Management of Chronic Subdural Hematoma: A Rural Institutional Experience of 98 Patients
Journal Title: Journal of Medical Science And clinical Research - Year 2014, Vol 2, Issue 12
Abstract
BACKGROUND: Chronic subdural hematoma is a well known traumatic head injury in elderly patients. It has good prognosis if treated surgically in time. There are many operative interventional techniques for the treatment of CSDH. Burr hole craniostomy is the method of choice for evacuation of CSDH. It is the simplest and safest method with low morbidity and mortality, although it has a recurrence rate from 9.2% to 26.5%. The aim of this study is to see the effectiveness of single burr hole craniostomy without using any subdural drain. METHODS: 98 patients of CSDH admitted during a period from August 2011 to November 2014 were included in the study. Clinical assessment was done by GCS and radiological assessment was done by CT scan. All patients were operated by making a single burr hole at maximum thickness of CSDH. Thorough saline irrigation was done until returning fluid became clear. Multiple membranes were opened up widely by using bipolar coagulation. Subdural cavity was refilled with saline and wound closed without any drain. RESULTS: Only 2% patients had recurrence of CSDH. They were re-operated by using same burr hole. Both were improved after re-operation. Four patients readmitted with in 2 month of discharge with headache and hemi paresis. CSDH was diagnosed on CT. Two of them having history of repeated falls due to drug addiction and rest of two were on antiplatelets medication with deranged coagulation profile. CONCLUSION: In many studies use of close suction drain was recommended in CSDH for reducing the recurrence. Closed suction drain was not used in this study and recurrence rate was only 2%. So the results were in favour of making single burr hole craniostomy without any drain for the management of CSDH.
Authors and Affiliations
Dheer Singh
Keywords
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