gms | German Medical Science

Objective: Bedside percutaneous subdural tapping (BPST) in local anesthesia has proofed equally effective to placing subdural drains via extended burr-hole trephination. However, chronic subdural hematomas frequently consist of subacute parts with clots and septated compartments. In our institution BPST is the standard treatment of choice in any chronic subdural hematoma, enabling us to evaluate the effectiveness of BPST in this aforementioned subpopulation.

Method: All patients treated with BPST within the last eight years were reviewed. Patients were eligible for the retrospective analysis if digital CT data of the initial scan were available. The hematoma density was quantified by Hounsfield units. The treatment was assigned as successful when the hematoma associated neurological symptoms improved completely and the midline shift restored in follow-up CT scans. If improvement could not be achieved by up to three BPST on different days, subdural drains where placed by extended burr hole.

Results: 157 patients were enrolled in this study. The pre-treatment CT scans showed septated compartments in 40%, subacute clots in 46% and sedimentation in 37%. In 56% of the patients BPST resulted in complete improvement of neurological symptoms by performing one in 45%, two in 30% and three tappings in 25% of the patients. Septation, subacute clots or sedimentation were not associated with treatment failure of BPST (p=1.0, p=.6, p=.6, Fisher’s exact, respectively). Conversely maximum density of hematomas did not differ between successful and ineffective BPST (mean 66 vs. 68 HU, p=.76, t-test).

Conclusions: Bedsides percutaneous subdural tapping could be considered as first line treatment in any chronic subdural hematoma despite subacute clots or septation.