Article
Chronic subdural hematoma: Predisposition, surgical options, recurrence rate, complications and outcome over a 7-year-period
Das chronische Subduralhämatom: Prädisposition, chirurgische Behandlungsoptionen, Rezidivrate, Komplikationen und klinische Ergebnisse über einem Zeitraum von 7 Jahren
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Authors
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M. Kromer
- Neurochirurgische Klinik, Johannes Wesling Klinikum, Minden
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U. Knappe
- Neurochirurgische Klinik, Johannes Wesling Klinikum, Minden
| Published: | May 30, 2008 |
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Outline
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Objective: The chronic subdural hematoma (CSDH) is one of the most common entities in daily neurosurgical practice. Several neurosurgical treatments (burr-hole craniotomy, craniectomy with membranectomy) are established. We evaluated factors of predisposition, recurrence rate, complications and results after surgical therapy.
Methods: Clinical, radiological and predisposing factors, complications, recurrence rate and outcome were retrospectively analysed in 209 patients treated between 2000–2007 (age 59–91 years, male:female = 118:91) with respect to the following surgical options: burr-hole craniotomy with a closed system drainage, “second” burr-hole drainage and craniectomy. The data were correlated 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 (172) had good recovery after burr-hole craniostomy with a closed system drainage which is the treatment of choice. Recurrence of CSDH was found in 36 patients within 8 weeks after the first operation; a second burr-hole (16 patients) or a craniectomy (26 patients) were 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 in 83%); thrombocytopenia and INR (prothrombin time, international normalized ratio) >1,25 (14%); brain atrophy/preexisting infarction (64%); persistence of subdural air after burr-hole treatment and interval from onset of symptoms to surgical treatment. Postoperative complications were: acute subdural hematoma (2%), subdural empyema (1%), convulsion (6%) and pneumonia (12%).
Conclusions: All patients with recurrence of CSDH had ASS and/or Clopidogrel. A pre-operative antagonistic treatment with DDAVP/Vasopressin (Minirin (R)) is necessary and may prevent complications. Normal coagulation parameters are important to improve surgical outcome. The influx of air in the subdural space has to be minimized, the instillation of normal saline is helpful.
