The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage.

Abstract:

:A consecutive series of 32 adult patients with chronic subdural hematoma was studied in respect to postoperative cerebral reexpansion (reduction in diameter of the subdural space) after burr-hole craniostomy and closed-system drainage. Patients with high subdural pressure showed the most rapid brain expansion and clinical improvement during the first 2 days. Nevertheless, a computerized tomography (CT) scan performed on the 10th day after surgery demonstrated persisting subdural fluid in 78% of cases. After 40 days, the CT scan was normal in 27 of the 32 patients. There was no mortality and no significant morbidity. Our study suggests that well developed subdural neomembranes are the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10 to 20 days. However, blood vessel dysfunction and impairment of cerebral blood flow may participate in delay of brain reexpansion. It may be argued that additional surgical procedures, such as repeated tapping of the subdural fluid, craniotomy, and membranectomy or even craniectomy, should not be evaluated earlier than 20 days after the initial surgical procedure unless the patient has deteriorated markedly.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Markwalder TM,Steinsiepe KF,Rohner M,Reichenbach W,Markwalder H

doi

10.3171/jns.1981.55.3.0390

subject

Has Abstract

pub_date

1981-09-01 00:00:00

pages

390-6

issue

3

eissn

0022-3085

issn

1933-0693

journal_volume

55

pub_type

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