Article
Chronic subdural hematoma: predisposition, surgical treatment, recurrence rate, complications and outcome in a community hospital
Das chronisch subdurale Hämatom: Prädisposition, chirurgische Behandlung, Rezidivrate, Komplikationen und Outcome in einem Krankenhaus der regionalen Versorgung
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Authors
Published: | May 4, 2005 |
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Outline
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Objective
The chronic subdural hematoma (CSDH) is one of the most common neurosurgical entities in daily practice. The diagnosis and neurosurgical treatment (burr-hole craniostomie, craniectomie with membranectomie) are established. This study evaluated the factors of predisposition, recurrence rate, complications and results after surgical therapy of an illness of the advanced age.
Methods
The clinical, radiological, predisposing and operative factors, complications, recurrence rate and outcome were retrospectively analysed in 129 patients with CSDH treated with burr-hole craniostomie with closed system drainage, “second” burr-whole drainage and craniectomie between 2000 and 2004. The data were evaluated with age, sex, history of head injury, anticoagulation, bleeding tendency and mode of living; computed tomography (CT) findings such as brain atrophy, postoperative residual air and re-expansion of the brain.
Results
Most patients had good recovery after burr-hole craniostomie with closed system drainage (82%), wich is the treatment of choise. Recurrence of CSDH was recognized in 22 patients (17%) in 8 weeks after first operation; second burr-hole (8 patients) or craniectomie (14 patients) was necessary. No patient died. Predisposing factors for CSDH and recurrence of CSDH are: Mild head injury in combination with age >80 years (95%); anticoagulation (ASS and/or Clopidogrel was documented in 83%); thrombocytopenia and INR >1,25 (14%); brain atrophy/preexisting infarction (64%); persistence of subdural air after burr-hole treatment and interval from onset of symptomes to surgical treatment. Postoperative complications were: acute subdural hematoma (2%), subdural empyema (1%), pneumonia (12%). All patients with recurrence of CSDH had ASS and/or Clopidogrel.
In comparison with data of the early 80th the incidence of CSDH has increased.
Conclusions
A pre-operative antagonistic treatment with DAVP/Vasopressin (Minirin®) is necessary and may prevent from complications if Patients were pretreated with ASS and/or Clopidogrel. Normal hemostasis parameters are important to improve the surgical outcome. The influx of air in the subdural space had to be minimized, the instillation of normal saline is helpful. A possible reason for the increase of CSDH might be the aggressive anticoagulation with ASS and/or Clopodigrel to protect the elderly from strokes and myocardial infarction.