Underwent Burr Hole Drainage Research Articles

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 >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<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.

Burr hole and craniotomy in the treatment of subdural hematoma: A comparative study.

This article aims to study the clinical outcomes in patients with chronic subdural hematoma (CSDH) who underwent burr hole drainage or craniotomy. The length of hospitalization, Glasgow outcome scales (GOS) of patients undergoing burr-hole drainage or craniotomy, were evaluated and compared statistically. In this study, we also evaluated the relationship by receiver operating characteristic (ROC) analysis. The sex and age distribution and specific clinical parameters of the patients were investigated. In this study, we provide the evidence of the GOS and length of hospitalization findings of the patients and the superiority of burr hole drainage over craniotomy. Chronic subdural hematoma responds better to burr hole drainage with shorter hospitalization and improved Glasgow score.

Comparative Study of Single versus Double Burr Hole Drainage for Chronic Subdural Hematoma

Introduction: Various surgical technique is used for evacuation of chronic subdural hematoma. Burr hole drainage is a most preferred. However, there exist a controversy regarding single versus double burr hole among neurosurgeon. This study aims to compare the single versus double burr hole drainage for chronic subdural hematoma in terms of mortality, wound infection andrecurrence. Methods: A retrospective observational study was performed over the period of 3 years. Data were collected in terms age, gender, type of surgery, mortality, wound infection and recurrence. These data were analysed to compare between the single versus double burr hole groups. Results: A total of 53 patients with chronic subdural hematoma underwent burr hole drainage were enrolled. Mean age of patients was 61.87 ± 17.35 years with male to female ratio 4.88:1. In this study, single burr hole was performed in 35 patients (66%) versus double burr hole in 18 patients (34%). Superficial surgical site infection was observed in 3 patients (5.7%) wherein 1 from single burr hole and 2 from double burr hole group with no statistically significant association (P value = 0.26). There was only 1 recurrence (1.9%). This was from single burr hole group versus no recurrence from double burr hole group which was not statistically significant (P value = 1.00). There was no mortality in both the groups in this study. Conclusions: There is no effect on mortality, infection and recurrence comparing single versus double burr hole drainage following evacuation of chronic subdural hematoma. Keywords: burr hole drainage; chronic subdural hematoma; recurrence.

Contralateral subdural effusion after decompressive craniectomy: What is the optimal treatment?

ObjectiveContralateral subdural effusion after decompressive craniectomy (CSEDC) is rare, and the optimal treatment is not determined. We present 11 cases of CSEDC and give an overview of the English literature pertaining to this disease. MethodsWe searched the database at our institution and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows (single word or combination): “subdural hygroma”; “subdural effusion”; “decompressive craniectomy”. Only patients with CSEDC and contained adequate clinical information pertinent to the analysis were included. Results11 cases of CSEDC were recorded at our institution. They comprised ten men and one woman with an average age of 41.9 years. All the 8 symptomatic patients underwent surgery and the CSEDC resolved gradually. 68 cases of CSEDC were found in the literature. Including ours, a total of 79 patients were analyzed. Conservative treatment was effective in the asymptomatic patients. 41.7% of the symptomatic CSEDC underwent burr hole drainage and successfully drained the CSEDC. However, 76% of them received subsequent surgery to manage the reaccumulation of CSEDC. 25% of the symptomatic patients underwent cranioplasty, while 13.3% of them received Ommaya drainage later because of CSEDC recurrence. 18.3% of the symptomatic patients underwent cranioplasty plus subduroperitoneal shunting, and all CSEDC resolved completely. ConclusionsBurr hole drainage appears to be only a temporary measure. Early cranioplasty should be performed for patients with CSEDC. CSF shunting procedures may be required for patients in whom CSEDC have not been solved or hydrocephalus manifest after cranioplasty.

Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.

Burr hole drainage without irrigation for chronic subdural hematoma.

