Chronic Subdural Hematomas: Principles of Surgical and Conservative Treatment

G.G. Shaginyan, M.I. Baichorov, V.L. Smirnov, V.L. Bachursky, M.V. Lyadova

(Pirogov Municipal Clinical Hospital N1, Moscow )

The goal of the present report is to analyze tactics of treatment and outcomes of patients with chronic subdural hematomas (CSH) from the point of view of a clinical course phase, localization and size of hematoma.

A number of patients with CSH, treated in Pirogov Clinical Municipal Hospital N 1 (Moscow) in 1998-2001, was equal to 57. Their age varied from 17 up to 87. Besides neurologic examination, basic methods of diagnosis included X-ray of the skull, echoencephaloscopy, CT or MRI of the brain. A state on admission was as follows: a stage of clinical compensation and a level of consciousness, equal 13-15 according to the Glasgow Coma Scale - 32 cases (group I), a subcompensation stage and a score of 9-12 according to the above Scale - 20 patients (group II), a decompensation stage and a score of 3-8 - 5 cases (group III). There were 7 patients with repeated craniocerebral trauma, which resulted in sub- or decompensation of patients' state.

Cases of group I were delivered with CSH, verified by CT or MRI examination. They were treated mainly with the help of closed external drainage (CED). Control CT or MRI examinations of the brain confirmed complete recovery during 0.5-2 months. There were no recurrences or complications in this group.

Cases of group II had a phase of clinical subcompensation on admission. CT or MRI examinations allowed to diagnose CSH in 8 of them. It was revealed during surgical intervention in 12 cases. When CSH was diagnosed by CT or MRI, CED of hematoma was used. One patient, treated by this method, had relapse of hematoma. If patients were admitted without data of CT or MRI examinations, resecting trephination of the skull with removal of a fluid part of hematoma and drainage of a subdural space were performed. There were 5 recurrences of hematoma, which demanded repeated surgical intervention. All cases remained alive.

Patients of group III, delivered in a stage of clinical decompensation, had life-saving operations. There were 4 cases with repeated craniocerebral trauma and a clinical picture of acute sub- or epidural hematoma. All patients underwent decompressive trephination of the skull with elimination of both acute and chronic subdural hematomas and total removal of a capsule. There were 2 fatal outcomes.