Skip to main content

Advertisement

SpringerLink
Log in

Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Background. The study was conducted to determine the causative factors in the postoperative recurrence (PR) of chronic subdural haematomas (CSDHs) and to evaluate the efficacy of surgery in adults enrolled in this trial.

Methods. 99 patients with 121 CSDHs, who were operated on between January 1999 and December 2001, were studied. We evaluated the PR rate related to anamnestic, clinical, surgical and neuroradiological imaging variables. In addition, we reviewed the number and the type of repeated operations, complications of surgery and the outcomes at one, three and 12 months.

Findings. 82.6% of lesions were successfully treated following the initial evacuation, and 95.9% of lesions following a second procedure. The PR rate was 14.9%.

A significantly high PR rate was found to be associated with separated type, frontal base type, a midline displacement >5 mm and the presence of acute subdural clots in cranial base type on CT scans obtained within four days postsurgery. The interval from head trauma to initial surgery <60 days, the maximum width of subdural space >10 mm and massive collection of air in the subdural space tended to give a high PR rate. The PR rate associated with the homogeneous type of CSDHs was significantly low.

Age, sex, cause of CSDH, anticoagulant therapy, preoperative neurological presentation, concomitant disease, variables on preoperative CT scans, and surgical factors such as the extent of the surgical procedure, use of drainage, duration and volume of drainage were not significantly associated with PR rate.

Conclusions. It is important to identify factors leading to a high or a low PR rate in the treatment of CSDHs because this may help to select appropriate surgical procedures and postoperative management to treat this condition efficiently.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • EG Benzel RM Bridges SuffixJr TA Hadden WW Orrison (1994) ArticleTitleThe single burr hole technique for the evacuation of non-acute subdural haematomas. J Trauma 36 IssueID2 190–194 Occurrence Handle8114134 Occurrence Handle1:STN:280:DyaK2c7lsl2mtg%3D%3D

    PubMed  CAS  Google Scholar 

  • M Camel RL Grubb (1986) ArticleTitleTreatment of chronic subdural haematoma by twist-drill craniostomy with continuous catheter drainage. J Neurosurg 65 IssueID2 183–187 Occurrence Handle3723175 Occurrence Handle1:STN:280:DyaL283ltlemsw%3D%3D

    PubMed  CAS  Google Scholar 

  • MM Cameron (1978) ArticleTitleChronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiatry 41 IssueID9 834–839 Occurrence Handle690655 Occurrence Handle1:STN:280:DyaE1M%2Fgs1Oruw%3D%3D

    PubMed  CAS  Google Scholar 

  • AJ Drapkin (1991) ArticleTitleChronic subdural haematoma: pathophysiological basis for treatment. Br J Neurosurg 5 IssueID5 467–473 Occurrence Handle1764228 Occurrence Handle1:STN:280:DyaK387gvF2gtA%3D%3D

    PubMed  CAS  Google Scholar 

  • RI Ernestus P Beldzinski H Lanfermann N Klug (1997) ArticleTitleChronic subdural haematomas: surgical treatment and outcome in 104 patients. Surg Neurol 48 IssueID3 220–225 Occurrence Handle9290707 Occurrence Handle1:STN:280:DyaK2svjs1Snsg%3D%3D

    PubMed  CAS  Google Scholar 

  • A Frati M Salvati F Mainiero F Ippoliti G Rocchi A Raco E Caroli G Cantore R Delfini (2004) ArticleTitleInflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural haematoma: a prospective study. J Neurosurg 100 IssueID1 24–32 Occurrence Handle14743908

    PubMed  Google Scholar 

  • H Fujisawa H Ito S Kashiwagi S Nomura M Toyosawa (1995) ArticleTitleKallikrein-kinin system in chronic subdural haematomas: its roles in vascular permeability and regulation of fibrinolysis and coagulation. J Neurol Neurosurg Psychiatry 59 IssueID4 388–394 Occurrence Handle7561918 Occurrence Handle1:STN:280:DyaK28%2FivFCqtg%3D%3D Occurrence Handle10.1136/jnnp.59.4.388