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions, with different strategies for treatment. Most recent trials favor the use of drainage to reduce the recurrence rate. However, few reports have discussed the efficacy of burr hole drainage without irrigation for treating CSDH. This study aimed to examine the efficacy of burr hole drainage without irrigation in a series of 385 symptomatic CSDH lesions.Methods: This retrospective study included a series of 385 symptomatic CSDH lesions in 309 patients, who underwent burr hole drainage without irrigation, between September 2009 and August 2017 at the Department of Neurosurgery, Yao Tokushukai General Hospital, Japan. The risk of recurrence was evaluated based on the patients’ age, sex, preoperative magnetic resonance imaging (MRI) findings, preoperative anticoagulants, hematoma drainage rate, and bilaterality.Results: Of the 385 lesions, 41 cases (16 with inadequate follow-up periods and 25 with contraindications for MRI) were excluded from the analysis. The overall recurrence rate in the index study was 4.9% (17/344 lesions). The effects of the preoperative hematoma volume and nonhyperintensity on T1-weighted imaging on the recurrence rate were significant.Conclusion: Our findings indicated that burr hole drainage without irrigation is a good surgical modality in patients with CSDH, and preoperative MRI findings can evaluate the risk of recurrence.

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

BackgroundTo investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage.MethodsA multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019.ResultsA total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH.ConclusionsThis study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Effect of Antithrombotic Therapy on Development of Acute Subdural Hematoma After Burr Hole Drainage of Chronic Subdural Hematoma.

To evaluate the relationship between the time from cessation of anticoagulant/antiplatelet medication to surgery and risk of postoperative acute subdural hematoma (ASDH) after burr hole drainage of chronic subdural hematoma (CSDH). A retrospective study of patients who underwent burr hole drainage of CSDH between December 2014 and December 2019 was performed. Demographic and clinical data regarding age, gender, medication (antithrombotic therapy), smoking, daily alcohol consumption, history of head trauma, presenting symptoms, and neurological examination were collected from the medical records. Patients were divided into 3 groups based on time from referral to surgery: < 24 hours, 24?72 hours, and > 72 hours. One hundred seventeen patients underwent burr hole drainage of CSDH during the 5-year study period. Seventy-two patients were male (61.5%) and 45 were female (38.5%). Mean age was 70.5 ± 7.2 years. Postoperative ASDH occurred in 2 of the 32 patients (6.3%) who were not taking antithrombotic medication and 6 of the 85 patients (7.1%) who were taking antithrombotic medication. The difference was not significant (p=0.797). The risk of ASDH after burr hole drainage of CSDH was not affected by antithrombotic medication. Although the literature suggests that antiplatelet and anticoagulant drugs to be discontinued between 5 and 7 days before surgery, our results showed that acute hemorrhage was not detected in any patient who underwent surgery more than 72 hours after referral.

Managing Intracranial Hemorrhage in Patients with a Durable Continuous Flow Left Ventricular Assist Device

Background&#x0D; While intracranial hemorrhage (ICH) is a known complication of left ventricular assist device (LVAD) support, and is associated with high morbidity and mortality, optimal care pathways have neither been elucidated nor reported. We describe management of LVAD patients following ICH, with a focus on anticoagulation, operative interventions, care team designation, complications, and outcomes.&#x0D; Methods&#x0D; We retrospectively reviewed all durable continuous-flow LVAD implantations at our academic medical center from January 2007 to July 2018. Patients who experienced ICH after LVAD were identified. We defined baseline and ICH characteristics, medical and surgical interventions, care teams, and outcomes including death, device thrombosis, ischemic stroke, and hemorrhage expansion.&#x0D; Results&#x0D; A total of 321 patients underwent LVAD implantation during the study period, and 27 (8%) developed ICH (17 intraparenchymal, 7 subdural, 2 subarachnoid, 1 intraventricular) while on support. Twenty-five were anticoagulated at onset of bleed. Of those, 13 were managed with immediate cessation of anticoagulation and administration of reversal products (Group A). Group A had a median of 6 days off anticoagulation and 60 days of follow up with 1 patient (8%) developing device thrombosis at day 8, 1 (8%) developing subsequent ischemic stroke at day 14, and 4 (31%) with ICH expansion. Seven patients had anticoagulation stopped at onset of bleed without administration of reversal products (Group B). With a median of 2 days off anticoagulation and 2 days of follow up, no patients in Group B developed ischemic stroke or device thrombosis while 1 (14%) had ICH expansion. Five patients had anticoagulation continued at onset of bleed (Group C) with a median follow up of 330 days. One (20%) developed device thrombosis at day 5 while 2 (40%) developed ICH expansion. Four patients with subdural hemorrhage underwent Burr hole drainage with all 4 surviving to discharge. Two patients with intraparenchymal hemorrhage underwent open craniotomy with neither surviving to discharge. An interdisciplinary discussion occurred in all cases. Following ICH, only one-third of patients in the study survived to 6 months.&#x0D; Conclusion&#x0D; LVAD patients who experience an ICH have variable outcomes. Their care is multidisciplinary and can involve operative intervention. The discontinuation and reversal of anticoagulation is generally well-tolerated, with a low risk for early device thrombosis. Like for many hemorrhagic complications of LVADs, ICH often persists or worsens. Additional investigation is needed to elucidate the most optimal management strategies.

Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas.

ObjectiveChronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas.MethodsFrom January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images.Results60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group.ConclusionBurr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.

A comparative study of irrigation versus no irrigation during burr hole craniostomy to treat chronic subdural hematoma

BackgroundBurr hole craniostomy is a widely used method for the evacuation of CSDH. However it is not clear whether the irrigation during operation improves the prognosis or gives rise to additional complications instead. This retrospective cohort study was conducted to determine this issue.MethodsPatients attending two medical centers in China who underwent burr hole drainage with irrigation (BHDI) or burr hole drainage without irrigation (BHD) for unilateral CSDH during January 2013 to December 2016 were included in this study. The patients’ clinical information and follow-up data were retrospectively reviewed, and the radiologic findings were processed using the 3D Slicer software. The differences in outcomes were identified using t-test, chi-square test, or Fisher’s exact test.ResultsA total of 151 patients comprising 63 patients in the BHD group and 88 patients in the BHDI group were included. Patients in the BHDI group had a higher volume of pneumocrania on the first postoperative day than that of patients in the BHD group (p < 0.05). No significant differences were observed between the two approaches in rates of rebleeding, recurrence and other complications (p > 0.05).ConclusionsIrrigation had no improvement in the long-term curative effect on CSDH, but it increased the risk of short-term complication in terms of pneumocrania. Therefore, this study suggests that irrigation is not an obligatory procedure during burr hole drainage.

Identifying patients with mild traumatic intracranial hemorrhage at low risk of decompensation who are safe for ED observation

BackgroundPatients with traumatic intracranial hemorrhage and mild traumatic brain injury (mTIH) receive broadly variable care which often includes transfer to a trauma center, neurosurgery consultation and ICU admission. However, there may be a low risk cohort of patients who can be managed without utilizing such significant resources. ObjectiveDescribe mTIH patients who are at low risk of clinical or radiographic decompensation and can be safely managed in an ED observation unit (EDOU). MethodsRetrospective evaluation of patients age≥16, GCS≥13 with ICH on CT. Primary outcomes included clinical/neurologic deterioration, CT worsening or need for neurosurgery. Results1185 consecutive patients were studied. 814 were admitted and 371 observed patients (OP) were monitored in the EDOU or discharged from the ED after a period of observation. None of the OP deteriorated clinically. 299 OP (81%) had a single lesion on CT; 72 had mixed lesions. 120 patients had isolated subarachnoid hemorrhage (iSAH) and they did uniformly well. Of the 119 OP who had subdural hematoma (SDH), 6 had worsening CT scans and 3 underwent burr hole drainage procedures as inpatients due to persistent SDH without new deficit. Of the 39 OP who had cerebral contusions, 3 had worsening CT scans and one required NSG admission. No patient returned to the ED with a complication. Follow-up was obtained on 81% of OP. 2 patients with SDH required burr hole procedure >2weeks after discharge. ConclusionsPatients with mTIH, particularly those with iSAH, have very low rates of clinical or radiographic deterioration and may be safe for monitoring in an emergency department observation unit.

Quantitative assessment of brain shifting in the late phase postevacuation in unilateral and bilateral chronic subdural hematomas

Aim of the study: Recurrence is more common in bilateral chronic subdural hematomas (CSDHs) than in unilateral. Our aim was to quantitatively compare the late phase of brain shifting postevacuation in unilateral and bilateral CSDHs. Materials and Methods: We reviewed computed tomography (CT) scans and medical records of consecutive patients with CSDHs who underwent burr hole drainage. CT scan images (preoperative and postoperative days [PODs] 30 and 60) were imported to Adobe Photoshop, and temporal and spatial changes in brain shifting between PODs 30 and 60, and also the subdural space on POD 60, were analyzed. Results: The bilateral group exhibited a significantly greater late phase of brain shifting than the unilateral group between PODs 30 and 60 (P < 0.001). The median late phase of brain shifting of the bilateral group was 8.9 mm (interquartile range [IQR]: 8.3–9.0 mm) between PODs 30 and 60, while that of the unilateral group was 1.8 mm (IQR: 1.3–2.5 mm). Conclusions: The postevacuation late phase of brain shifting is statistically greater in bilateral CSDHs than in unilateral CSDHs, which might facilitate bridging vein tearing and consequent rebleeding. This may be one factor accounting for the higher recurrence rate of bilateral CSDHs.

