Surgical Tactics in Chronic Subdural Hematomas

Zharikova E.V., Okutov V.D., Alguzhin K.N., Enaleev E.N.

City Clinical Hospital N 67, Moscow, Russia


The study goal has been obtaining more precise information on tactics of treatment in chronic subdural hematomas (CSH).

Material and Methods. The results of treatment of 90 cases with CSH, aged 28-92, were analyzed. There were 52 males and 38 females. The main cause of CSH was trauma, sustained 3 weeks - 6 months ago. Clear consciousness, topor, sopor and moderate-to-severe coma were watched in 11%, 10%, 39% and 30% of cases, respectively. Standard clinical-neurological examination with applying spiral CT (SCT) was carried out. A volume of CSH varied from 90 up to 190 ml. Dislocation of median structures was 5-28 mm. All the cases were operated on the first day after CSH diagnosis and verification of its volume with SCT. A method of choice was closed external drainage of CSH through one or two (57%) burr holes. Drainage on both sides was used in 4 cases. Sutures removal was followed by repeated closed external drainage in 10 cases. Operation was performed both under general and local anesthesia.

Results. The best restoration was observed after drainage of more than 70% of CSH volume during the first two days. Positive changes of a clinical picture always took the lead over those, seen in SCT-examination. Sometimes the latter became normal only 2-3 moths after operation. A state severity was estimated on the basis of Karnofsky scale. Good restoration was watched in 88 cases: 2 patients died.

Conclusion. Closed external drainage is an effective and little-invasive method of CSH treatment.