes in the pneumocephalus group than in the control. Pneumocephalus after surgical evacuation of CSDH was associated with the recurrence rate of hematoma. Pneumocephalus affecting recurrence was correlated with gas volume, and moderate pneumocephalus may have less impact, while patients with large pneumocephalus are more likely to recur than those with moderate pneumocephalus. More prospective cohort studies are needed for further investigation and verification. This meta-analysis was registered (PROSPERO CRD42022321800).

Outcomes of chronic subdural hematoma and their correlations with old age

Objective: This study explored the prognostic factors of chronic subdural hematoma in patients who underwent burr hole drainage, both overall and in elderly patients.Methods: This study enrolled 120 patients with chronic subdural hematoma who underwent burr hole drainage at a single center between January 2016 and December 2020. Old age was defined as &gt;65 years, and a good prognosis was defined as a decrease in the modified Rankin scale from admission to the last follow-up. Factors correlated with good prognosis in elderly patients compared with total patients were evaluated using the chi-square test and logistic regression analysis.Results: Among the 120 patients, 66 (55.0%) were ≥65 years old, and 76 (63.3%) had severe symptoms on admission. Old age (≥65) was the only factor significantly correlated with severe symptoms (P=0.021; odds ratio [OR], 2.618; 95% confidence interval [CI], 1.154–5.942). The following variables were significantly associated with the prognosis in both groups: diabetes (total: P=0.008; OR, 0.207; 95% CI, 0.064–0.664; old age: P=0.011; OR, 0.017; 95% CI, 0.044–0.672) and severe symptoms on admission (total: P&lt;0.001; OR, 6.994; 95% CI, 2.771–17.399; old age: P=0.007; OR, 6.177; 95% CI, 1.656–23.046).Conclusion: No difference in prognostic factors was observed between the overall patients and elderly patients with chronic subdural hematoma who underwent burr hole drainage. In both groups, patients without diabetes or with severe symptoms during hospitalization showed better recovery after burr hole drainage.

The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort

PurposeTo study the effect of antithrombotic therapy (ATT) on the outcome of operatively treated chronic subdural hematomas (CSDH).MethodsA retrospective population-based cohort study from Eastern Finland including all adult patients who underwent a burr-hole craniostomy (BHC) for CSDH during 2016 and 2017. The follow-up time for recurrence was 6 months and for mortality 3 years.ResultsA total of 301 CSDH patients were included in the study. ATT (antithrombotic therapy; antiplatelet or anticoagulant medication) was used by 164 patients (54.5%) at the time of diagnosis. The hematoma was bilateral in 102 patients (33.9%). Forty-seven patients (15.8%) encountered hematoma recurrence. Bilateral CSDHs required reoperations more often than unilateral hematomas (12.6% vs. 22.0%; p = 0.036) regardless of the primary operation (uni- or bilateral). A bivariate logistic regression analysis showed that bilateral hematoma (OR 1.918; 95% CI 1.013–3.630; p = 0.045) and male gender (OR 2.363; 95% CI 1.089–5.128; p = 0.030) independently predicted hematoma recurrence. The overall three-year mortality was 27.9%. The use of ATT was not associated with CSDH recurrence, and the length of the temporary postoperative ATT discontinuation did not correlate with the rate of thromboembolic events.ConclusionsATT did not affect CSDH recurrence in our study population, and the duration of the temporary postoperative ATT discontinuation was not associated with the rate of thromboembolic complications. Male gender and bilateral hematomas were more frequently associated with recurrences.

