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Indian Journal of Neurotrauma 2019; 16(01): 63-66
DOI: 10.1055/s-0039-1698715
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Neurotrauma Society of India

Demonstration of Brain Expansion in Cases of Chronic SDH during Admission Leads to Decreased Rates of Recurrence

Nishant S. Yagnick
1   Department of Neurosurgery, Paras Hospital, Gurugram, Haryana, India
,
Sandeep Moolchandani
1   Department of Neurosurgery, Paras Hospital, Gurugram, Haryana, India
,
Sumit Sinha
2   Department of Neurosurgery and Minimal Access Spine Surgery, Paras Hospital, Gurugram, Haryana, India
,
V. S. Mehta
3   Department of Neurosciences, Paras Hospital, Gurugram, Haryana, India
› Author Affiliations
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Publication History

received 04 September 2019

accepted 05 September 2019

Publication Date:
23 October 2019 (online)

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Abstract

While being considered a simple procedure among the wide spectrum of neurosurgical procedures, the surgical management of chronic subdural hematoma (SDH) still possesses a degree of variability. Present concepts of production versus absorption of chronic SDH fluid has led to practitioners differing in the use of drains, the treatment of inner membrane, the flushing of the subdural cavity, and the perioperative decision making for cases with comorbidities and a history of anticoagulant/antiplatelet usage. In this article, we present the management of chronic SDH over a period of 15 months using the principles followed at our center. In 60 patients of chronic SDH, with the use of drains, we waited for radiological demonstration of brain expansion before drain removal and discharge. In our experience, this has led to better prognostication and very low recurrence rates, particularly in patients with comorbidities and on anticoagulant/ antiplatelet medication.

Keywords

burr hole - chronic SDH - drains - imaging - treatment
 

  • References

  • 1 Kawaguchi R, Osuka K, Aoyama M, Miyachi S, Takayasu M. Expressions of eotaxin-3, interleukin-5, and eosinophil-derived neurotoxin in chronic subdural hematoma fluids. J Neurotrauma 2018; 35 (19) 2242-2249
    CrossrefPubMedSearch in Google Scholar
  • 2 Nagahori T, Nishijima M, Takaku A. Histological study of the outer membrane of chronic subdural hematoma: possible mechanism for expansion of hematoma cavity [in Japanese]. No Shinkei Geka 1993; 21 (08) 697-701
    PubMedSearch in Google Scholar
  • 3 Loh JK, Howng SL. Electron microscopic study on the outer membrane of chronic subdural hematoma. Kaohsiung J Med Sci 1998; 14 (01) 25-30
    PubMedSearch in Google Scholar
  • 4 Osuka K, Watanabe Y, Usuda N, Aoyama M, Takeuchi M, Takayasu M. Expression of autophagy signaling molecules in the outer membranes of chronic subdural hematomas. J Neurotrauma 2019; 36 (02) 403-407
    CrossrefPubMedSearch in Google Scholar
  • 5 Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 2017; 14 (01) 108
    CrossrefPubMedSearch in Google Scholar
  • 6 Thavara BD, Kidangan GS, Rajagopalawarrier B. Comparative study of single burr-hole craniostomy versus twist-drill craniostomy in patients with chronic subdural hematoma. Asian J Neurosurg 2019; 14 (02) 513-521
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Xu C, Chen B, Xue L. et al. Randomized controlled study on the curative effects of twist-drill craniotomy and burr-hole craniotomy in the treatment of chronic subdural hematoma. Exp Ther Med 2018; 16 (02) 959-965
    PubMedSearch in Google Scholar
  • 8 Goyal RK, Nayak B, Maharshi R, Bidhar DD, Panchal S, Pathak HC. Management of chronic subdural hematoma: burr hole versus twist drill - a prospective study. Asian J Neurosurg 2018; 13 (02) 319-323
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Wang K, Chen D, Cao X, Gao L. A prospective comparative study of twist drill craniostomy versus burr hole craniostomy in patients with chronic subdural hematoma. Turk Neurosurg 2017; 27 (01) 60-65
    PubMedSearch in Google Scholar
  • 10 Gökmen M, Sucu HK, Ergin A, Gökmen A, Bezircio Lu H. Randomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas. Zentralbl Neurochir 2008; 69 (03) 129-133
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Tommiska P, Lönnrot K, Raj R, Luostarinen T, Kivisaari R. Transition of a clinical practice to use of subdural drains after burr hole evacuation of chronic subdural hematoma: the Helsinki experience. World Neurosurg 2019; 129: e614-e626
    CrossrefPubMedSearch in Google Scholar
  • 12 Sivaraju L, Moorthy RK, Jeyaseelan V, Rajshekhar V. Routine placement of subdural drain after burr hole evacuation of chronic and subacute subdural hematoma: a contrarian evidence based approach. Neurosurg Rev 2018; 41 (01) 165-171
    CrossrefPubMedSearch in Google Scholar
  • 13 Chan DY, Woo PY, Mak CH. et al. Use of subdural drain for chronic subdural haematoma? A 4-year multi-centre observational study of 302 cases. J Clin Neurosci 2017; 36: 27-30
    CrossrefPubMedSearch in Google Scholar
  • 14 Ou Y, Dong J, Wu L. et al. An exhaustive drainage strategy in burr-hole craniostomy for chronic subdural hematoma. World Neurosurg 2019; S1878-8750 (19)30779-X
    PubMedSearch in Google Scholar