Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients.
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Retrospective analysis of operative treatment of a series of 100 patients with subdural hematoma.
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This retrospective study of medical records, surgical protocols, patient observation cards, and imaging files of 100 patients treated for subdural hematoma analyzed the type of hematoma, patient age and sex, operative technique, neurological status, cause of injury, duration of hospital stay, mortality rate, and the number of and reasons for reoperations to determine the effects on treatment outcomes. The time between the head injury and onset of neurological symptoms was analyzed versus the type of hematoma determined from computed tomography (CT) scans. Acute hematomas accounted for 38% of the cases, with subacute hematomas representing 20%, and chronic ones accounting for 42%. In trauma patients, the mean time interval between the injury and onset of neurological symptoms was 0.38 days for acute hematomas, 13.8 days for subacute hematomas, and 23.75 days for chronic hematomas. Repeat surgery was carried out in 26% of the cases. Improvement was obtained in 44% of cases, deterioration in 20%, and no change in neurological status in 36%. Timing of the operations was between 15:00 and 23:00 in 45%, between 23:00 and 7:00 in 33%, and between 7:00 and 15:00 in 22%. The classification of hematomas based on CT presentation corresponds to the classification based on the time elapsed between injury and onset of symptoms, and appears to be appropriate and useful in everyday practice. No preceding injury was identified in 31.6% of acute hematomas, 50% of subacute hematomas, and 61.9% of chronic hematomas. Analysis of reoperations indicates that trepanation may be superior to craniotomy as primary surgery for subacute and chronic hematomas. Subdural hematoma surgeries take place at all times of the day, with most carried out outside the usual working hours. (+info)
Investigating the possibility and probability of perinatal subdural hematoma progressing to chronic subdural hematoma, with and without complications, in neonates, and its potential relationship to the misdiagnosis of abusive head trauma.
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Critical classification of craniostomy for chronic subdural hematoma; safer technique for hematoma aspiration.
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Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The "closed condition" represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The "open condition" includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the "open condition," shortens the operation time, and achieves good irrigation of the hematoma. (+info)
Acute subdural hematoma requiring surgery in the subacute or chronic stage.
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The aim of this study was to clarify the clinical characteristics and pathophysiology of conservatively treated cases of acute subdural hematoma (ASDH) that ultimately require surgery in the subacute or chronic stage, and devise an appropriate form of management for them. A total of 50 patients with ASDH were admitted to our institution during a 5-year period. Hematoma removal in the subacute or chronic stage was performed in 8 patients. The ASDH had been caused by a fall in 5 patients. Five patients had been treated with antiplatelet agents. Fluid-attenuated inversion recovery magnetic resonance (MR) imaging demonstrated an irregularly shaped hematoma with gyrus patterns in 4 of 5 patients. Diffusion-weighted MR imaging demonstrated a two-layered hematoma structure in 3 of 4 patients. The hematoma was removed via a craniotomy, a small craniotomy, and a burr hole in 1, 1, and 6 patients, respectively. At surgery in the craniotomy case, a solid clot was located beneath the dura, and a liquid hematoma was located close to the brain. After hematoma removal, no inner membrane was observed on the brain surface. One patient had typical chronic subdural hematoma in the subacute stage, and 2 patients had so-called subacute subdural hematoma (SASDH) in the chronic stage. Although the majority of such cases can be treated by burr-hole surgery, a small craniotomy or craniotomy ought to be considered as a further surgical option if SASDH is diagnosed on the basis of clinical and radiological data, especially diffusion-weighted MR imaging. (+info)
Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly.
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