Surgical Outcome of Chronic Subdural Hematoma (C.D.S.H.) after Burr Bole and Catheter Drainage

Background: Chronic Subdural Hematoma (C.S.D.H.) is familiar with the collection of blood on the brain's surface, and in everyday neurological practices, it is the most ordinary clinical entity. This leads to the commendatory prognosis of infection. Surgical therapy is linked with numerous complications because of patients' medical problems and advanced generations. C.S.D.H. is commonly not being out symptoms, but it requisite surgical approaches when it occurs. C.S.D.H. has very well diagnosis and treatment approaches that are most effective, but some essential factors that lead to this disease are still unknown. This study is to know about the surgical outcome. Method: Out of 80 C.S.D.H. Patients between 60 to 70 years were selected.50 male and 30 female C.S.D.H. patients were treated with one burr hole and catheter drainage. The study was conducted at the neurosurgery unit of MartbaChuhan Medical College and Mardan Medical Complex from April 2018 to March 2021. A total of 80 patients were included in this study. Burhhole and Cather Drainage were performed for all patients. These patients were reviewed after 2, 5, and 6 weeks at O.P.D. Results: Mostly the patients, 94% show a good recovery, and 4% represent no recovery. However, only 2% show the complications against this approach. As for the burr hole and catheter drainage, there was a remarkable reduction of the C.S.D.H. However, 5% of the sample patients show the repetition of Hematoma after the 1 week of operation. In contrast, 2% suffered from some operative complications. Conclusion: Burr hole and Catheter drainage is an affected way of treatment for the patients suffering from C.D.S.H.

Third Ventricle Volume Predicts Functional Outcome in Chronic Subdural Hematoma.

There is a lack of evidence demonstrating the utility of computed tomography (CT) to predict chronic subdural hematoma (CSDH) clinical outcomes. We aim to analyze the role of tomographic volumetric analysis in patients with CSDH. We performed a retrospective study of patients undergoing burr-hole craniostomy (BHC) for CSDH over five years at a tertiary care center. Degree of midline shift, radiographic density, subdural hematoma volume, acute blood volume, and third ventricle (3VV) and fourth ventricle (4VV) volume were estimated using semiautomatic segmentation of preoperative CT. Postoperative functional outcome was measured by two endpoints: National Institute of Health Stroke Scale (NIHSS) at discharge and short-term modified Rankin Scale (mRS) at 6-week follow-up. Univariate and multivariate analyses were performed using nonparametric tests. Discriminative capacity and optimal thresholds of independent variables were calculated by means of receiving-operative curves (ROC). A total of 79 patients were included for analysis with a median age of 78.5years. Greater preoperative 3VV independently correlated with poor discharge NIHSS (p=.01) and short-term mRS (p=.03). A cutoff value of 0.545mL demonstrated the highest sensitivity (77.1%) and specificity (88.8%) with an odds ratio for an mRS functional dependence of 9.29 (p=.001). Greater preoperative tomographic 3VV independently prognosticates poor discharge NIHSS and 6-week mRS. A threshold 3VV of 0.545mL can be used to identify patients at higher risk of being dependent at first protocolized follow-up.

Clinical characteristics and outcomes of chronic subdural hematoma in patients with a history of antiplatelet therapy

ObjectiveChronic subdural hematoma (CSDH) is a common neurosurgical disease. Many patients with CSDH take antiplatelet (AP) drugs. Several studies have focused merely on the relationship between AP drug use and recurrence without deeply analyzing the specific clinical features of these patients. The primary objective of this study was to investigate the detailed clinical characteristics and outcomes of CSDH patients with a history of AP therapy. MethodsA total of 1181 CSDH patients over 40 years of age who received burr-hole craniostomy were enrolled. Clinical information, computed tomographic findings, and data on long-term outcomes and recurrence among these patients were gathered. We divided these patients into two groups according to whether they had a history of AP therapy. Percentages and χ2 tests were applied for categorical variables. Standard deviations and 2-sided unpaired t-tests were applied for continuous variables. Univariate and multivariate logistic regression analyses were performed to identify independent factors of the outcomes (6 months after discharge). ResultsAP therapy was not related to the outcomes of patients with CSDH (P = 0.48), and there were no differences in recurrence between the AP and non-AP group. Only Bender grade (P < 0.01, B = −3.14, Exp (B) = 0.04, 95% CI 0.01–0.29) was associated with the outcomes of patients in the AP group. The incidence of complications in the AP group was higher than that in the non-AP group (P < 0.01). Postoperative thrombotic events may be more likely to occur in the AP group than in the non-AP group (P = 0.02). Patients in the AP group were older (P < 0.01) and had more comorbidities (P < 0.01). ConclusionsPatients treated with AP therapy had more complications. The outcomes of patients treated with AP therapy were associated with their status of admission. Patients treated with AP therapy were at greater risk for postoperative thrombotic events. The recurrence rate of CSDH did not appear to be affected by AP therapy.

