gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Does anticoagulation therapy in patients with chronic subdural hematoma treated with twist drill trepanation without the use of a closed drainage system affect outcome?

Beeinflusst eine Antikoagulation bei Patienten mit chronisch subduralem Hämatom, die durch eine Twist drill trepanation ohne Verwendung eines geschlossenen Drainagesystems therapiert werden, das Outcome?

Meeting Abstract

  • corresponding author Ioannis Pechlivanis - Neurochirurgische Klinik, Ruhr-Universität Bochum, Bochum
  • M. Engelhardt - Neurochirurgische Klinik, Ruhr-Universität Bochum, Bochum
  • K. Schmieder - Neurochirurgische Klinik, Ruhr-Universität Bochum, Bochum
  • A. G. Harders - Neurochirurgische Klinik, Ruhr-Universität Bochum, Bochum

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 12.130

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0414.shtml

Veröffentlicht: 23. April 2004

© 2004 Pechlivanis et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, and often occurs in elderly patients. CSDHs develop after mild head injury, other risk factors include therapeutic anticoagulation and coagulopathies. Surgical treatment has been widely accepted as the most efficacious way to deal with CSDH. The aim of this prospective study was to evaluate the results after twist drill trepanation without the use of a closed drinage system in patients older than 70 years with therapeutic anticoagulation and coagulopathies.

Methods

Between May 2002 and October 2003, we treated 42 patients (20 women, 22 men) older than 70 years (mean 72 years) with chronic subdural hematoma with a twist-drill trepanation. In 14 (33%) patients therapeutic anticoagulation was done and in one patient (2,3%) a myeloproliferate syndrom with thrombopenia was present. On the base of a pre-op CT scan a 2,5 –3,0 mm twist drill trepanation frontally at the maximum expansion of the CSDH was done under local anaesthesia. The hematoma was evacuated using an Vialon IV Catheter.

Results

Aspirated volumes were between 10 and 170 ml in a single session in both groups of patients. No perioperative complications such as acute hematoma, infections or seizures were seen in all patients. One (7%) patient with warfarin died due to a postoperative cardiac arrest. In 24 (57%) patients, one evacuation was successful, 13 (31%) had two surgical procedures and 5 (12%) had to be treated more often with this method before success. A Robinson drainage had to be placed in 8 (19%) patients because of incomplete removal of the chronic subdural hematoma. In the group of patients who were treated with anticoagulopathies 8 (53%) patients underwent one, 4 (33%) patients two and one ( 7%) had 3 or more twist drill trepanations before successful treatment. Three (20%) patients of this group received a Robinson drainage. In all patients 24 (56%) had no symptoms and 13 (30%) had an improvement of symptoms whereas 3 (20%) patients of the anticoagulation group had no symptoms and 11 (73%) had an improvement of symptoms at discharge.

Conclusions

Twist drill trepanation without the use of a closed drainage system has a low risk of infection and is a fast way to treat most chronic subdural hematomas in the elderly. Especially in the group of the anticoagulated patients, twist drill trepanation is a successful treatment option in this high risk group of patients.