Quantitative assessment of post-operative recurrence of chronic subdural haematoma using mean haematoma density

Purpose: The purpose of this study was to establish a quantitative method with which to assess the post-operative recurrence of chronic subdural haematoma (CSDH).Methods: CT scans were reviewed from 44 consecutive patients with CSDHs who underwent burr hole drainage between July 2008 and January 2012. The area of the haematoma was quantified according to the mean haematoma density (MHD) using computer-based image analysis of pre-operative brain CT scans. MHD as well as other variables of patients with and without post-operative recurrences was statistically compared.Results: Post-operative recurrence was noted in six of the 44 patients that underwent surgical procedures. Among these variables, high MHD, separated type and bilateral and skull base involvement of CSDHs were shown to be significantly related to post-operative recurrence (p < 0.05). Controlling for separated type in logistic regression analysis revealed the OR of MHD as statistically significant indicators with a p value of less than 0.05 (OR = 1.243; 95% CI = 1.003–1.54).Conclusion: This study provides statistical proof that MHD is a significant, independent, prognostic factor for the post-operative recurrence of CSDH. As such, consideration of MHD could aid in the prediction of post-operative prognosis of CSDHs.

Value of routine early post-operative computed tomography in determining short-term functional outcome after drainage of chronic subdural hematoma: An evaluation of residual volume

Background:Computed tomography (CT) scans are widely used in managing chronic subdural hematoma (CSDH). Factors that determine early post-operative volume have not been examined. The value of routine early post-operative residual volume have not been evaluated. Our study aims to compare pre-operative and early post-operative CT findings to determine the factors affecting residual hematoma and evaluate if early post-operative CT scans are useful in the management of CSDH.Methods:Forty-three patients who underwent burr hole drainage of unilateral CSDH from August 2006 to January 2013 and had routine post-operative CT scans within 48 hours of surgery were selected. Data regarding age, sex, neurological deficit, Glasgow Coma Scale (GCS), pre-existing medical conditions, use of antiplatelets or anticoagulation, operative time, usage of drains, and number of burr holes were obtained. The pre-operative CSDH volume, CSDH density, and midline shift were measured. Residual volume was calculated from early post-operative CT scans. Clinical outcome was evaluated with Glasgow Outcome Scale (GOS) at the time of discharge. Statistical analysis was performed to look for correlation between the pre-operative factors and residual volume, and the residual volume and GOS.Results:Pre-operative volume was found to correlate significantly with post-operative residual volume. There was no significant correlation between all other pre-operative factors and residual volume. There was also no correlation between residual volume and GOS at discharge.Conclusion:Routine post-operative CT brain for burr hole drainage of CSDH may be unnecessary in view of the good predictive value of pre-operative volume, and also because it is not predictive of the clinical outcome.

Treatment of chronic subdural haematomas – A retrospective comparison of minicraniectomy versus burrhole drainage

Primary chronic subdural haematomas remains one of the commonest conditions managed by neurosurgeons. Despite this there is a relative lack of evidence regarding best management and certain treatments such as minicraniectomy, have rarely been assessed in the literature. A retrospective case note review comparing minicraniectomy and burrhole drainage of primary chronic subdural haematoma was therefore performed. We sought to determine the proportion of patients requiring repeat drainage or dandy cannula aspiration following initial surgery and to assess outcome at outpatient follow-up. The mean age of patients undergoing minicraniectomy was 73, compared to 63 in the burrhole group (p < 0.001). 130 patients underwent burrhole drainage, 23 of whom (18%) developed a symptomatic recurrence. 21 (16%) of these patients required repeat drainage. Of the 116 patients who underwent a craniectomy 23 (20%) patients suffered a symptomatic recurrence. 15 (13%) patients required the minicraniectomy to be reopened for further washout (p = 0.48). (8%) patients who underwent burrhole drainage died compared to 20 (17%) patients following craniectomy (95%CI 2 to 18%; p = 0.03). However, controlling for age using logistic logression, showed no significant difference between the two treatment groups in recurrence (p = 0.28) or death (p = 0.06). Craniectomy may be considered as a treatment option particularly in the elderly population and in patients with multiple loculated collections.

