Catheter Drainage for Chronic Subdural Hematoma
Keywords:
Chronic Subdural Hematoma, Catheter Drainage, Glasgow Outcome ScoreAbstract
Objective: To evaluate the functional outcome of patients having chronic subdural hematoma (CSDH) in terms of Glasgow Outcome Scale subjected to single burr-hole craniostomy and catheter drainage without prior subdural space irrigation.
Materials and Methods: This study was performed in Neurosurgery Department, PGMI Lady Reading Hospital, Peshawar, Pakistan from January 01, 2016 to December 31, 2016. Through a Descriptive Case Series, 116 patients presenting with CSDH were included in the study in a consecutive manner, subjected to single burr hole craniostomy and catheter drainage and followed up for up to 06 weeks.
Results: The mean age group of the sample was 37.31 +/- 10.74 years, of which 69% were male and 31%female patients respectively. At the presentation, there were 37.06% of patients in Class I group with GCS13-14, 47.41% of patients in Class II group with GCS 9-12 and 15.52% of patients in Class III group with GCS 3-8. On follow up, Glasgow Outcome Score of the sample was 4.04 +/- 0.75, with 84.48% favorable and 15.52% unfavorable outcome respectively.
Conclusion: This study suggested that chronic subdural hematoma managed with single burr hole subdural catheter drainage is associated with a high frequency of a favorable outcome in terms of Glasgow Outcome Score. Admission Glasgow Coma Scale of less than 8 and advanced age are associated with lesser frequency of favorable outcome and more prone to unfavorable outcomes.
References
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2. Sousa BE, Brandao SFL, Tavares BC, Borges CBI, Neto FGN and Kessler MI. Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematoma in brasilia, brazil. BMC Surg. 2013; 13: 5.
3. Singh KM, Suryanarayanan B, Choudhary A, Prasad A, Singh S, Gupta NL. A prospective randomized study of drain versus no drain after burr-hole evacuation of chronic subdural hematoma. Neurol India, 2014; 62 (2): 169-74.
4. Chari A, Kolias GA, Santarius T, Bond S and Hutchinson JP. Twist drill craniostomy with hollow screws for evacuation of chronic subdural hematoma. J Neurosurg. 2014; 121: 176-83.
5. Lega CB, Danish FS, Malothra RN, Sonnad SS and Stein CS. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010; 113: 615-21.
6. Belkhair S, Pickett G. One versus double burr holes for treating chronic subdural hematoma Meta-Analysis. Can J Neurol Sci. 2013; 40: 56-60.
7. Latini FM, Fiore AC, Romano ML, Spadaro E, Zorrilla PJ, Gonorazky ES. Minimally invasive treatment of chronic subdural hematoma in adults. Results in 116 patients. Neurologia. 2012; 27 (1): 22-7.
8. Lee YG, Oh HC, Shim SY, Yoon HS, Park CH, Park OC, et al. Comparison of drainage volume of chronic subdural hematoma according to drainage catheter type. Yonsei Med J. 2013; 54 (5): 1091-7.
9. Rehman R, Khattak A, Azam F, Alam W, Ullah A. Outcome of chronic subdural hematoma patients treated by two burr holes method. GJMS. 2010; 8 (2): 161-5.
10. Ishibashi A, Yokokura Y and Adachi H. A comparative study of treatments for chronic subdual hematoma:Burr hole drainage versus Burr hole drainage with irrigation. Kurume Med J. 2011; 58: 35-9.
11. Matsumoto K, Akagi K, Abekura M, Ryujin H, Ohkawa M, Iwasa N, Akiyama C. Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage. Neurol Res. 1999; 21 (3): 277-80.
12. Antunes DG, Alliez RJ, Eva L, Reynier Y, Alliez B. Analysis of the surgical treatment of chronic subdural hematoma in 100 elderly patients. Arq Bras Neurocir. 2006; 25: 156–60.
13. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol. 1997 Sep; 48 (3): 220-5.
14. Foelholm R, Waltimo O. Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien). 1975; 32 (3-4): 247-50.
15. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol. 1997 May; 47 (5): 418-22.
16. Yasuda CL, Morita ME, Nishimori FY, Yasuda AM, Alves HL. [Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalities]. Arq Neuropsiquiatr. 2003 Dec; 61 (4): 1011-4.
17. Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ. The management of primary chronic subdural haematoma: A questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg. 2008; 22: 529?34.
18. Cenic A, Bhandari M, Reddy K. Management of chronic subdural hematoma: A national survey and literature review. Can J Neurol Sci. 2005; 32: 501?6.
19. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery, 2008 Dec; 63 (6): 1125-9.
20. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery, 2008 Dec; 63 (6): 1125-9.
21. LaLonde AA, Gardner WJ. Chronic subdural hematoma. Expansion of compressed cerebral hemisphere and relief of hypotension by spinal injection of physiologic saline solution. New Eng J Med. 1948; 239 (14): 493-6.
22. Svien HJ, Gelety JE. On the surgical management of encapsulated subdural hematoma: A comparison of the results of membranectomy and simple evacuation. J Neurosurg. 1964; 21 (3): 172-7.
23. Markwalder T-M, Heuler H-J. Influence of neomembranous organization, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma – An analysis of 201 cases. Acta Neurochirurgica. 1986; 79: 100-6.
24. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence-based review. J Neurol Neurosurg Psychiatr. 2003; 74: 937-43.
25. Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases. J Clin Neurosci. April 2010; 17 (4): 428-9.
26. Han HJ, Park CW, Kim EY, Yoo CJ, Kim YB. One vs. two burr holecraniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc. 2009; 46: 87-92.
27. Kubo S, Nakata H. Subdural hematoma recurrence. J Neurosurg. 2001; 94: 1023-4.
28. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurologia Medicochirurgica. 2001; 41: 382-6.
29. Rabow C. Chronic subdural hematoma. Acta Neurochirurgica. 2001; 143: 619.
30. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010; 113: 615-21.
31. Gökmen M, Sucu HK, Ergin A, Gökmen A, Bezircio Lu H. Randomized comparative study of burr?hole craniostomy versus twistdrill craniostomy; surgical management of unilateral hemisphericchronic subdural hematomas. Zentralbl Neurochir. 2008; 69: 129?33.
32. Krupa M. Comparison of two surgical methods as to early results inchronic subdural hematoma. Ann Acad Med Stetin. 2009; 55: 39?47.
33. Soto?Granados M. Treatment of chronic subdural hematoma through aburr hole. Cir Cir. 2010; 78: 203?7.
34. Khadka NK, Sharma GR, Roka YB, Kumar P, Bista P, AdhikariD,et al. Single burr hole drainage for chronic subdural haematoma. Nepal Med Coll J. 2008; 10: 254?7.
35. Taussky P, Fandino J, Landolt H. Number of burr holes as independentpredictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg. 2008; 22: 279?82.
36. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg. 1984 Aug; 61 (2): 263-8.
37. Zumofen D, Regli L, Levivier M, Krayenbühl N. Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system. Neurosurgery, 2009 Jun; 64 (6): 1116-21.
38. Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery, 1993 Jul; 33 (1): 67-72.
39. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg. 1986 Aug; 65 (2): 183-7.
40. Ramachandran R, Hegde T. Chronic subdural hematomas--causes of morbidity and mortality. Surg
Neurol. 2007 Apr; 67 (4): 367-72.
41. Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005 Apr; 107 (3) :223-9.
42. 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 Mar; 68 (3): 571-5.
43. Amirjamshidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, Shirani A, Asadollahi M, Aleali H. Outcomes and recurrence rates in chronic subdural haematoma.Br J Neurosurg. 2007 Jun; 21 (3): 272-5.
44. Amirjamshidi A, Abouzari M, Rashidi A. Glasgow Coma Scale on admission is correlated with postoperative Glasgow Outcome Scale in chronic subdural hematoma. J Clin Neurosci. 2007 Dec; 14 (12): 1240-1.
45. Kotwica Z, Brzezinski J. Clinical course and theresults of the treatment of unilateral chronic subdural Hematoma. Neurol Neurochir Pol. 1992; 1: 293-9.
46. Sakho Y, Kabre A, Badiane SB, Ba MC, Gueye M. Chronic subdural hematoma of the adult in Senegal. Dakar Med. 1991; 36: 94-104.