    Article  PubMed  CAS  Google Scholar 

  • H Fujisawa H Ito K Saito K Ikeda H Nitta J Yamashita (1991) ArticleTitleImmunohistochemical localization of tissue-type plasminogen activator in the lining wall of chronic subdural haematoma. Surg Neurol 35 IssueID6 441–445 Occurrence Handle1905064 Occurrence Handle1:STN:280:DyaK3M3nt1WntQ%3D%3D

    PubMed  CAS  Google Scholar 

  • H Fujisawa S Nomura E Tsuchida H Ito (1998) ArticleTitleSerum protein exudation in chronic subdural haematoma: a mechanism for haematoma enlargement? Acta Neurochir (Wien) 140 IssueID2 161–165 Occurrence Handle10.1007/s007010050077 Occurrence Handle1:STN:280:DyaK1MzislWqtg%3D%3D

    Article  CAS  Google Scholar 

  • F Grisoli N Graziani J Peragut F Vincentelli A Fabrizi G Caruso S Bellard (1988) ArticleTitlePerioperative lumbar injection of Ringer s lactate solution in chronic subdural hematomas: a series of 100 cases. Neurosurgery 23 IssueID5 616–621 Occurrence Handle3059219 Occurrence Handle1:STN:280:DyaL1M%2FntVygtg%3D%3D

    PubMed  CAS  Google Scholar 

  • MG Hamilton JB Frizzell BI Tranmer (1993) ArticleTitleChronic subdural haematoma: the role for craniotomy reevaluated. Neurosurgery 33 IssueID1 67–72 Occurrence Handle8355849 Occurrence Handle1:STN:280:DyaK3szmtFaisQ%3D%3D

    PubMed  CAS  Google Scholar 

  • Harders A, Weigel K, Gilsbach J, Eggert HR (1981) Follow-up and results of external drainage therapy of chronic subdural haematomas. In: Schiefer W, Klinger M, Brock M (eds) Brain abscess and meningitis. Subarachnoid haemorrhage: timing problems. Advances in Neurosurgery, vol 9. Springer Berlin Heidelberg New York Tokyo, pp 388–390

  • SA Konig U Schick J Dohnert A Goldammer HE Vitzthum (2003) ArticleTitleCoagulopathy and outcome in patient with chronic subdural haematoma. Acta Neurol Scand 107 IssueID2 110–116 Occurrence Handle10.1034/j.1600-0404.2003.01340.x Occurrence Handle12580860 Occurrence Handle1:STN:280:DC%2BD3s7hs1egtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • Z Kotwica J Brzezinski (1991) ArticleTitleChronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients. Br J Neurosurg 5 IssueID5 461–465 Occurrence Handle1764227 Occurrence Handle1:STN:280:DyaK387gvF2gtw%3D%3D

    PubMed  CAS  Google Scholar 

  • WF Krupp PJ Jans (1995) ArticleTitleTreatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage. Br J Neurosurg 9 IssueID5 619–627 Occurrence Handle10.1080/02688699550040909 Occurrence Handle8561934 Occurrence Handle1:STN:280:DyaK287is1Onsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • T Kuroki M Katsume N Harada T Yamazaki K Aoki N Takasu (2001) ArticleTitleStrict closed-system drainage for treating chronic subdural haematoma. Acta Neurochir (Wien) 143 IssueID10 1041–1044 Occurrence Handle10.1007/s007010170010 Occurrence Handle1:STN:280:DC%2BD3MngvFKjuw%3D%3D

    Article  CAS  Google Scholar 

  • TH Kwon YK Park DJ Lim TH Cho YG Chung HS Chung JK Suh (2000) ArticleTitleChronic subdural haematoma: evaluation of the clinical significance of postoperative drainage volume. J Neurosurg 93 IssueID5 796–799 Occurrence Handle11059660 Occurrence Handle1:STN:280:DC%2BD3crgslyhug%3D%3D

