Post-Operative Complications of Surgery for Chronic Subdural Hematoma (SDH) and Prevention

A prospective study

  • Shahid Smaija 03008481914
  • Feroze Nawaz Department of Neurosurgery, Bahawal-Victoria Hospital
  • Sajjad Noor Department of Neurosurgery, Bahawal-Victoria Hospital
  • Habib Ullah Shahida Islam Medical College, Bahawalpur
  • Faisal Bokhari
  • Mumtaz Ahmad
Keywords: Chronic, Subdural Hematoma, Burr hole, Complications

Abstract

Objective:  The study aimed to determine the rate and type of complications during surgery for treatment of chronic subdural hematoma and assess ways for their prevention.

Material and Methods:  A total of 50 patients of chronic SDH were selected from the Neurosurgery Department of Bahawal Victoria Hospital. Patients were treated surgically with a single burr hole evacuation under local anesthesia, introduced a subdural drain, nursed in a head-down position for 24 hours, and given plenty of fluids orally and intravenous route. The surgical technique involved a formation of a single burr hole at the point of maximum density.

Results:  Out of 50, 43 patients recovered smoothly postoperatively and discharged on the 7th postoperative day. Two patients were re-operated due to inadequate evacuation or reaccumulation. One patient developed subdural empyema post-operatively and expired in spite of good antibiotic cover. In one patient subdural drain penetrated the brain parenchyma resulting in dysphasia. Another patient formed an intracerebral hematoma due to irrigation of the cavity with pressure. One patient with GCS 4/15 developed seizures postoperatively and expired after one hour. One patient developed gross subdural tension pneumocephalus after removing the subdural drain was re-operated and recovered.

Conclusion:  Single burr hole evacuation of chronic SDH under local anesthesia is the most accepted surgical treatment. Using proper aseptic surgical techniques, the introduction of the minimum necessary length of the subdural catheter to avoid penetration into the brain parenchyma, followed by careful irrigation of the subdural cavity can help prevent complications.

