Artikel
Minimal invasive decompression of chronic subdural hematomas using hollow screws: therapeutic efficacy, patients' acceptance and quality of life
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Autoren
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S. Krieg
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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F. Aldinger
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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J. Gempt
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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M. Stoffel
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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B. Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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J. Kreutzer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
| Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: Chronic subdural hematoma (cSDH) is common in the elderly population and a major pathology in neurosurgery. Surgical treatment varies widely and is often characterized by repeated decompression widely in general anesthesia. For first and second line treatment we are using hollow screws, which are placed bed side under local anesthesia. In this study, we report on 351 cases of chronic subdural hematoma treated with hollow screws between 2006 and 2010.
Methods: Primary therapeutic efficacy was evaluated by reduction of cSDH on pre- and postoperative CT scans. Moreover, we investigated the number of operations until the cSDH was not evident any more. Furthermore correlations between treatment efficacy and predisposing factors such as anticoagulants or septation were examined. In addition patients were asked about their experience of an operation under local anesthetic and their current quality of life by using a questionnaire.
Results: In general, 77.2% of cases were adequately treated by a single operation with hollow screws. 17.4% of cases needed a second operation using hollow screws, whereas only 5.4% needed burr hole placement with membranectomy under general anesthesia. Comparing initial presence and absence of septation, 64.7% of cases were adequately treated by a single operation with hollow screws when the cSDH was septated, compared to 83.2% when there was no septation. 12.6% of cases needed a second operation using hollow screws when the cSDH was septated, compared to 10.4% when there was no septation, while 22.7% needed burr hole placement with membranectomy under general anesthesia when the cSDH was septated, compared to 6.4% when there was no septation.
The mean number of operation was 1.32 ± 0.60. This number decreased when the initial CT scans showed a hypodense hematoma and increased when the hematoma was hyperdense, as this is a sign of a subacute hematoma.
Although the mean age was 75.8 ± 13.2 years there were no severe operation-related complications such as acute subdural hematoma or infection.
Conclusions: Initial placement of hollow screws under local anesthesia is adequate treatment in most cases and should be favored as first-line treatment in these generally old and multi-morbid patients.
