TITLE:
Chronic Subdural Hematoma: Pitfalls to Avoid for Better Outcome
AUTHORS:
Ahmed El Fiki, Ahmed Assem
KEYWORDS:
Chronic Subdural Hematoma, Pitfalls, Avoidance
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.9 No.4,
October
11,
2019
ABSTRACT: Introduction: Chronic subdural hematoma is one of the commonest intracranial haemorrhages that affect elderly. Headache and focal neurological deficits are among the commonest presentations. It carries excellent prognosis especially when evacuated probably on right timing. Recurrence rate ranging from 8% - 37% in literatures, we will highlight tricks during peri-operative period to have better outcome and decrease recurrence. Patients and methods: We operated 45 cases of chronic subdural hematoma in Cairo university emergencyhospital, during the period from November 2016 to December 2017; CT brain was done for all cases; clinical data were reported; burr hole evacuation was the standard technique. Suction drain with mild suction pressure was applied and hospital stay was 3 - 4 days after surgery. Patients were followed up to three months. Results: Forty-five patients were operated with 27 cases (60%) having their ages between 5th and 7th decades. Among Twenty-nine males and 16 females, eleven patients (25%) were confused; headache was observed in 12 patients, weakness in 31 cases (69%), dysphasia in two cases and two patients were on renal dialysis. Hypertension was associated as a comorbidity in 18 patients, diabetes mellitus in 11 patients, and smoking in 11 patients. Forty-two patients were discharged home within 3 - 4 days; two cases developed small-sized intra-cerebral hematoma, one case of wound infection, and excellent outcome for all cases on three months follow up visit. Conclusions: Chronic subdural hematoma is one of the commonest intra-cranial haemorrhages in elderly with excellent outcome if managed meticulously in right timing. Good control of co-morbidities, insuring slow clearing of hematoma fluid and staged closure technique are factors linked with better outcome. But larger studies are needed.