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[Comparison of two surgical methods as to early results in chronic subdural hematoma]
1Oddzial Kliniczny Kliniki Neurochirurgii i Neurotraumatologii Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie ul. Botaniczna 3, 31-503 Kraków.
Objective:
Despite general agreement among neurosurgeons concerning operative treatment in chronic subdural hematoma (CSDH), the optimal procedure remains controversial. Two surgical approaches are available: evacuation of hematoma fluid by trepanation; craniotomy and removal of hematoma with surrounding membranes. The main goal of this study was to compare the results of treatment in CSDH depending on the method of surgery.
Material And Methods:
This retrospective study was done basing on case histories and computed tomography findings in 433 patients with CSDH operated between 1983 and 2003 at the Department ofNeurotraumatology, Jagiellonian University. Altogether, 495 neurosurgical procedures were done. Hematoma was managed by burr hole evacuation in 333 cases and by craniotomy in 162 cases.
Result:
Neurological grading on discharge indicated that trepanation produced significantly better results than craniotomy.
Conclusions:
(1) In comparison with literature data and by separate evaluation, the results of treatment in CSDH at the Department of Neurotraumatology were good in trepanation and craniotomy groups alike. (2) Literature data and case histories of the present study demonstrate that burr hole evacuation is the preferred method of treatment in CSDH. (3) In the overwhelming majority of cases, computed tomography fails to identify CSDH patients necessitating craniotomy.