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Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage

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Summary

The radiological aspect, pathology, treatment and results of 132 subdural haematomas observed in 100 patients, are discussed.

The majority of these cases were characterized by a nonhomogenous CT scan picture, resulting from repeated bleeding in a previous subdural haematoma evolving to chronicity, or in a pre-existent subdural hygroma. Taking aspirin may have constituted a predisposing factor in 16% of our patients, whilst coagulation disturbances, including anticoagulant treatment, were observed in another 6%; ethylism was present in 11%. A traumatic origin was ascertained in 80% of the patients.

The treatment consisted of burr hole evacuation and drainage in 91.5% of the haematomas, corresponding to 92% of the patients; it was eventually repeated once or twice in some cases. In 6% of the patients, a subduro-peritoneal drainage had to be placed ultimately and in 2%, a membranectomy had to be performed because the haematoma had become nearly completely fibrous. The necessity for repeated evacuation and eventual subduro-peritoneal drainage seems to depend mainly on a slow brain re-expansion in some elderly people, who are actually more frequently referred.

Two patients died; one was deeply comatose and another in poor general condition. Morbidity in the 96 remaining patients, 2 being lost to follow-up, was 11%: 5% related to the haematoma or to the causal trauma, and 6% from other concomitant neurological disease. The functional result was satisfactory in 85%.

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References

  1. Aoki N (1984) Subdural tapping and irrigation for the treatment of chronic hematoma in adults. Neurosurgery 14: 545–548

    Google Scholar 

  2. Aoki N, Tsutsumi K (1990) Symptomatic subacute subdural haematoma following spontaneous acute subdural haematoma. Acta Neurochir (Wien) 102: 149–151

    Google Scholar 

  3. Bret P, Lecuire J, Lapras C, Deruty R, Desge M, Prudhon JL (1976) Hématome sous-dural et thérapeutique anticoagulante. Neurochirurgie 22: 603–620

    Google Scholar 

  4. Brodersen P, Gjerris F (1975) Regional cerebral blood flow in patients with chronic subdural hematomas. Acta Neurol Scand 51: 233–239

    Google Scholar 

  5. Christensen E (1956) Pathologie der intrakraniellen Blutungen. Haematoma subdurale chronicum. In: Olivecrona H, Tönnis W (eds) Handbuch der Neurochirurgie, III, Pathologische Anatomie der raumbeengenden intrakraniellen Prozesse. Springer, Berlin Göttingen Heidelberg, pp 708–722

    Google Scholar 

  6. Davis DH (1992) Discussion of Hasegawa Met al. Neurosurgery 31: 585

    Google Scholar 

  7. Destandau J, Dartigues JF, Cohadon F (1987) Hématome sousdural chronique de l'adulte. Facteurs prognostiques de la chirurgie. A propos de 100 cas. Neurochirurgie 33: 17–22

    Google Scholar 

  8. Ectors L (1963) Le phénomène de Montgolfier et le traitement chirurgical de l'hématome sous-dural chronique de la convexité chez l'adulte. Neurochirurgie 9: 219–228

    Google Scholar 

  9. Fogelholm R, Heiskanen O, Waltimo O (1975a) Chronic subdural hematoma in adults. Influence of patient's age on symptoms, signs and thickness of hematoma. J Neurosurg 42: 43–46

    Google Scholar 

  10. Fogelholm R, Waltimo O (1975b) Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien) 32: 247–250

    Google Scholar 

  11. Grisoli F, Graziani N, Peragut JC,et al (1988) Perioperative lumbar injection of Ringer's lactate solution in chronic subdural haematoma: a series of 100 cases. Neurosurgery 23: 616–621

    Google Scholar 

  12. Hamilton MG, Frizzell JB, Tranmer BI (1993) Chronic subdural hematoma: the role of craniotomy reevaluated. Neurosurgery 33: 67–72

    Google Scholar 

  13. Harders A, Weigel K, Gilsbach J, Eggert HR (1981) Follow up and results of external drainage therapy of chronic subdural hematomas. In: Schiefer W, Klinger M, Brock M (eds) Advanced in neurosurgery 9. Springer, Berlin Heidelberg New York, pp 388–390