    PubMed  CAS  Google Scholar 

  • R Laumer J Schramm K Leykauf (1989) ArticleTitleImplantation of a reservoir for recurrent subdural haematoma drainage. Neurosurgery 25 IssueID6 991–996 Occurrence Handle2601834 Occurrence Handle1:STN:280:DyaK3c%2FpvVamtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • TM Markwalder (1981) ArticleTitleChronic subdural haematomas: a review. J Neurosurg 54 IssueID5 637–645 Occurrence Handle7014792 Occurrence Handle1:STN:280:DyaL3M7ptlOrug%3D%3D

    PubMed  CAS  Google Scholar 

  • TM Markwalder HJ Reulen (1986) ArticleTitleInfluence of neomembranous organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma – an analysis of 201 cases. Acta Neurochir (Wien) 79 IssueID2–4 100–106 Occurrence Handle1:STN:280:DyaL287otlWhtA%3D%3D

    CAS  Google Scholar 

  • TM Markwalder RW Seiler (1985) ArticleTitleChronic subdural hematomas: to drain or not to drain? Neurosurgery 16 IssueID2 185–188 Occurrence Handle3974829 Occurrence Handle1:STN:280:DyaL2M7jvVehsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • TM Markwalder KF Steinsiepe M Rohner W Reichenbach H Markwalder (1981) ArticleTitleThe course of chronic subdural haematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 55 IssueID3 390–396 Occurrence Handle7264730 Occurrence Handle1:STN:280:DyaL3M3ms1CgtA%3D%3D

    PubMed  CAS  Google Scholar 

  • V Masopust D Netuka M Hackel (2003) ArticleTitleChronic subdural haematoma treatment with a rigid endoscope. Minim Invasive Neurosurg 46 IssueID6 374–379 Occurrence Handle14968410 Occurrence Handle1:STN:280:DC%2BD2c%2FnvVGqtw%3D%3D

    PubMed  CAS  Google Scholar 

  • K Matsumoto K Akagi M Abekura H Ryujin M Ohkawa N Iwasa C Akiyama (1999) ArticleTitleRecurrence factors for chronic subdural haematomas after burr-hole craniostomy and closed system drainage. Neurol Res 21 IssueID3 277–280 Occurrence Handle10319336 Occurrence Handle1:STN:280:DyaK1M3lt1yqtg%3D%3D

    PubMed  CAS  Google Scholar 

  • M Matsumoto Y Sakata T Yamazaki G Endo H Ohishi N Takasu (1999) ArticleTitleLocal coagulofibrinolysis in the postsurgical recovery of patients with chronic subdural haematoma. Acta Neurochir (Wien) 141 IssueID2 177–181 Occurrence Handle1:STN:280:DyaK1M3gsFCqug%3D%3D

    CAS  Google Scholar 

  • P Mellergård O Wisten (1996) ArticleTitleOperations and re-operations for chronic subdural haematomas during a 25-year period in a well defined population. Acta Neurochir (Wien) 138 IssueID6 708–713

    Google Scholar 

  • H Murakami Y Hirose M Sagoh K Shimizu M Kojima K Gotoh Y Mine T Hayashi T Kawase (2002) ArticleTitleWhy do chronic subdural haematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 96 IssueID5 877–884 Occurrence Handle12005395

    PubMed  Google Scholar 

  • K Nagata T Asano N Basugi T Tango K Takakura (1989) ArticleTitle[Studies on the operative factors affecting the reduction of chronic subdural haematoma, with special reference to the residual air in the hematoma cavity]. No Shinkei Geka 17 IssueID1 15–20 Occurrence Handle2710282 Occurrence Handle1:STN:280:DyaL1M3hvFCmsw%3D%3D

    PubMed  CAS  Google Scholar 

  • H Nakaguchi T Tanishima N Yoshimasu (2000) ArticleTitleRelationship between drainage catheter location and postoperative recurrence of chronic subdural haematoma after burr-hole irrigation and closed-system drainage. J Neurosurg 93 IssueID5 791–795 Occurrence Handle11059659 Occurrence Handle1:STN:280:DC%2BD3crgslyhtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • H Nakaguchi T Tanishima N Yoshimasu (2001) ArticleTitleFactors in the natural history of chronic subdural haematomas that influence their postoperative recurrence. J Neurosurg 95 IssueID2 256–262 Occurrence Handle11780895 Occurrence Handle1:STN:280:DC%2BD38%2FlsFGhtg%3D%3D