References

1. Mukhtiar Ahmed1, Fauzia Sajjad2, Ajmal Khan3, Talha Abass4,Hamid Akbar5& Khawar Anwar.Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma Pak. J. of Neurol. Surg. –2020–24 (4): 369-375
2. .NAQIB ULLAH ACHAKZAI, IRFAN ADIL, SALEEM KHAN Outcome of Surgical Management ofChronic Subdural Hematoma Pakistan Pak. J. of Neurol. Surg. –Vol. 22, No. 2, Apr. –Jun., 2018-61-ORIGINAL ARTICLE
3. Outcome of Chronic Subdural Hematoma Treated with and without External Drainage. Eastern Green Neurosurgery, 2020; 2 (1): 30-34.
4. Rashid, S. M., Deliran, S. S., Dekker, M. C. J., & Howlett, W. P. Chronic subdural hematomas: a case series from the medical ward of a north Tanzanian referral hospital. Egyptian Journal of Neurosurgery, 2019; 34 (1): 29.
5. Edlmann, E., Giorgi-Coll, S., Whitfield, P. C., Carpenter, K. L., & Hutchinson, P. J. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. Journal of neuroinflammation, 2017; 14 (1): 1-13.
6. Tayfun Hakan, Ozkan Ates et al. Chronic Subdural hematomas in adults: A Review of Surgically Treated 60 Cases. Journal of Neurological Sciences (Turkish) Norol Bild 16: 4, 1999.
7. R.A. Beatty, Subdural Haematoms in the elderly: Experience with treatment by trephine craniotomy and not closing the dura or replacing the bone plate. British Journal of Neurosurgery 1999; 13(I): 60-64.
8. Tom Sealetta, MD. Subdural Hematoma. emdicine free online topic 560.htm. 08/07/2000.
9. G.Stroobandt, P.Fransen, C.Thauvoy, and E.Menard. Pathogenetic Factors in Pak. J. of Neurol. Surg. –Vol. 22, No. 2, Apr. –Jun., 2018-61-ORIGINAL ARTICLEOutcome of Surgical Management ofChronic Subdural HematomaNAQIB ULLAH ACHAKZAI, IRFAN ADIL, SALEEM KHANDepartment of Neurosurgery, Bolan Medical College/Sandeman Provincial Teaching Hospital, Quetta 87300 PakistanNeurochirurgica (Wien) (1995) 137: 6-14.
10. Mukesh Misra, M.D, Jose L. Salazar, M.D F.A.C.S, and Donna M. Bloom, R.N., B.S.N. Subdural-Peritoneal Shunt: Treatment for Bilateral Chronic Subdural Hematoma. Surg Neurol 1996; 46: 378-83.
11. Komiyama, M.D., Toshihiro Yasui, M.D. Katsuhiko Tamura, M.D er al. Chronic Subdural Hematoma Associated with Middle Meningeal Arteriovenous Fistula Treated by a Combination of Emblization and Buit Hole Drainage. Surg Neurol 1994; 42: 316-9.
12. Robert A. Sabo, M.D William C.Hanigan, M.D., Ph.D, and Jean C Aldag, Ph.D. Chronic Subdural Hematomas and Seizures: The Role of Prophylactic Anticonvulsive Medication. Surg. Neurol, 1995; 43: 579-82.
13. R.G Wiest. J.M Burgunder, and J.K Krauss. Chronic Subdural Haematomas and Parkinsosnian Syndromes. Acta Neurochirurgica (Wien) (1999) 141: 753-758.
14. Ralf-Ingo Ernestus, M.D., Piotr Beldzinski, M.D, Heinrich Lanfermann et al. Chronic Subdural Hematoma: Surgical Treatment and Outcome in 104 Patients. Surg Neurol, 1997; 48: 220-5.
15. Deepak Awasthi, M.D Jay Howington, MD and Greg Dowd, MD. Chronic Subdural Hematoma- To Drain or Not to Drain? Http://www.medschool.islam.edu/nsurgery/chsdh.html.
16. Zafar, Iqbal, Muhammad Yasin, shahid Rafique, Muhammad Afzal. Management of Chronic Subdural Haematoma A Study of 31 Cases. Pakistan journal of Neurology. Jan-Jun 1998; Volume 4, Number 1, 25-29
17. R.S Maurice-Wiliams, Chronic Subdural Haematoma an every day problem for the neurosurgeon. British Journal of Neurosurgery 1999; 13(6): 547-549.
18. Jacek Ouschowski. Chronic Subdural Haematoma. Neuro Section G Head Trauma Chapter 112, 545-7
19. S.Spektor, E.Ashkenazi, and Z. Israel. Internation Haemorrhage from a Meningioma in a patient Receiving Aspirin Prophylaxis: a Case Report. Acta Neurochirurgica (Wien) (1995) 134: 51-53
