gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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

Meeting Abstract

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  • corresponding author M. Kromer - Neurochirurgische Klinik, Johannes Wesling Klinikum, Minden
  • U. Knappe - Neurochirurgische Klinik, Johannes Wesling Klinikum, Minden

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.14.04

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Kromer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.