Citation Information :
Kumar A, Singh L, Singh SP. An Institutional Experience with Surgical Evacuation for Chronic Subdural Hematomas with Burr-Hole Drainage. Arch Craniofac Sci 2018; 6 (1):5-9.
BACKGROUND: Surgery for chronic SDH (CSDH), one of the most common clinical entities in neurosurgery with the best prognosis, is the gold standard of therapy for elderly patients with a history of moderate trauma.
RESEARCH GOALS: This study aimed to evaluate the clinical presentation, radiologic findings, therapy, and consequences of individuals with CSDH following surgical burr-hole evacuation.
MATERIALS AND PROCEDURES: This prospective study was conducted on 24 patients who underwent cranial burr hole surgery for chronic subdural hematomas.
RESULT: Five (20.8%) of the 24 patients in this study were female, and 19 (79.19%) were male. The most common age range for CSDH detection was 51-70 years old. The most frequent presenting symptoms of the patients were headache (14 {58.33%}) and giddiness (17 {70.8%}), which were followed by hemiparesis, or one-sided weakness. Of the patients, 22 (91.6%) exhibited a midline displacement greater than 5 mm. Recurrence of CSDH was the most common result in our study, occurring in 3 instances (12.5%). Recurrence was 8.3% (1 case out of 12) after two burr holes and 16.6% (2 cases out of 12) after a single burr hole. Mild uncomplicated pneumocephalus was present in 66.66% of the cases. We discovered a wound infection in 1 case (4.1%), which was treated with antibiotics. We did not have complications such as severe bleeding, CSF (cerebrospinal fluid) leakage, or tension pneumocephalus (TP).
CONCLUSION: Two burr holes at the highest point of the hematoma are sufficient to fully drain the unilateral CSDH. Significant midline movement, single or multiple burr holes, and the age of the patient with comorbidities all affect the recurrence rate. Surgery is not required to treat postoperative mild pneumocephalus that appears on follow-up radiological imaging. For hazardous conditions such infection, post-operative pneumocephalus CSF leak, and recurrence of CSDH, emergency care is required.
Ihab Z. Pneumocephalus after surgical evacuation of chronic subdural hematoma: is it a serious complication?. Asian J Neurosurg 2012; 7 (02) 66-74
Richard Winn H. Youmans Neurological Surgery. 6th ed.. Amsterdam, The Netherlands: Elsevier Saunders; 2011: 532- 536
Miele VJ, Sadrolhefazi A, Bailes JE. Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma. Surg Neurol 2005; 63 (05) 420-423
Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review. Neurocrit Care 2010; 13 (01) 152-158
Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005; 107 (03) 223-229
Murata K. Chronic subdural haematoma be preceded by persistent traumatic subdural effusion. Neurol Med Chir (Tokyo) 1993; 33: 691-696
Ohno K, Suzuki R, Masaoka H, Matsushima Y, Inaba Y, Monma S. Chronic subdural haematoma preceded by persistent traumatic subdural fluid collection. J Neurol Neurosurg Psychiatry 1987; 50 (12) 1694-1697
Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 2001; 41 (08) 371-381
Delgado PD, Cogolludo FJ, Mateo O, Cancela P, García R, Carrillo R. [Early prognosis in chronic subdural hematomas. Multivariate analysis of 137 cases] [n Spanish]. Rev Neurol 2000; 30 (09) 811-817
Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol 1997; 47 (05) 418- 422
Han H-J, Park C-W, Kim E-Y, Yoo CJ, Kim YB, Kim WK. One vs. two burr holecraniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc 2009; 46 (02) 87-92
Gurunathan J. Treatment of chronic subdural hematoma with burr-hole craniostomy and irrigation. Indian J Neurotrauma 2005; 2 (02) 127-130
Markwalder TM, Seiler RW. Chronic subdural hematomas: to drain or not to drain?. Neurosurgery 1985; 16 (02) 185-188
Erol FS, Topsakal C, Faik Ozveren M, Kaplan M, Tiftikci MT. Irrigation vs. closed drainage in the treatment of chronic subdural hematoma. J Clin Neurosci 2005; 12 (03) 261-263
Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery 1993; 33 (01) 67-72
Yamashima T. The inner membrane of chronic subdural hematomas: pathology and pathophysiology. Neurosurg Clin N Am 2000; 11 (03) 413-424
Murakami H, Hirose Y, Sagoh M. et al. Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 2002; 96 (05) 877-884
Sarkar C, Lakhtakia R, Gill SS, Sharma MC, Mahapatra AK, Mehta VS. Chronic subdural haematoma and the enigmatic eosinophil. Acta Neurochir (Wien) 2002; 144 (10) 983-988 discussion 988
Lee KS. Natural history of chronic subdural haematoma. Brain Inj 2004; 18 (04) 351-358
Weir B. Oncotic pressure of subdural fluids. J Neurosurg 1980; 53 (04) 512-515
Shaikh N, Masood I, Hanssens Y, Louon A, Hafiz A. Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: a case report. Surg Neurol Int 2010; 1: 27
Zakaraia AM, Adnan JS, Haspani MS, Naing NN, Abdullah JM. Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia: an analysis. Surg Neurol 2008; 69 (06) 608-615 discussion 616
Thapa A, Agrawal B. Mount Fuji sign in tension pneumocephalus. Indian J Neurotrauma 2009; 6: 161-162
Caron JL, Worthington C, Bertrand G. Tension pneumocephalus after evacuation of chronic subdural hematoma and subsequent treatment with continuous lumbar subarachnoid infusion and craniostomy drainage. Neurosurgery 1985; 16 (01) 107-110
Lavano A, Benvenuti D, Volpentesta G. et al Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma: report of seven cases. Clin Neurol Neurosurg 1990; 92 (01) 35-41
Hong W, Yoo C, Park C, Lee S. Two cases of delay tension pneumocephalus. J Korean Neurosurg Soc 2005; 37: 59-62
Eltorai IM, Montroy RE, Kaplan SL, Ho WH. Pneumocephalus secondary to cerebrospinal fluid leak associated with a lumbar pressure ulcer in a man with paraplegia. J Spinal Cord Med 2003; 26 (03) 262-269
Yamashita S, Tsuchimochi W, Yonekawa T, Kyoraku I, Shiomi K, Nakazato M. The Mount Fuji sign on MRI. Intern Med 2009; 48 (17) 1567-1568
Pop PM, Thompson JR, Zinke DE, Hasso AN, Hinshaw DB. Tension pneumocephalus. J Comput Assist Tomogr 1982; 6 (05) 894-901
Ishiwata Y, Fujitsu K, Sekino T. et al Subdural tension pneumocephalus following surgery for chronic subdural hematoma. J Neurosurg 1988; 68 (01) 58-61