Management of chronic subdural haematoma

ABSTRACT

The objective of this study was to assess the management strategy of chronic subdural haematoma and to find out the best treatment option. The study was conducted in the Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar. Duration of study was 6 months from 1st July, to 31st December, 2004. All the cases were included. It was a prospective observational study. No patient was excluded from this study. Both the sexes and all ages were included. After relevant investigation all patients were operated by performing single/double Burr hole or craniotomy. Out come of patients was recorded. The age range of our patients was from 1 year to 90 years. There were 13 males and 4 females and ratio was 41. Ten [58.8%] patients had features of raised intracranial pressure in the form of headache and vomiting and nine [52.9%] patients had come with focal neurological deficit. The GCS of patients was from 13 to 15 in fifteen [29.4%] patients, from 8 to 12 in ten [58.8%] patients, and two [11.8%] patients had GCS below 8. Head injury was the cause in thirteen [76.5%] patients. Brain atrophy was seen in two [11.8%] cases and one patient [5.9%] had bleeding disorder. Subdural haematoma was unilateral in fifteen [88.2%] patients and bilateral in two [12%]. All the patients were operated upon and two burr holes were performed in the majority [59%]. Single burr hole was the other method done in five [29.4%] patients and craniotomy was done in two cases [11.8%], as the second line treatment. Respiration was done in three [17.6%] cases. Post-operative complications were recollection [17.6%], seizures [35%] and two [11.8%] had post-operative wound infection, fifteen [88.23%] patients improved after treatment and two [12%] remained static. None of them deteriorated and the mortality was nil. Burr hole aspiration can be reasonably used as a first line of treatment for chronic subdural haematoma