Comparison of Outcome of Chronic Subdural Hematoma (SDH) In Terms of Recurrence with Drain and without Drain

Background/Objectives: Chronic subdural hematoma commonly reported in neurosurgical practices. Variations are reported in neurosurgical practices regarding the treatment of chronic subdural hematoma (SDH). This study determined the outcomes of SDH with Drain and without Drain in terms of recurrence and effectiveness.&#x0D; Material and Methods: A randomized control trial was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad. Group-A patients were subjected to drainage of chronic subdural hematoma without drain and Group-B patients were subjected to drainage with drain. All patients were followed up to one month for recurrence of subdural hematoma like on CT-scan.&#x0D; Results: Overall, the recurrence of chronic subdural hematoma in both groups was seen in 16.7% of patients and the procedures were effective in 83.3% of patients. In Group A, 79.6% of patients were successfully treated through burr hole with irrigation, while 20.4% of patients had recurrent chronic SDH. In Group B, only 13% of patients had a recurrence, while 87% of patients were successfully treated with burr with the closed continuous drainage system. An insignificant difference (p-value: 0.302) existed between groups for both types of procedures.&#x0D; Conclusion: The patients who were treated with burr hole and irrigation of the subdural space with normal saline had high recurrence incidence than those with burr hole with closed continuous drainage system.

Impact of early intervention on the cognitive outcome of chronic subdural haematoma

Impact of early intervention on the cognitive outcome of chronic subdural haematoma

Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma

Objective: The aim of this study was to access clinical presentation of chronic subdural hematoma and to evaluate the surgical outcome of evacuation of chronic subdural hematoma after single burrhole craniotomy with a close drainage system under local anesthesia.&#x0D; Material &amp; Methods: A descriptive study conducted in the Neurosurgery Department of Khairpur Medical College Sindh. 30 patients of chronic subdural hematoma were included. Patients prepared for evacuation of chronic subdural hematoma through single burr hole followed by closed drainage system for two days.&#x0D; Results: The most common feature was gait disturbance followed by Hemiparesis and headache. Coexisting diseases were hypertension, Diabetes mellitus and Chronic Liver Disease, etc. and causes of CSDH were head injury (trivial trauma) and anticoagulant. Surgical decisions were taken on the bases of clinical presentation and radiological findings of patients. Surgical procedure single burrhole craniotomy followed by irrigation with normal saline and close drainage system for two days. On post-operative follow-up, a recurrence of CSDH occurred in two patients.&#x0D; Conclusion: Single burrhole craniotomy with close drainage system is a simple and safe procedure under local anesthesia for treatment of chronic subdural hematoma.&#x0D; Keywords: CSDH (chronic subdural hematoma), GCS (Glasgow coma score), Burrhole craniotomy, Neurosurgery &amp; Subdural drain.

