Experience with a Burr-hole Craniostomy for Chronic Subdural Hematoma


Authors: R. Kaiser 1;  L. Douda 1;  P. Waldauf 2;  L. Houšťava 1;  P. Haninec 1
Authors‘ workplace: 3. LF UK a FN Královské Vinohrady, Praha Neurochirurgická klinika 1;  3. LF UK a FN Královské Vinohrady, Praha Klinika anesteziologie a resuscitace 2
Published in: Cesk Slov Neurol N 2011; 74/107(5): 556-559
Category: Short Communication

Overview

Chronic subdural haematoma is a very common disease of advanced age. Although often considered a trivial affection, its treatment in frequent recurrence may be difficult and its course may be fatal even if mini-invasive methods are used. The most-often used technique is evacuation via a burr-hole craniostomy, increasingly also via a simple twist-drill cranio­stomy. We present our experience of a group of 180 patients and a total of 201 symptomatic haematomas treated primarily by evacuation and irrigation via a small, burr-hole cranio­stomy. Drainage was employed in most of the cases. Risk of recurrence of haematoma led to 14.9% of the cases being re-operated. Mortality was low: 0.5% of the patients died soon after the operation. The risk of the recurrence was higher in cases of septated hematoma.

Key words:
chronic subdural hematoma – burr-hole craniostomy – craniotomy


Sources

1. Crooks DA. Pathogenesis and biomechanics of traumatic intracranial haemorrhages. Virchows Arch A Pathol Anat Histopathol 1991; 418(6): 479–483.

2. Häckel M, Benes V jr. Diagnosis and therapy of chronic subdural hematoma. Rozhl Chir 1993; 72(3): 118–123.

3. Horn EM, Feiz-Erfan I, Bristol RE, Spetzler RF, Harrington TR. Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surg Neurol 2006; 65(2): 150–153.

4. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003; 74(7): 937–943.

5. Tsai TH, Lieu AS, Hwang SL, Huang TY, Hwang YF. A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitating factors and postoperative outcomes. J Trauma 2010; 68(3): 571–575.

6. Houdek M, Kala M, Heřman M. Interhemispheric subdural haematoma. Cesk Slov Neurol N 1996; 59/93(6): 338–340

7. Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 2001; 95(2): 256–262.

8. Senturk S, Guzel A, Bilici A, Takmaz I, Guzel E, Aluclu MU, Ceviz A. CT and MR imaging of chronic subdural hematomas: a comparative study. Swiss Med Wkly 2010; 140(23–24): 335–340.

9. Markwalder TM, Reulen HJ. Influence of neomembranous organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma – an analysis of 201 cases. Acta Neurochir (Wien) 1986; 79(2–4): 100–106.

10. Virchow R. Das Hämatom der Dura Mater. Verh Phys Med Ges Würzburg 1857; 7: 134–142.

11. Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma-craniotomy versus burr hole trepanation. Br J Neurosurg 2009; 23(6): 612–616.

12. Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases. J Clin Neurosci 2010; 17(4): 428–429.

13. Taussky P, Fandino J, Landolt H. Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg 2008; 22(2): 279–282.

14. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009; 374(9695): 1067–1073.

15. Gökmen M, Sucu HK, Ergin A, Gökmen A, Bezircio Lu H. Randomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas. Zentralbl Neurochir 2008; 69(3): 129–133.

16. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery 2007; 61(4): 794–797.

17. Lee JY, Ebel H, Ernestus RI, Klug N. Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary? Surg Neurol 2004; 61(6): 523–527.

18. Vaverka M, Kala M. Zkušenosti s léčbou chronického subdurálního hematomu dospělých. Cesk Slov Neurol N 1993; 56/89(4): 155–159.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2011 Issue 5

Most read in this issue
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account