    PubMed  CAS  Google Scholar 

  • S Nakamura T Tsubokawa (1989) ArticleTitleExtraction of angiogenesis factor from chronic subdural haematomas. Significance in capsule formation and haematoma growth. Brain Inj 3 IssueID2 129–136 Occurrence Handle2471567 Occurrence Handle1:STN:280:DyaL1M3nsVGntw%3D%3D

    PubMed  CAS  Google Scholar 

  • S Nomura S Kashiwagi H Fujisawa H Ito K Nakamura (1994) ArticleTitleCharacterization of local hyperfibrinolysis in chronic subdural haematomas by SDS-PAGE and immunoblot. J Neurosurg 81 IssueID6 910–913 Occurrence Handle7965121 Occurrence Handle1:CAS:528:DyaK2MXis1OlsrY%3D

    PubMed  CAS  Google Scholar 

  • Y Okada T Akai K Okamoto T Iida H Takata H Iizuka (2002) ArticleTitleA comparative study of the treatment of chronic subdural haematoma-burr hole drainage versus burr hole irrigation. Surg Neurol 57 IssueID6 405–409 Occurrence Handle12176202

    PubMed  Google Scholar 

  • HP Richter HJ Klein M Schafer (1984) ArticleTitleChronic subdural haematomas treated by enlarged burr-hole craniotomy and closed system drainage. Retrospective study of 120 patients. Acta Neurochir (Wien) 71 IssueID3–4 179–188 Occurrence Handle1:STN:280:DyaL2c3ltlWgsw%3D%3D

    CAS  Google Scholar 

  • GS Rodziewicz WC Chuang (1995) ArticleTitleEndoscopic removal of organized chronic subdural hematoma. Surg Neurol 43 IssueID6 572–573

    Google Scholar 

  • R Robinson (1984) ArticleTitleChronic subdural haematoma: surgical management in 133 patients. J Neurosurg 61 IssueID2 263–268 Occurrence Handle6737050 Occurrence Handle1:STN:280:DyaL2c3ktF2ksg%3D%3D

    PubMed  CAS  Google Scholar 

  • M Sambasivan (1997) ArticleTitleAn overview of chronic subdural haematoma: experience with 2300 cases. Surg Neurol 47 IssueID5 418–422 Occurrence Handle9131021 Occurrence Handle1:STN:280:DyaK2s3nslKgtQ%3D%3D

    PubMed  CAS  Google Scholar 

  • C Sarkar R Lakhtakia SS Gill MC Sharma AK Mahapatra VS Mehta (2002) ArticleTitleChronic subdural haematoma and the enigmatic eosinophil. Acta Neurochir (Wien) 144 IssueID10 983–988 Occurrence Handle1:STN:280:DC%2BD38nitlOgtw%3D%3D Occurrence Handle10.1007/s00701-002-0994-6

    Article  CAS  Google Scholar 

  • C Smely A Madlinger R Scheremet (1997) ArticleTitleChronic subdural haematoma – a comparison of two different treatment modalities. Acta Neurochir (Wien) 139 IssueID9 818–826 Occurrence Handle1:STN:280:DyaK1c%2FhtlahtQ%3D%3D

    CAS  Google Scholar 

  • HJ Svien JE Gelety (1964) ArticleTitleOn the surgical management of encapsulated subdural haematoma: a comparison of the results of membranectomy and simple evacuation. J Neurosurg 21 172–177 Occurrence Handle14127617 Occurrence Handle1:STN:280:DyaF2c%2FosFelug%3D%3D

    PubMed  CAS  Google Scholar 

  • K Suzuki S Takano T Nose M Doi N Ohashi (1999) ArticleTitleIncreased concentration of vascular endothelial growth factor (VEGF) in chronic subdural haematoma. J Trauma 46 IssueID3 532–533 Occurrence Handle10088869 Occurrence Handle1:STN:280:DyaK1M7os1Ogsg%3D%3D Occurrence Handle10.1097/00005373-199903000-00040

