gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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

Meeting Abstract

Suche in Medline nach

  • corresponding author M. Kromer - Neurochirurgische Klinik, Klinikum Minden
  • G. Warnecke - Neurochirurgische Klinik, Klinikum Minden

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-11.02

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Veröffentlicht: 4. Mai 2005

© 2005 Kromer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.




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.


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.


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.


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.