gms | German Medical Science

Introduction: Techniques that promote continued drainage after the immediate procedure and that may thus reduce residual fluid and prevent reaccumulation of chronic subdural hematoma are well established. The most common procedure is to place a burr hole with a subdural drain, maintained for 24–48 hours. More than 70% of such treated patients show rest effusions in CT scan. About 30% do not improve or clinical deterioration occurs. Then, a second operation is necessary.

Materials and methods: Between 2000 and October 2008 471 operations on 364 patients with chronic subdural hematoma were done at our hospital. OP-indication, operation procedures and success were retrospectiveliy evaluated.

Results: The average age of all patients was 60±19 years and did not significantly differ for those patients, who had reaccumulation of subdural fluid (59±19 years).

253 patients underwent classical surgery with burr holes and subdural drains. In 56 cases (22,5%) a second or further operation was necessary because the patient did not recover or deteriorated. Furthermore, for 36 patients a craniotomywas initially planned to evacuate the subdural fluid, but 23 had to be treated with an treapanation because of intraoperative complications. 10 (28%) of these patients showed no recovery and had to be reoperated. However, 73 patients initially underwent subdural peritoneal shunt implantation. In these cases, only 8 patients (10,9%) had recurrence of effusions and had to undergo a revision.

Conclusion: Our data suggest that the safest treatment of chronic subdural hematoma is to initially implant a subdural peritoneal shunt in those cases if the hematoma has become rather fluid of it appears as a hygroma on CT scan.