    Google Scholar 

  14. Hasegawa M, Yamashima T, Yamashita J, Suzuki M, Shimada S (1992) Traumatic subdural hygroma: pathology and meningeal enhancement of magnetic resonance imaging. Neurosurgery 31: 580–585

    Google Scholar 

  15. Hashimoto N, Sakakibara T, Yamamoto K, Fujimoto M, Yamaki T (1992) Two fluid-blood density levels in chronic subdural hematoma. Case report. J Neurosurg 77: 310–311

    Google Scholar 

  16. Hashimoto N, Sakakibara T, Yamamoto K, Fujimoto M, Yamaki T (1993) Response to Drapkin AJ. J Neurosurg 78: 525–526

    Google Scholar 

  17. Horwitz NH (1992) Discussion of Hasegawa Met al. Neurosurgery 31: 585

    Google Scholar 

  18. Hosada K, Tamaki N, Masamura M, Matsumoto S, Maeda F (1987) Magnetic resonance images of chronic subdural hematomas. J Neurosurg 67: 677–683

    Google Scholar 

  19. Ito H, Maeda M, Uehara T, Yamamoto Sh, Tamura M, Takashima T (1984) Attenuation values of chronic subdural haematoma and subdural effusion in CT scans. Acta Neurochir (Wien) 72: 211–217

    Google Scholar 

  20. Ito H, Yamamoto S, Saito Ket al (1987) Quantitative estimation of hemorrhage in chronic subdural hematoma using the51Cr erythrocyte labeling method. J Neurosurg 66: 862–864

    Google Scholar 

  21. Jennett B, Teasdale G (1981) Chronic subdural hematoma. In: Management of head injuries, contemporary neurology series. Davis, Philadelphia, pp 184–187

    Google Scholar 

  22. Kao MC (1983) Sedimentation level in chronic subdural hematoma, visible on computerized tomography. J Neurosurg 58: 246–251

    Google Scholar 

  23. Kremiansky J (1868) Quoted by Putnam TJ and Cushing H (1925) Chronic subdural hematoma. Its pathology, its relation to pachymeningitis hemorrhagica and its surgical treatment. Arch Surg 11: 329–393

    Google Scholar 

  24. Lesoin F, Villette L, Rousseaux M, Pruvo JP, Jomin M (1986) Drainage continu, progressif, à circuit fermé dans les hématomes sous-duraux chroniques. Neurochirurgie 32: 316–319

    Google Scholar 

  25. Loew F, Kivelitz R (1976) Chronic subdural haematomas. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, Vol 24. North Holland and Elsevier, Amsterdam New York, pp 297–327

    Google Scholar 

  26. Loew F (1982) Management of chronic subdural haematomas and hygromas. In: Krayenbühlet al (eds) Advances and technical standards in neurosurgery, Vol 9. Springer, Wien New York, pp 113–131

    Google Scholar 

  27. Lozes G, Fawaz A, Jomin M,et al (1987) Traitement des hématomes sous-duraux chroniques de l'adulte par ponction lavage “fermée” (méthode d'Aoki). Neurochirurgie 33: 429–431

    Google Scholar 

  28. Markwalder TM (1981) Chronic subdural hematomas: a review. J Neurosurg 54: 637–645

    Google Scholar 

  29. Markwalder TM, Reulen HJ (1986) Influence 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: 100–106

    Google Scholar 

  30. Maurice-Williams RS (1975) Surimposed chronic subdural hygromas. Report of two cases. J Neurosurg 43: 623–626

    Google Scholar 

  31. Moussa A, Josky N (1982) The impact of computed tomography on the treatment of chronic subdural haematoma. J Neurol Neurosurg Psychiatry 45: 1156–1158

    Google Scholar 

  32. Nathan PE, Sonenblick D, Chakote V, Wolf R, Sacchi TJ (1994) Headache, thrombolytic therapy and chronic subdural hemorrhage: a case report. Angiology 45: 77–80

    Google Scholar 

  33. Oku Y, Takimoto N, Yamamoto K, Onishi T (1984) Trial of a new operative method for recurrent chronic subdural hematoma. J Neurosurg 61: 269–272