47. Busch G, Ramm K. Clinical studies on chronic subdural haematomas in 140 adults. Neurochirurgia (Stuttg). 1980; 23: 224-8.
48. Liliang PC, Tsai YD, Liang CL, Lee TC, Chen HJ. Chronic subdural haematoma in young and extremely aged adults: a comparative study of two age groups. Injury, 2002; 33: 345-8.
49. Giray S, Sarica FB, Sen O, KizilkilicO. Parkinsonian syndrome associated with subacute. subduralhaematoma and its effective surgical treatment: a case report. Neurol Neurochir Pol. 2009; 43: 289-92.
50. De-Araújo-Silva DO, Matis GK, Costa LF. Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old “horses” are not to be shot! Surg Neurol Int. 2012; 3: 150.
2. Sousa BE, Brandao SFL, Tavares BC, Borges CBI, Neto FGN and Kessler MI. Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematoma in brasilia, brazil. BMC Surg. 2013; 13: 5.
3. Singh KM, Suryanarayanan B, Choudhary A, Prasad A, Singh S, Gupta NL. A prospective randomized study of drain versus no drain after burr-hole evacuation of chronic subdural hematoma. Neurol India, 2014; 62 (2): 169-74.
4. Chari A, Kolias GA, Santarius T, Bond S and Hutchinson JP. Twist drill craniostomy with hollow screws for evacuation of chronic subdural hematoma. J Neurosurg. 2014; 121: 176-83.
5. Lega CB, Danish FS, Malothra RN, Sonnad SS and Stein CS. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010; 113: 615-21.
6. Belkhair S, Pickett G. One versus double burr holes for treating chronic subdural hematoma Meta-Analysis. Can J Neurol Sci. 2013; 40: 56-60.
7. Latini FM, Fiore AC, Romano ML, Spadaro E, Zorrilla PJ, Gonorazky ES. Minimally invasive treatment of chronic subdural hematoma in adults. Results in 116 patients. Neurologia. 2012; 27 (1): 22-7.
8. Lee YG, Oh HC, Shim SY, Yoon HS, Park CH, Park OC, et al. Comparison of drainage volume of chronic subdural hematoma according to drainage catheter type. Yonsei Med J. 2013; 54 (5): 1091-7.
9. Rehman R, Khattak A, Azam F, Alam W, Ullah A. Outcome of chronic subdural hematoma patients treated by two burr holes method. GJMS. 2010; 8 (2): 161-5.
10. Ishibashi A, Yokokura Y and Adachi H. A comparative study of treatments for chronic subdual hematoma:Burr hole drainage versus Burr hole drainage with irrigation. Kurume Med J. 2011; 58: 35-9.
11. Matsumoto K, Akagi K, Abekura M, Ryujin H, Ohkawa M, Iwasa N, Akiyama C. Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage. Neurol Res. 1999; 21 (3): 277-80.
12. Antunes DG, Alliez RJ, Eva L, Reynier Y, Alliez B. Analysis of the surgical treatment of chronic subdural hematoma in 100 elderly patients. Arq Bras Neurocir. 2006; 25: 156–60.
13. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol. 1997 Sep; 48 (3): 220-5.
14. Foelholm R, Waltimo O. Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien). 1975; 32 (3-4): 247-50.
15. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol. 1997 May; 47 (5): 418-22.
16. Yasuda CL, Morita ME, Nishimori FY, Yasuda AM, Alves HL. [Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalities]. Arq Neuropsiquiatr. 2003 Dec; 61 (4): 1011-4.
17. Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ. The management of primary chronic subdural haematoma: A questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg. 2008; 22: 529?34.
18. Cenic A, Bhandari M, Reddy K. Management of chronic subdural hematoma: A national survey and literature review. Can J Neurol Sci. 2005; 32: 501?6.
19. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery, 2008 Dec; 63 (6): 1125-9.
20. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery, 2008 Dec; 63 (6): 1125-9.
21. LaLonde AA, Gardner WJ. Chronic subdural hematoma. Expansion of compressed cerebral hemisphere and relief of hypotension by spinal injection of physiologic saline solution. New Eng J Med. 1948; 239 (14): 493-6.