Spontaneous Subdural Hematoma in the Setting of Immune Thrombocytopenia Complicated by Ischemic Infarcts

The occurrence of spontaneous subdural hematoma (SDH) in immune thrombocytopenia (ITP) is rare. We report a spontaneous subacute subdural hematoma in a patient with chronic ITP. The patient presented with headache and a noncontrast head CT scan showed an 11 mm subacute right frontoparietal SDH causing an 8 mm right to left midline shift. The patient underwent medical management with platelets, FFP and packed RBC transfusions, steroids, IVIG and mannitol, which failed to prevent deterioration of her clinical condition. The patient then underwent burr hole drainage of the SDH. Her postoperative course was complicated by ischemic infarcts in the right posterior cerebral artery territory leaving her with a residual left homonymous hemianopia. Our patient was unique in the concurrent development of ischemic infarcts postoperatively, following burr hole drainage of the SDH in the setting of ITP. This case highlights the diagnostic and therapeutic dilemmas involved in taking care of such patients.

A comparative study of the treatment of chronic subdural hematoma—burr hole drainage versus burr hole irrigation

BACKGROUND Several surgical procedures have been reported for the treatment of chronic subdural hematoma. Whether irrigation is required is not clear. We compared the results of treatment of chronic subdural hematoma obtained with burr hole drainage and burr hole irrigation retrospectively. METHODS Forty patients with chronic subdural hematoma underwent surgery at our institution in the last 3 years. The first 20 patients were treated by burr hole irrigation (irrigation group), while the last 20 patients underwent burr hole drainage (drainage group). The rates of recurrence, changes in hematoma size, and number of days of postoperative hospitalization for the two groups were compared. No significant differences were found between the two groups in the presence of head injury, alcohol consumption, age, gender, or preoperative hematoma size. RESULTS Duration of postoperative hospitalization was 14.1 days in the drainage group and 25.5 days in the irrigation group. Recurrence was observed in 1 case (5%) in the drainage group, and in 5 cases (25%) in the irrigation group. In the drainage group, postoperative hematoma size was significantly decreased compared to preoperative hematoma size on the first postoperative day, after which change in hematoma size was minimal. On the other hand, in the irrigation group, hematoma size was decreased on the first postoperative day, but not to a significant extent. CONCLUSION For treatment of chronic subdural hematoma, postoperative hospitalization was shorter and the recurrence was less frequent with drainage than with irrigation.

SURGICAL OUTCOME OF CHRONIC SUBDURAL HAEMATOMA: A 5‐YEAR AUDIT *

Chronic subdural haematoma (CSDH) is a common neurosurgical condition that has been studied extensively.1–3 Unlike acute post‐traumatic subdural haematoma, there is often minimal associated parenchymal brain injury with CSDH and surgical outcome is satisfactory in most cases. However, the fact that CSDH affects primarily elderly people means that operative mortality and morbidity is by no means uncommon.4,5 In this review, we report the surgical outcome of CSDH at a local neurosurgical centre over the course of 5 years, with emphasis on treatment‐related morbidity and mortality.A retrospective analysis was performed on 108 patients who underwent operation for CSDH at Queen Mary Hospital, Hong Kong, between January 1995 and December 1999. The diagnosis of CSDH was made on computerized tomography (CT) in all cases and confirmed at operation. Patients with acute post‐traumatic subdural haematoma and subdural effusion were excluded.There were 108 patients. The male to female ratio was 3 : 1. The mean age was 73 years. The majority of patients presented with limb weakness. History of head injury could be identified with certainty in less than half of the patients. Eight patients had bleeding tendency who required delayed operations—six were taking salicylate, one was taking ticlopidine and one was on warfarin.Two patients underwent craniotomy—one for a heavily loculated CSDH and the other had a solid mass of organized CSDH. Both recovered uneventfully. For those who underwent burr hole drainage, more than half did not have any postoperative drainage.One 55‐year‐old female developed subdural empyema. One 64‐year‐old male suffered from postoperative tonic‐clonic seizure. There were five recollections of haematoma which required re‐operations. There were four deaths, giving rise to a hospital mortality rate of 4%.This series is an audit of the surgical outcome of chronic subdural haematoma at a local neurosurgical centre and shows that the mortality and morbidity rates are compatible with current standard of care. The nature of a retrospective study is such that detailed assessment of postoperative clinical and functional improvement is severely hampered by suboptimal documentation and recall bias. It is hoped that a prospective study in the near future will revisit the issue in more positive light.