Related Experiment Video
Updated: Jun 9, 2025
Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
Published on: June 18, 2021
Simultaneous and Consecutive Drainage of Bilateral Chronic Subdural Hematoma: A Randomized Controlled Trial
Omer Akar1, Hasan Kamil Sucu2, Selin Bozdag3
1Department of Neurosurgery, Izmir Cigli Training and Research Hospital.
Insights
Simultaneous or consecutive burr-hole craniostomy for bilateral chronic subdural hematoma (CSDH) showed similar treatment success rates. Surgeons can choose either technique based on their preference.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Bilateral chronic subdural hematoma (CSDH) poses a higher risk of brain herniation compared to unilateral cases.
- The management of bilateral CSDH requires careful consideration to prevent complications, especially temporal lobe herniation.
- The optimal surgical approach, simultaneous versus consecutive evacuation, remains a subject of debate.
Purpose of the Study:
- To compare the efficacy and safety of simultaneous burr-hole craniostomy versus consecutive burr-hole craniostomy for treating bilateral CSDH.
- To determine if consecutive evacuation increases the risk of brainstem complications.
- To evaluate treatment success rates, mortality, morbidity, and surgical complications between the two techniques.
Main Methods:
- A randomized controlled trial over 6.5 years involving patients with bilateral CSDH requiring surgical intervention.
- Patients were randomly assigned to either simultaneous evacuation (n=18) or consecutive evacuation (n=25).
- Outcomes assessed included Glasgow Coma Scale, Markwalder grade, mortality, morbidity, surgical complications, reoperation rates, and overall treatment success at 12 months post-discharge.
Main Results:
- No significant difference in treatment success rates was observed between the simultaneous and consecutive evacuation groups at any follow-up point.
- Treatment success rates were lower in patients with mixed-density hematomas and in female patients at 12 months.
- No significant difference in mortality, morbidity, or surgical complications was found between the two surgical approaches.
Conclusions:
- Both simultaneous and consecutive burr-hole craniostomy are effective and safe techniques for managing bilateral CSDH.
- The choice between simultaneous and consecutive evacuation can be left to the surgeon's discretion.
- Surgeons should consider patient factors like hematoma density and sex, which may influence long-term outcomes.
Abstract:
Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, particularly in elderly individuals. Although most patients present with unilateral CSDH, bilateral involvement is not rare. Furthermore, bilateral CSDHs are associated with rapid deterioration and poorer outcomes because of a higher risk of brain herniation than unilateral hematomas. The most contentious issue is the potential herniation of the medial temporal lobe, which remains on the unevacuated side during the brief interval between right and left procedures. We compared simultaneous burr-hole craniostomy with consecutive burr-hole craniostomy for treating bilateral CSDH and to determine whether consecutive evacuation is riskier in terms of brain stem complications.Over a 6.5-year period, patients with bilateral CSDH who had an indication for operation were allocated into two groups randomly. The first group (n = 18) underwent simultaneous evacuation, and the second group (n = 25) underwent consecutive evacuation. Glasgow Coma Scale and Markwalder grades were recorded during the postoperative period. Patients were followed up during the inpatient period and postoperatively at 1, 3, 6, and 12 months after discharge. Mortality, morbidity, surgical complications, reoperation, and, as a combination of all of these, treatment success rates were compared. Treatment success rates were worse in patients with mixed-density hematomas and in female patients at the end of 12 months, but there was no significant difference between the simultaneous and consecutive evacuation groups at any time. Therefore, the choice of technique can be decided by the surgeon.
