OPTIMUM MANAGEMNT OF CHRONIC SUBDURAL HEMATOMA:EVALUATION OF VARIOUS SURGICAL OPTIONS FOR THE TREATMENT OF CHRONIC SUBDURAL HEMATOMA
Objective: To evaluate the various surgical treatment options and find out the best possible treament for chronic subdural
Methodology: This descriptive study was conducted in the Department of Neurosurgery, Hayatabad Medical Complex,
Peshawar from February 2009 to 30th January 20112. CSDH was diagnosed on CT scan brain. Patients below sixteen
years of age were excluded from the study. Surgical techniques used were two burr holes aspiration, craniectomy and
in recurrent cases craniotomies. Patients were evaluated for improvement in neurological status and development of
any complications. Data was analyzed in SPSS 16.
Results: Total 161 patients were operated for CSDH during this study period. 125(77.64.0%) males and 36 (21.36%)
females with the mean age of 61+ 2.23 years (22-74 years) .Causes of CSDH was fall in 65 (40.37%) and road traffic
accidents in 49 (30.43%) patients. Forty eight (29.81%) patients did not remember any head trauma. Most common presentations
include headache in 105(65.21 %),Hemiparesis in 64(39.75%)patients, altered sensorium in 52 (32.75%),amnesia
in 23(14.28%)patients, fits in 21(13.04%) patients, dysphasia in 14(8.70%) patients and facial palsy in 10(6.21%)
patients. CSDH was unilateral in 133(82.61%) patients and bilateral in 28 (17.39%) patients. Two burr-hole aspirations
were performed in 98 patients (Group 1). And in 52 patients enlarged craniectomy, with a diameter of about 30 mm
(Group 2) was performed. Complications included recollection in 8(12.88%),intracerebral bleed in 5(8.05%),seizures in
4(6.66%),pneumocephalous in 3(4.83%),wound infection in 6(9.66%) and subdural empyema in 2(3.22%) patients. Two
patients (3.22%) died in postoperative period. Twenty six patients needed re-exploration for recurrences. Craniotomy
was performed in 11 patients after two recurrences.
Conclusion: In properly indicated cases of chronic subdural hematoma, surgical treatment has good outcome .For the
initial treatment of chronic subdural hematoma, better option is two burr-hole drainage with irrigation of the hematoma
cavity .Craniectomy has relatively higher re accumulation rate. In recurrent cases craniotomy and membranectomy is
appropriate treatment option.
Key Words:Chronic subdural hematoma, Two burr holes evacuation, Craniectomy, Craniotomy, Outcome.
Abreviations: CSDH: Chronic subdural hematoma