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Accessing the Subdural Space of the Rodent Spinal Cord for Treatment Delivery
Published on: August 8, 2025
Variation of Ventricular Size after Surgical Treatment of Chronic Subdural Hematoma
Abad Cherif El Asri1,2, Mohammed Benzagmout2, Khalid Chakour2
1Department of Neurosurgery, Military Hospital, Rabat, Morocco.
Insights
This study found that delayed CT scans after surgery for chronic subdural hematoma (CSDH) showed improved ventricular size compared to early scans. Evans
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Chronic subdural hematoma (CSDH) is typically treated with surgical removal.
- Post-operative CT scans may show residual hematoma, raising concerns about surgical success.
- Assessing changes in ventricular size is crucial for evaluating CSDH treatment outcomes.
Purpose of the Study:
- To evaluate ventricular size changes before and after CSDH surgery.
- To investigate the relationship between ventricular size and residual hematoma post-surgery.
- To compare the efficacy of early versus delayed post-operative CT scans in assessing CSDH treatment.
Main Methods:
- A prospective study involving 63 patients undergoing burr-hole drainage for CSDH.
- Patients were divided into two groups: early (≤3 days) and delayed (4-7 days) post-operative CT scan control.
- Ventricular size was measured using Evans' index.
Main Results:
- No significant difference in preoperative hematoma thickness or Evans' index between groups.
- Postoperative residual hematoma thickness was similar in both groups (7.7 mm vs. 8.4 mm).
- Delayed CT scan group showed a statistically significant improvement in Evans' index (32.1%) compared to the early group (28.5%).
Conclusions:
- Evans' index is a simple and effective method for assessing ventricular size changes post-CSDH surgery.
- Delayed CT scan control may provide a better assessment of ventricular recovery after CSDH drainage.
- Early detection of residual collection does not necessarily indicate surgical failure when considering ventricular size changes.
Background:
Surgical removal is the treatment of choice for chronic subdural hematoma (CSDH). Despite clinical improvement after surgery, computed tomography (CT) scan control often showed residual collection, which may discuss the possibility of failed surgery. The aim of this study is the assessment of ventricular size before and after surgery and to study its relation with residual hematoma.
Methods:
In this prospective study (2013-2016), 63 patients who had burr-hole drainage of CSDH were sequentially allocated to either two groups; Group 1 with CT scan control under the 3rd day of surgery and Group 2 with delayed CT scan control (from 4th to 7th day). Linear measure of ventricular size was assessed by Evans' index. We reviewed and analyzed the data between both groups.
Results:
There were 33 patients in Group 1 and 30 patients in Group 2. Preoperatively, the average thickness of hematoma was 20.5 mm in Group 1 versus 19.9 mm in Group 2 (P = 0.67); the mean midline shift was 8.5 mm in each group; Evans' index was 26.7% in Group 1 and 27% in Group 2 (P = 0.7). Postoperatively, the mean thickness of the residual hematoma was 7.7 mm in Group 1 and 8.4 mm in Group 2 (P = 0.57); the mean midline shift was 3.3 mm in Group 1 and 1.9 mm in Group 2 (P = 0.08); Evan's index was 28.5% in Group 1 and 32.1% in Group 2 (P = 0.002).
Conclusion:
The adoption of Evans' index, for assessing the variation of ventricular size after surgery, by neurosurgeons appears to be a good and simple method for evaluation and following the success of surgical removal of CSDH, despite the observation of some residual collection in early CT scan control.
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