22. Svien HJ, Gelety JE. On the surgical management of encapsulated subdural hematoma: A comparison of the results of membranectomy and simple evacuation. J Neurosurg. 1964; 21 (3): 172-7.
23. Markwalder T-M, Heuler H-J. Influence of neomembranous organization, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma – An analysis of 201 cases. Acta Neurochirurgica. 1986; 79: 100-6.
24. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence-based review. J Neurol Neurosurg Psychiatr. 2003; 74: 937-43.
25. Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases. J Clin Neurosci. April 2010; 17 (4): 428-9.
26. Han HJ, Park CW, Kim EY, Yoo CJ, Kim YB. One vs. two burr holecraniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc. 2009; 46: 87-92.
27. Kubo S, Nakata H. Subdural hematoma recurrence. J Neurosurg. 2001; 94: 1023-4.
28. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurologia Medicochirurgica. 2001; 41: 382-6.
29. Rabow C. Chronic subdural hematoma. Acta Neurochirurgica. 2001; 143: 619.
30. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010; 113: 615-21.
31. Gökmen M, Sucu HK, Ergin A, Gökmen A, Bezircio Lu H. Randomized comparative study of burr?hole craniostomy versus twistdrill craniostomy; surgical management of unilateral hemisphericchronic subdural hematomas. Zentralbl Neurochir. 2008; 69: 129?33.
32. Krupa M. Comparison of two surgical methods as to early results inchronic subdural hematoma. Ann Acad Med Stetin. 2009; 55: 39?47.
33. Soto?Granados M. Treatment of chronic subdural hematoma through aburr hole. Cir Cir. 2010; 78: 203?7.
34. Khadka NK, Sharma GR, Roka YB, Kumar P, Bista P, AdhikariD,et al. Single burr hole drainage for chronic subdural haematoma. Nepal Med Coll J. 2008; 10: 254?7.
35. Taussky P, Fandino J, Landolt H. Number of burr holes as independentpredictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg. 2008; 22: 279?82.
36. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg. 1984 Aug; 61 (2): 263-8.
37. Zumofen D, Regli L, Levivier M, Krayenbühl N. Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system. Neurosurgery, 2009 Jun; 64 (6): 1116-21.
38. Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery, 1993 Jul; 33 (1): 67-72.
39. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg. 1986 Aug; 65 (2): 183-7.
40. Ramachandran R, Hegde T. Chronic subdural hematomas--causes of morbidity and mortality. Surg
Neurol. 2007 Apr; 67 (4): 367-72.
41. Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005 Apr; 107 (3) :223-9.
42. 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 Mar; 68 (3): 571-5.
43. Amirjamshidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, Shirani A, Asadollahi M, Aleali H. Outcomes and recurrence rates in chronic subdural haematoma.Br J Neurosurg. 2007 Jun; 21 (3): 272-5.
44. Amirjamshidi A, Abouzari M, Rashidi A. Glasgow Coma Scale on admission is correlated with postoperative Glasgow Outcome Scale in chronic subdural hematoma. J Clin Neurosci. 2007 Dec; 14 (12): 1240-1.
45. Kotwica Z, Brzezinski J. Clinical course and theresults of the treatment of unilateral chronic subdural Hematoma. Neurol Neurochir Pol. 1992; 1: 293-9.
46. Sakho Y, Kabre A, Badiane SB, Ba MC, Gueye M. Chronic subdural hematoma of the adult in Senegal. Dakar Med. 1991; 36: 94-104.
47. Busch G, Ramm K. Clinical studies on chronic subdural haematomas in 140 adults. Neurochirurgia (Stuttg). 1980; 23: 224-8.
48. Liliang PC, Tsai YD, Liang CL, Lee TC, Chen HJ. Chronic subdural haematoma in young and extremely aged adults: a comparative study of two age groups. Injury, 2002; 33: 345-8.
49. Giray S, Sarica FB, Sen O, KizilkilicO. Parkinsonian syndrome associated with subacute. subduralhaematoma and its effective surgical treatment: a case report. Neurol Neurochir Pol. 2009; 43: 289-92.
50. De-Araújo-Silva DO, Matis GK, Costa LF. Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old “horses” are not to be shot! Surg Neurol Int. 2012; 3: 150.
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