Role of brain natriuretic peptide in the prediction of long-term surgical outcome of chronic subdural hematoma

ObjectiveTo investigate the role of brain natriuretic peptide (BNP) in predicting long-term functional outcome and develop a new predictive score of poor functional outcome after surgery for chronic subdural hematoma (cSDH). MethodsPatients with cSDH that were surgically treated in our department between November 2016 and December 2019 were included in the study. Pre- and postoperative plasma BNP and clinical condition were prospectively recorded. At follow-up (5–6 months), a simplified modified Rankin Scale (mRS) questionnaire was conducted through a standardized telephone interview. A poor outcome was defined by a mRS > 3. Based on predictors of the long-term functional outcome, a score was calculated. Its accuracy was tested using the area under the curve (AUC) of the receiver operating characteristic analysis. ResultsIn total, 119 patients were analyzed (median age: 76 years, range: 44–94 years). Preoperative plasma BNP (BNP-1) was elevated in 77 patients (64.7%). For the follow-up phone interview, 101 patients (84.8%) were available. In the multivariate analysis, poor outcome at follow-up could be predicted using BNP-1 (p = 0.034), age (p = 0.036), motor deficit (p = 0.013) and Glasgow coma scale score on admission (p = 0.008). The “Functional Long-term Outcome Predictive score” (FLOP-score) was therefore computed, and revealed an excellent discriminative capacity compared to other scores, with an AUC of 0.86 (0.77–0.95). ConclusionsPreoperative plasma BNP is an independent predictor of functional outcome at follow-up. Using the FLOP-score, the risk of experiencing a poor outcome could accurately be predicted.

In Reply: COVID-19 Infection Affects Surgical Outcome of Chronic Subdural Hematoma.

To the Editor: We read with interest the letter “COVID-19 Infection Affects Surgical Outcome of Chronic Subdural Hematoma” by Panciani et al.1 These authors reported high mortality in 5 patients with chronic subdural hematoma (CSDH) and COVID-19. On one hand, the viral infection provoked thrombocytopenia, thus increasing the risk of postoperative hemorrhages. On the other hand, the immune system could have been impaired by surgical procedures, thus facilitating the development of interstitial pneumonia (IP). Indeed, as the authors correctly stated, presently, there are no reliable data regarding the neurosurgical outcome of COVID-19 patients. After the outbreak of the COVID-19 contagion in Lombardy, our department suspended elective surgery and became one of 3 regional hubs for neurosurgical emergencies. During the last month, we surgically managed 4 symptomatic patients with CSDH and COVID-19: 2 males and 2 females. Mean age was 75.5 yr. None presented preoperative respiratory symptoms. Of these patients, 2 were taking chronic antiplatelet drugs and 1 had a history of chronic liver failure. In all cases, the CSDH was monolateral. All patients were operated under local anesthesia and received postoperative prophylaxis by low-molecular-weight heparin before mobilization. There was 1 case of severe postoperative IP: an 85-yr-old woman died 3 wk after surgery. Mild thrombocytopenia was found in 2 patients and was promptly corrected without any significant problem or postoperative rebleeding. Three patients fared well for what concerns both the CSDH and the evolution of COVID-19. Of course, this series is too small to draw any conclusion. Undoubtedly, neurosurgical procedures may have the potential to worsen the course of COVID-19. However, IP occurred only in our oldest patient, and age is a well-known risk factor regardless of the surgical treatment. Except for this case, neurosurgical treatment and COVID-19 did not seem to influence each other significantly. We suppose that a role could have been played by anesthesia: All our patients were managed under local anesthesia, whereas Panciani and colleagues1 operated their patients under general anesthesia. In our experience, general anesthesia did not represent a problem in younger COVID-19 patients. Accordingly, the combined effect of age and anesthesia might be crucial. A final brief comment is deserved by the reliability of nasopharyngeal swab in these patients. Two individuals underwent surgery with an already ascertained diagnosis of COVID-19 and early started antiretroviral therapy with lopinavir/ritonavir and hydroxychloroquine. Conversely, both the remaining 2 patients were studied by 2 repeated preoperative swabs, which always resulted negative. The diagnosis was ascertained postsurgery. Since one of these 2 patients was the elderly woman who developed lethal IP, perhaps this diagnostic delay could have been important. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Letter: COVID-19 Infection Affects Surgical Outcome of Chronic Subdural Hematoma.

