gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Does internal hematoma architecture and extension of chronic subdural hematomas influence the rate of recurrence after bedside twist drill evacuation?

Meeting Abstract

  • R. Burger - Klinik für Neurochirurgie, Krankenhaus Nordstadt, Hannover
  • B. Schönnagel - Klinik für Neurochirurgie, Universitätsklinikum Göttingen
  • S. Pilgram - Klinik für Neurochirurgie, Universitätsklinikum Göttingen
  • V. Rohde - Klinik für Neurochirurgie, Universitätsklinikum Göttingen

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.08-04

doi: 10.3205/09dgnc224, urn:nbn:de:0183-09dgnc2247

Published: May 20, 2009

© 2009 Burger 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: Correlation between internal architecture/ extension of hematomas and recurrence rate after bedside twist drill evacuation of chronic subdural hematomas.

Methods: Chronic subdural hematomas (cSDH) were evacuated by bedside twist drill evacuation in local anaesthesia in 37 pts. (75 ± 6 yrs.; male/ female, 2:1) with unilateral (n=20) or bilateral (n=17) cSDH. CAT scans before and after hematoma evacuation were completed in 31 of 37 pts. and classified for internal architecture (homogeneous, laminar, separated, gradation and trabecular stage) and intracranial extension (convexity, cranial base, interhemispheric extension) according to Nakaguchi et al.. Recurrence rate of hematomas, the incidence of reoperation, days in hospital and outcome (Barthel Index) were assessed.

Results: A total of 45 hematomas were evacuated in 37 pts. A bilateral cSDH evacuation was performed in 8/17 pts. In 60% of the pts. at least 1–3 reoperations were necessary due to deterioration (58 %), persistent neurological deficit (15 %) or extension of hematoma in a follow-up CAT scan (27 %). Homogenous or laminar cSDH types rarely required a reoperation (22 %), while hematomas in the gradation and separated stage had to be reoperated in 70 % and 100 %. Reoperation rate was 2,25 in the separated and 1,3 in the gradation type. Consequently separated cSDH genrally had to be reoperated with burr hole trephination and drainage. Trabecular cSDH had to be reoperated in 57 %. The incidence of reoperations clearly correlated with intracranial extension of cSDH, days in hospital and Barthel Index after 6 months.

Conclusions: CSDH’s of the homogenous and laminar type are easy to treat by bedside twist drill manoevers while cSDH in the separated and gradation stage should be evacuated by burr hole trephination and drainage to reduce days in hospital and improve outcome.