20. Fogelholm R. Waltion O. Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien) 1978; 32:247-250.
21. Michael L.J Apuzzo, M.D Chronic Subdural Haematoma in Adults. Brain Surgery, Complication Avoidance and Management Volume 2, 1993: 1299-1314.
22. Fobben ES, Grossmand RI, Atlas, et al. MR characteristics of subdural hematomas and hygromss at 1.5 T. Aim J Neurororadi 1989:153:589-595.
23. Sipponen JT, Sepponen RE, Sivula A. Chronic Subdural hematoma: demonstration by magnetic resonance. Radiology 1984; 150:79-85.
24. Thulborn KR, Atlas SW. Intracranial hemmorrage. In Atlas SW (ed); Magnetic Resonance Imaging of the Brain and Spine. New Yourk:Raven Press, 1991 pp 175-222.
25. Virchow R: (1857) Quoted by G. Stroobandt, P.Fransen, C. Thauvoy, and E.Menard. Pathogentic Factors in Chronic Subdural Haematoma and Causes of Recurrence After Drainage. Acta Neurochir (Wien) (1995) 137: 6-14.
26. Trotter W: (1914) Quoted By G. Stroobandt, P.Fransen, C. Thauvoy, and E.Menard. Pathogentic Factors in Chronic Subdural Haematoma and Causes of Recurrence After Drainage. Acta Neurochir (Wien) (1995) 137: 6-14.
27. Virchow R: (1857) Quoted by Dieter Hellwig, Thomas J.Kuhn, Bernhard L.Bauer, and Elisabeth List-Hellwig. Endoscopic Treatment of Sepated Chronic Subdural Haematoma. Surg Neurol 1996; 45: 272-7.
28. Dieter Hellwig, Thomas J.Kuhn, Bernhard L.Bauer, and Elisabeth List- Hellwig. Endoscopic Treatment of Sepated Chronic Subdural Haematoma. Surg Neurol 1996; 45: 272-7.
29. Trotter W: (1914) Quoted by Dieter Hellwig, Thomas J.Kuhn, Bernhard L.Bauer, and Elisabeth List- Hellwig. Endoscopic Treatment of Sepated Chronic Subdural Haematoma. Surg Neurol 1996; 45: 272-7.
30. McKissock W, Richardson A (1960), Quoted by Dieter Hellwig, Thomas J.Kuhn, Bernhard L.Bauer, and Elisabeth List- Hellwig. Endoscopic Treatment of Sepated Chronic Subdural Haematoma. Surg Neurol 1996; 45: 272-7.
31. Svien HJ, Gelety JE. (1964) Quoted by Dieter Hellwig, Thomas J.Kuhn, Bernhard L.Bauer, and Elisabeth List- Hellwig. Endoscopic Treatment of Sepated Chronic Subdural Haematoma. Surg Neurol 1996; 45: 272-7.
32. C.Smely, A.Madlinger, and R.Scheremet. Chronic Subdural Haematoma-a Comparison of Two Different Treatment Modalities. Acta Neurochirurgica (Wien) (1997) 139: 818-826.
33. P.Melegard and O.Wisten. Operations and Re-Operations for Chronic Subdural Haematomas During a 25-Year Period in a Well Defined Population. Acta Neurochirurgica (Wien) (1996) 138: 708-713.
34. Bender MB, Christoff N. Nonsurgical treatment of subdurl hemato-mas. Arch Neurol 1974; 31:73-79.
35. Steimle R. Jacquet G, Godard J, et al. Hematome sous-dural chronique des personnes agees et scanner: etude de 80 cas. Chirugie 1990; 116:160-167.
36. Mckissock W, Richardson A, Bloom WH. Subdural hematoma: a review of 389 cases. Lancet 1960; 1:1365-1369.
37. Irfan Malik, Khaliq-uz-Zaman (PIMZ Islamabad) 1998---Dissertation (The Proposed Study on Chronic Subdural hematoma in Adults) Library C.P.S.P Karachi Pakistan.
38. Krupp-WF; Jans-PJ (1995) Treatment of Chronic Subdural hematoma with burr-hole craniostomy and closed drainage. Br-J-Neursug. 1995; 9(5)619-27
39. Fukui-S(1993) Evaluation of Surgical Treatment of Chronic Subdural hematoma in extremely aged (Over 80 Years Old) patients. No-To-Shinkei. 1993 May; 45(5): 449-53.
40. Yonezawa-K; Kim-S Tanaka-M. Acute epidural Hematoma following evacuation of Chronic Subdural hematoma with continuous closed system drainage. No-Shinkei-Geka. 1992 Sep; 20(9): 1013-6.
41. A.Weisse and J,Berney. Chronic Subdural hematoma results of a Closed Drainage Method in Adults. Acta Neurochirurgica (Wien) (1994) 127: 37-40.
Published
2021-06-14
Section
Original Articles