    Article  PubMed  CAS  Google Scholar 

  • M Suzuki S Endo K Inada A Kudo A Kitakami K Kuroda A Ogawa (1998) ArticleTitleInflammatory cytokines locally elevated in chronic subdural haematoma. Acta Neurochir (Wien) 140 IssueID1 51–55 Occurrence Handle10.1007/s007010050057 Occurrence Handle1:STN:280:DyaK1c7otlGjuw%3D%3D

    Article  CAS  Google Scholar 

  • M Suzuki A Kudo A Kitakami M Doi N Kubo K Kuroda A Ogawa (1998) ArticleTitleLocal hypercoagulative activity precedes hyperfibrinolytic activity in the subdural space during development of chronic subdural haematoma from subdural effusion. Acta Neurochir (Wien) 140 IssueID3 261–266 Occurrence Handle10.1007/s007010050093 Occurrence Handle1:STN:280:DyaK1czgt1Wisg%3D%3D

    Article  CAS  Google Scholar 

  • M Tanikawa M Mase K Yamada N Yamashita T Matsumoto T Banno T Miyati (2001) ArticleTitleSurgical treatment of chronic subdural haematoma based on intrahematomal membrane structure on MRI. Acta Neurochir (Wien) 143 IssueID6 613–619 Occurrence Handle10.1007/s007010170067 Occurrence Handle1:STN:280:DC%2BD3MvptF2nsA%3D%3D

    Article  CAS  Google Scholar 

  • K Tsutsumi K Maeda A Iijima M Usui Y Okada T Kirino (1997) ArticleTitleThe relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural haematoma. J Neurosurg 87 IssueID6 870–875 Occurrence Handle9384397 Occurrence Handle1:STN:280:DyaK1c%2FksVSmsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • J Vaqueros M Zurita R Cincu (2002) ArticleTitleVascular endothelial growth-permeability factor in granulation tissue of chronic subdural haematomas. Acta Neurochir (Wien) 144 IssueID4 343–347

    Google Scholar 

  • S Wakai K Hashimoto N Watanabe S Inoh C Ochiai M Nagai (1990) ArticleTitleEfficacy of closed-system drainage in treating chronic subdural haematoma: a prospective comparative study. Neurosurgery 26 IssueID5 771–773 Occurrence Handle2352594 Occurrence Handle1:STN:280:DyaK3c3nvFynsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • R Weigel L Schilling P Schmiedek (2001) ArticleTitleSpecific pattern of growth factor distribution in chronic subdural haematoma (CSH): evidence for an angiogenic disease. Acta Neurochir (Wien) 143 IssueID8 811–819 Occurrence Handle10.1007/s007010170035 Occurrence Handle1:STN:280:DC%2BD3MrntVOhug%3D%3D

    Article  CAS  Google Scholar 

  • A Weisse J Berney (1994) ArticleTitleChronic subdural haematomas. Results of a closed drainage method in adults. Acta Neurochir (Wien) 127 IssueID1–2 37–40 Occurrence Handle1:STN:280:DyaK2M%2FivVKmsw%3D%3D

    CAS  Google Scholar 

  • K Yoshii Y Seki T Aiba (1987) ArticleTitleCausative factors of recurrence of chronic subdural haematoma. No Shinkei Geka 15 IssueID10 1065–1071 Occurrence Handle3323930 Occurrence Handle1:STN:280:DyaL1c7it12ntQ%3D%3D

    PubMed  CAS  Google Scholar 

  • Y Yoshimoto S Kwak (1997) ArticleTitleFrontal small craniostomy and irrigation for treatment of chronic subdural haematoma. Br J Neurosurg 11 IssueID2 150–151 Occurrence Handle9156003 Occurrence Handle1:STN:280:DyaK2szgtV2rsQ%3D%3D

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway

    M. Stanisic, M. Lund-Johansen & R. Mahesparan

Authors
  1. M. Stanisic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Lund-Johansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Mahesparan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stanisic, M., Lund-Johansen, M. & Mahesparan, R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien) 147, 1249–1257 (2005). https://doi.org/10.1007/s00701-005-0616-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-005-0616-1

Search

Navigation