Background: Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial.
Object: The aim of this retrospective single-center study is to compare for the first time two surgical methods in the treatment of subdural hematoma that have been proven to be efficient in previous studies in a direct comparison.
Methods: We analyzed the data of 143 scSDHs in 113 patients undergoing surgery for subdural hematoma with placement of subperiosteal or subdural drainage after double burr-hole trepanation for hematoma evacuation.
Results: Overall, there were no statistically significant differences regarding general patient characteristics, preoperative and postoperative symptoms, postoperative hematoma remnant, rates of recurrences, mortality, complications, and outcome at discharge and at 3-month follow up between the groups. There was a close to significant tendency of lower mortality after placement of subperiosteal drainage system and a tendency towards lower rate of recurrent hematoma after placement of subdural drainage system.
Conclusions: Our study shows for the first time a direct comparison of two mainly used surgical techniques in the treatment of scSDH. Both methods proved to be highly effective, and general patient data, complications, outcome and mortality of both groups are equal or superior compared with previously published series. Because there is a clear tendency to less mortality and fewer serious complications, treatment with double burr-hole trepanation, irrigation, and placement of subperiosteal drainage is our treatment of choice in patients with predictable high risk of complications.
Department of Neurosurgery, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, 637000, China.
Background: The main surgical interventions for chronic subdural hematoma (CSDH) include craniotomy for hematoma evacuation, neuroendoscopic hematoma evacuation, and burr hole drainage.However, elderly patients often present with significant comorbidities, which limit their ability to tolerate general anesthesia and invasive surgical procedures.Minimally invasive soft-channel drainage under local anesthesia has emerged as a viable alternative, particularly suitable for elderly patients or those with high surgical risk.
A 68-year-old patient came to the emergency department complaining of headaches and general weakness for the past month. The patient is known to have myeloproliferative disease. Non-contrast computer tomography showed a hyperdense extra-axial collection in bilateral frontoparietal regions, which was presumed to be bilateral subdural hematoma as the initial diagnosis.
Background: Standard treatment for symptomatic chronic subdural hematoma (CSDH) is a burr-hole evacuation. However, in patients in whom surgical evacuation carries a very high risk, we do not have an established practice guideline.
Objective: To analyze the outcome of symptomatic CSDH treated only by tranexamic acid.
Introduction: Chronic subdural hematoma (CSDH) is characterized by the collection of blood beneath the dura mater. Traditional treatments involve surgical drainage of the hematoma, but recurrence rates can be high. A highly vascularized neo-membrane irrigated by the middle meningeal artery (MMA) may be involved in CSDH re-accumulation.
Objective: Subdural fluid collection is a common neurosurgical condition in the pediatric population. Patients requiring surgical intervention have historically been managed with subdural drains, subdural-subgaleal shunting, subdural-peritoneal shunting, and mini-craniotomies. An alternative procedure for patients with an open anterior fontanelle is bedside transfontanelle drainage.