    Google Scholar 

  34. Park CK, Choi KH, Kim MC, Kang JK, Choi CR (1994) Spontaneous evolution of posttraumatic subdural hygroma into chronic subdural haematoma. Acta Neurochir (Wien) 127: 41–47

    Google Scholar 

  35. Probst C (1988) Peritoneal drainage of chronic subdural hematomas in older patients. J Neurosurg 68: 908–911

    Google Scholar 

  36. Ram Z, Hadani M, Sahar A, Spiegelmann R (1993) Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial. Acta Neurochir (Wien) 120: 40–43

    Google Scholar 

  37. Reymond MA, Marbet G, Radü EW, Gratzl O (1992) Aspirin as a risk factor for hemorrhage in patients with head injuries. Neurosurg Rev 15: 21–25

    Google Scholar 

  38. Richter HP, Klein H, Schäfer M (1984) Chronic subdural hematomas treated by enlarged burr-hole craniotomy and closed system drainage. Retrospective study of 120 patients. Acta Neurochir (Wien) 71: 179–188

    Google Scholar 

  39. Robinson RG (1984) Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg 61: 263–268

    Google Scholar 

  40. Rubin G, Rappaport ZH (1993) Epilepsy in chronic subdural haematoma. Acta Neurochir (Wien) 123: 39–42

    Google Scholar 

  41. Rychlicki F, Recchioni MA, Burchianti M, Marcolini P, Messori A, Papo I (1991) Percutaneous twist drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 113: 38–41

    Google Scholar 

  42. Saito K, Ito H, Hasegawa T, Yamamoto S (1989) Plasmin-α2 plasmin inhibitor complex and α2-plasmin inhibitor in chronic subdural hematoma. J Neurosurg 70: 68–72

    Google Scholar 

  43. Sato S, Suzuki J (1975) Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 43: 569–578

    Google Scholar 

  44. Scotti G, Terbrugge K, Melancon D, Bélanger G (1977) Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg 47: 311–315

    Google Scholar 

  45. Stroobandt G (1989) Les localisations des épanchements péricérébraux du nourrisson. Neurochirurgie 35: 407–409

    Google Scholar 

  46. Svien HJ, Gelety JE (1964) On the surgical management of encapsulated subdural hematoma. A comparison of the results of membranectomy and simple evacuation. J Neurosurg 21: 172–177

    Google Scholar 

  47. Tabaddor K, Shulman K (1977) Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46: 220–226

    Google Scholar 

  48. Trotter W (1914) Chronic subdural haemorrhage of traumatic origin, and its relation to pachymeningitis haemorrhagica interna. Br J Surg 2: 271–291

    Google Scholar 

  49. Tyson G, Strachan WE, Newman P, Winn R, Butler A, Jane J (1980) The role of craniectomy in the treatment of chronic subdural hematomas. J Neurosurg 52: 776–781

    Google Scholar 

  50. Virchow R (1857) Quoted by Putnam TJ and Cushing H (1925) Chronic subdural hematoma. Its pathology, its relation to pachymeningitis hemorrhagica and its surgical treatment. Arch Surg 11: 329–393

    Google Scholar 

  51. Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M (1990) Efficacy of closed system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurg 26: 771–773

    Google Scholar 

  52. Weir B, Gordon P (1983) Factors affecting coagulation: fibrinolysis in chronic subdural fluid collections. J Neurosurg 58: 242–245

    Google Scholar 

  53. Weisse A, Berney J (1994) Chronic subdural haematomas. Results of a closed drainage method in adults. Acta Neurochir (Wien) 127: 37–40

    Google Scholar 

  54. Yamada I, Watanabe T, Murata S,et al (1980) Developmental process of chronic subdural collections of fluid based on CT-scan findings. Surg Neurol 13: 441–448

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Cliniques Universitaires St. Luc, Brussels, Belgium

    G. Stroobandt, P. Fransen, C. Thauvoy & E. Menard

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  1. G. Stroobandt
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  2. P. Fransen
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  3. C. Thauvoy
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  4. E. Menard
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Stroobandt, G., Fransen, P., Thauvoy, C. et al. Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. Acta neurochir 137, 6–14 (1995). https://doi.org/10.1007/BF02188772

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