Letter: COVID-19 Infection Affects Surgical Outcome of Chronic Subdural Hematoma.

Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients.&#x0D; Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared.&#x0D; Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days.&#x0D; Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

A Comparison of Subperiosteal or Subgaleal Drainage with Subdural Drainage on the Outcomes of Chronic Subdural Hematoma: A Meta-Analysis

The aim of the present study was to compare the outcomes of patients with chronic subdural hematoma after undergoing burr hole craniotomy with subperiosteal or subgaleal drainage (SPGD) with those of patients who have undergone burr hole craniotomy with subdural drainage. We searched 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) for relevant reports from January 1995 to September 2019. Two reviewers recorded the major outcomes data as follows: recurrence, mortality, postoperative seizures, postoperative bleeding events, surgical infection, pneumocephalus, modified Rankin scale scores, and Glasgow outcome scale scores. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A total of 3149 patients from 10 studies were included in our analysis. Compared with the SSD group, the SPGD group had a lower recurrence rate (OR, 0.72; 95% CI, 0.57-0.91) and a smaller risk of postoperative bleeding (OR, 0.41; 95% CI, 0.22-0.78). Also, no significant differences were found in the incidence of mortality (OR, 0.79; 95% CI, 0.54-1.18), postoperative seizures (OR, 0.74; 95% CI, 0.39-1.40), surgical infection (OR, 0.98; 95% CI, 0.55-1.76), pneumocephalus (OR, 0.58; 95% CI, 0.28-1.20), modified Rankin scale score 0-3 (OR, 1.04 at discharge; OR, 1.33 at 6 months), and Glasgow outcome scale score 4-5 (OR, 1.48; 95% CI, 0.82-2.67). Burr hole craniotomy with SPGD can be recommended as an effective and safe surgical therapy for patients with chronic subdural hematoma owing to its lower recurrence rate and reduced incidence of postoperative brain injuries, in addition to no increase in the rate of some postoperative complications. However, more studies are necessary for further confirmation.

Etiology and Surgical outcome of chronic Subdural hematoma at Tertiary Care Hospital.

Objectives: To determine etiology and management outcome among patients presenting with chronic subdural hematoma at tertiary care Hospital. Study Design: Cross Sectional. Setting: Department of neurosurgery, Liaquat University Hospital, Hyderabad/Jamshoro. Period: One year from 2015 to 2016. Material &amp; Methods: All the patients with diagnosis of unilateral chronic subdural hematoma, and both male and female gender were included in this study. CT scan and other relevant laboratory investigations were done. All the patients underwent treatment of burr hole evacuation after taken informed consent. Antibiotics were given to all the patients pre- and post-operatively. All the subjects underwent CT scan for the evaluation of hematoma cavity. Patients were discharged generally following 1-week and were followed at outpatients department for 1-month, 3-months and 3-months, respectively. All the patients were assessed according to Glasgow Outcome Scale. Results: Over a period of one year; total thirty patients were selected, most of them were in the 6th and 7th decades of their lives and males were in majority 25(83%). Sixteen patients had a history of minor head injury, eleven patients had no obvious cause and one patient had chronic subdural hematoma secondary to over shunting. According to complications; intracerebral bleed was among 2(6%) cases and Pneumocephalus was in 2(6%) cases, followed by subdural empyema, acute subdural hematoma, extra dural hematoma, penetration into brain via drain catheter, C.S.F leakage and dysphasia were found in one patient, in each case, respectively. Almost every patient recovered and survival rate was 28(93%), while only two patients died. Conclusion: It was concluded that patients showed best outcome (93% survival rate) according to Glasgow Outcome Scale, after burr hole evacuation management. Head injury due to road traffic accident was the most common etiology and burr hole evacuation was the best treatment option for chronic subdural hematoma.