Chronic and subacute subdural hematoma in the adult population. The Puerto Rico experience.

OBJECTIVE: The purpose of this investigation was to study the epidemiology of chronic and subacute subdural hematoma in an adult population and associated factors such as treatment, recurrence, seizures, complications, and outcome. METHODS: We retrospectively reviewed 267 consecutive cases operated for a suspected diagnosis of chronic or subacute subdural hematoma during a six-year period. RESULTS: An incorrect diagnosis was done in 12 of the cases (4.5%) giving a total of 255 cases of chronic or subacute subdural hematoma. The mean age of the patients was 68-year old. Two-thirds of the cases were chronic and one-third were subacute. A history of head trauma was identified in 79% of the patients occurring more frequently in the subacute group. The hematoma was bilateral in 16% of the patients. Recurrence occurred in 7.8% of the cases, but there was no significant difference between chronic and subacute cases nor the type of operation done. Postoperative seizures occurred in 6.2% of the cases. Preoperative seizures are not associated to the development of postoperative seizures. A postoperative intracerebral hematoma occurred in 2.7% of the patients and was associated in most of the cases with a poor outcome. The morbidity rate was 9% and the mortality rate was 0.9%. Outcome is good in 95% of the patients. CONCLUSIONS: Chronic subdural hematoma occurs more frequently than subacute subdural hematoma. Surgical treatment modality and the use of a drain do not change the recurrence rate. Preoperative seizures are not associated to the development of postoperative seizures. The use of postoperative prophylactic antiepileptic drugs does not decrease the postoperative seizure rate even in the alcoholic patient, therefore, their prophylactic use is not indicated.

Cystic meningiomas: a review.

Cystic meningiomas are uncommon tumors that are easily confused with metastatic or glial tumors that have cystic components. We have retrospectively reviewed all of the meningiomas operated on at the University of Puerto Rico in a 5-year period (1989-1993) and found only five cystic meningiomas (4.3% of total meningiomas). There is still debate about the etiology of the cyst wall; thus, multiple biopsies and frozen sections are recommended. Magnetic resonance imaging has improved diagnostic accuracy with its ability to demonstrate the dural attachment of the tumor.