Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma / 대한신경손상학회지

Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

A Comparative Analysis of Chronic Subdural Hematoma in Two Age Groups of Younger and Older than 75 Years / 대한신경손상학회지

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhage. As the number of elderly people is increasing, the incidence of cSDH is growing. Therefore, we analyzed clinical manifestation of the cSDH. METHODS: The authors retrospectively reviewed the data of the 169 patients of cSDH who were 65 years or older and undergone burr-hole trephination and closed drainage in our hospital between January 2008 and December 2012. Patients were divided into two subgroups; group A: young than 75 years, group B: 75 years or older. We analyzed the differences of clinical aspects and surgical results in both groups. RESULTS: Proportion of male patients in group A (83.8%) was higher than in group B (58.4%) with statistical significance (p=0.003). Alteration of consciousness as an initial symptom was significantly more frequent in group A (17.5%) than in group B (4.4%)(p=0.006). Postoperatively, 164 of 169 patients (97%) were free from symptom within three days in both groups. Pneumonia followed the surgery in three patients (one in group A and two in group B). CONCLUSION: There were no difference in the rate of complications between group A and B. Therefore, burr-hole trephination and external drainage is safe and effective management in both groups.

Factors Affecting the Reaccumulation of Chronic Subdural Hematoma after Burr-hole Trephination and Closed-system Drainage

OBJECTIVE: The reaccumulation of hematoma is one of the most frequent problems on the chronic subdural hematoma. The aim of this study is to determine the factors affecting the reaccumulation of hematoma and the reasonable site for the burr-hole trephination to achieve a low reaccumulation rate after burr-hole trephination and closed-system drainage METHODS: The authors studied 93 patients with chronic subdural hematoma in whom the location of burr-hole trephination was randomly placed and precisely determined on postoperative brain computerized tomographic scans or skull roentgenogram. Eighty five patients with chronic subdural hematoma were obtained with brain computerized tomographic scans the postoperative 3 day. The location of the burr-hole trephination, the location of subdural catheter tip, the maximum postoperative width of the subdural space, and the percentage of the ipsilateral subdural space occupied by air postoperatively were measured and analyzed the correlation with the postoperative reaccumulation rates. RESULTS: Patients with the parietal trephination had much more subdural air and a higher of chronic subdural hematoma reaccumulation than those with the frontal one. In addition, patients with residual subdural air on brain computerized tomographic scans obtained the postoperative 3 day also had a higher reaccumulation rate than those without subdural air collections. CONCLUSION: The incidence of postoperative subdural fluid reaccumulation can be reduced by the burr-hole trephination on the frontal convexity and by preventing subdural air accumulation during operation.

Clinical Studies of the Occipital Bone Fracture

In the past the patients with fracture on the occipital bone involved the lateral sinus and/or the foramen magnum, were treated with the early exploratory burr hole trephination regardless of mental state. The 64 cases occipital bone fracture were evaluated used the computed tomography of the brain scan. The fracture lines involved both the transeverse sinus and the foramen magnum were 59.4%, only the transeverse sinus were 29.7% and only the foramen magnum were 10.9%. The findings of the computed tomography of the brain scan were normal 42 cases, brain edema 13 cases. The 5 cases had large hematoma on the computed tomography of the brain scan performed emergency operation. The other 59 cases were treated with only close observation and conservative treatment. The mortality rate was 20% in operative treatment and 8.5% in conservative treatment. So we concluded that the patients with significant fracture on the occipital bone but had no surgical indication on the computed tomography of the brain scan might be treated with close observation & conservative treatment and it would not be necessary to perform the exploratory craniotomy as was done in the past.