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Chronic subdural haematoma: surgical treatment and outcome in 1000 cases
Miguel Gelabert-González1, Miguel Iglesias-Pais, Alfredo García-Allut
1Neurosurgical Service, Department of Surgery, Clinic Hospital of Santiago, University of Santiago de Compostela, La Choupana, 15706 Santiago de Compostela, Spain. cimigego@usc.es
Insights
This study analyzed 1000 patients with chronic subdural hematoma (CSDH). Older age and higher clinical grade on admission were linked to poorer outcomes after burr-hole craniotomy.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition.
- Understanding CSDH clinical features, imaging, and surgical outcomes is crucial.
Purpose of the Study:
- To evaluate clinical features, CT findings, and surgical results of CSDH.
- To identify factors influencing post-operative outcomes in CSDH patients.
Main Methods:
- Retrospective analysis of 1000 patients with 1097 CSDH.
- Treatment involved burr-hole craniotomy with closed-system drainage.
- Data collected from 1980-2002.
Main Results:
- Headache was the primary symptom in older patients (>70), while behavioral disturbance predominated in younger patients (<70).
- Post-operative complications occurred in 19.6% of patients, with a 2.1% in-hospital mortality rate.
- Advanced age (>70) and higher clinical grade on admission (grades 3-4) correlated with poor prognosis.
Conclusions:
- Burr-hole craniotomy with closed-system drainage is an effective CSDH treatment.
- Patient age and initial clinical severity are key prognostic indicators for CSDH.
- Further research can optimize CSDH management strategies.
Abstract:
Chronic subdural haematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice. To evaluate the clinical features, computed tomography findings, surgical results, and complications our series was statistically analysed to elucidate the factors affecting the post-operative outcome. A retrospective study (1980-2002) of the records of 1000 patients harbouring 1097 chronic subdural haematoma treated with burr-hole craniotomy with closed-system drainage was carried out. The series included 628 males and 372 females, age range 12-100 years, mean age 72.7+/-11.4 years. The mean interval from trauma to appearance of clinical symptoms was 49.1+/-7.4 days (15-751). The principal symptom was headache (29.7%) in the over 70s, and behavioural disturbance (33.8%) in the under 70s. The CSDH was right sided in 432 patients, left sided in 471, and bilateral in the remaining 97 cases. Post-operative complications occurred in 196 patients and 21 patients died in hospital. Poor prognosis was related to patient's age (>70) and clinical grade on admission (grades 0-2 versus grades 3-4).