Surgical Management of Chronic Subdural Hematoma:The Outcome and Factors Relating to The Brain Expansion

Ninety-seven patients with chronic subdural hematoma were treated surgically between 1983 and 1992. The case records and radiological findings on computerized tomography(CT) scan were studied with regard to surgical outcome and postoperative brain expansion after burr hole craniostomy and closed system drainage. Male:Female ratio was 3.6:1 and the peak incidence was in the sixth decade of life. The patients were graded according to the scale used by Markwalder et al. and 56% were in Grade 0 and 1. The CT scan demonstrated the brain expansion and resolution of subdural space within 2 weeks in 53% of patients. Risk factors causing poor postoperative brain expansion were poor intraoperative brain expansion, too young(below 20 years) or too old(more than 71 years) age, and underlying disease. Following surgery, most of the patients improved. Whereas at the time of admission only 7% were neurologically normal(Grade 0), 67% of the patients fell into this category during the postoperative phase and 90% of the patients were postoperatively in Grade 0 and 1. Four patients died in the hospital, for a mortality rate of 4.1%. The most important factor influencing outcome was preoperative neurologic state.

Surgical Treatment of Intracranial Arachnoid Cyst by Excision

Arachnoid cysts are benign developmental cysts that occur between aachnoid layers, which represent approximately 1 percent of all intracranial space-occupying lesions, their most common location being the middle cranial fossa. Current surgical treatment options for intracranial arachnoid cyst are either craniotomy and excision of cyst or shunting of cyst contents extracranially. We treated 10 cases of intracranial arachnoid cyst by excision during last two years. For the best surgical curability, we have, not only removed the cyst wall and adhesive gliotic tissue as possible, but also made the opening to basal cistern for communication. During average 8.4 months follow up, we observed, not specific morbidity and mortality, but good clinical improvement and brain expansion. As above result, if haven't specific problem, the direct surgical removal may be the primary choice for intracranial arachnoid cyst, especially in children with noncommunicating type in sylvian.