gms | German Medical Science

Objective: Techniques that promote continued drainage after the immediate procedure and that may thus reduce residual fluid and prevent reaccumulation of chronic subdural hematoma are well established. The most common procedure is to place a burr hole with a subdural drain, maintained for 24 - 48 hours. More than 70% of such treated patients show rest effusions in CT scan. About 30% do not improve or clinical deterioration occurs. Then, a second operation is necessary.

Method: Between 2002 and October 2010 471 operations on 364 patients with chronic subdural hematoma were done at our hospital. OP-indication, operation procedures and success were retrospectiveliy evaluated.

Results: The average age of all patients was 60±19 years and did not significantly differ for those patients, who had reaccumulation of subdural fluid (59±19 years). 253 patients underwent classical surgery with burr holes and subdural drains. In 56 cases (22,5%) a second or further operation was necessary due to patient did not recover. Furthermore 36 patients underwent craniotomy. 10 (27%) of these patients showed in control head computer tomography reacummulation of subdural hematoma and therefore needed a reoperation. 73 patients initially underwent subdural peritoneal shunt implantation. Only 8 of these patients (10,9%) had recurrence of effusions and had to undergo a revision.

Conclusions: According to our data the safest treatment of chronic subdural hematoma is to initially implant a subduro-peritoneal shunt. This method is especially indicated in elderly patient in order to avoid multiple reoperations. This indication is even stronger in those subjects, in whom the subdural effusions appear in computer tomography more as fluid-rich or hygroma. The exclusion criteria for the initial implantation of subduro-peritoneal shunt include children and patients with membrane abundant subdural effusions.