Clinical Analysis of Treatment of Chronic Subdural Hematoma.

Park, Se Hyuk; Kim, Young Soo; Chung, Sang Sup; Lee, Kyu Chang

Original Article

Journal of Korean Neurosurgical Society 1984;13(4): 669-679.

Se Hyuk Park, Young Soo Kim, Sang Sup Chung, Kyu Chang Lee

Department of Neurosurgery, Yonsei University, College of Medicine, Seoul, Korea.

ABSTRACT

The authors analyzed 103 cases of chronic subdural hematoma(SDH) treated in the department of Neurosurgery, Yonsei University Hospital from January 1976 to September 1983. All of the cases were operated on except a single case, which was treated conservatively. The results of the analysis are summarized as follows: 1) The chronic SDH occurred most frequently in the 5th decade, and 71.8% of the patients were older than their 4th decade. The chronic SDH were far more common in men(84.5%) than women(15.5%). 2) Seventy two patients(79.6%) had a history of previous head injury. Chronic alcoholism was noted in thirteen patients(12.6%). 3) Presenting symptoms and signs in decreasing order were headache(76.9%), motor weakness(44.7%), mental disturbance(43.7%), papilledema(42.7%), and vomiting(35%). 4) Brain CT scan was not only the most accurate diagnostic procedure but also important for planning operative intervention as well as evaluating the prognosis. Four patterns of CT densities were noted in chronic SDH;hypodense(43.3%), isodense(37.8%), hyperdense(13.5%), and mixed density(5.4%). Cerebral expansion rates decreased with age, which was less than 80% in patients over their 40s. The chronic SDH was found on the right side in 45.6% of cases and 41.8% on the left, while 12.6% of chronic SDH were bilateral. 5) Operative procedures in 102 cases, were as follows; 32 Simple burr hole closed drainage, 31 Simple burr hole open drainage, 31 craniotomy and membranectomy, and 10 craniectomy and membranectomy. In conclusion, simple burr hole closed system drainage is the most effective and the least invasive procedure for the treatment of chronic SDH. Membranectomy with craniotomy or craniectomy should be reserved for such cases as recollection of SDH, failure of brain expansion, solid hematoma, and extensive swelling of the white matter subjacent to the hematoma.

Key Words: Chronic subdural hematoma; Simple burr hole; Closed drainage; Brain CT scan