Volume 6, Issue 4 (Autumn 2020)                   Iran J Neurosurg 2020, 6(4): 181-194 | Back to browse issues page


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Rahmanian A, Samadian M, Sharifi G, Kalani N, Kazeminezhad A. Tips and Pearls in Chronic Subdural Hematoma. Iran J Neurosurg. 2020; 6 (4) :181-194
URL: http://irjns.org/article-1-247-en.html
1- Department of Neurosurgery, Namazi Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
2- Department of Neurosurgery, Skull Base Research Center, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3- Department of Anesthesiology, Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.
4- Department of Neurosurgery, Peymanieh Hospital, Jahrom University of Medical Sciences, Jahrom, Iran. , kazemimd@msn.com
Abstract:   (821 Views)
Background and Aim: One of the most prevalent neurosurgery conditions is Chronic Subdural Hematoma (CSDH). Among neurosurgeons, there are various CSDH treatment approaches.
Methods and Materials/Patients: This is a narrative review examining the various aspects of the CSDH. To provide up-to-date information on CSDH, we concisely reviewed the related articles. All of the relevant articles retrieved from Google Scholar, PubMed, and Medline were reviewed and critically analyzed. We searched for keywords including chronic subdural hematoma, burr hole craniotomy versus craniostomy, middle meningeal artery embolization, conservative therapy versus surgical therapy in CSDH, and recurrence of CSDH in published articles from 1960-2020.
Results: CSDH may present with various clinical presentations. Medical symptoms range from general and moderate symptoms (such as headache, tiredness) to severe symptoms (e.g. hemiparesis, coma). A definite trauma history may be obtained in most cases. Contrast-enhanced CT or MRI may help diagnosis. The treatment choice for uncomplicated CSDH is Burr-Hole Craniotomy (BHC). The use of drainage to decrease recurrence rates has been shown to have limited outcomes in most recent studies. Craniotomy is also used for treatment. Only asymptomatic or high-risk operative patients are subjected to non-surgical management.
Conclusion: Management of CSDH is still contentious. It is widely agreed that if neurological signs and radiological observations are present, CSDH should be evacuated. Burr-hole craniotomy appears to be the preferred surgical technique because, in most patients, it gives the best treatment outcomes. Several issues are still uncertain, including the proper surgical technique [Burr-hole craniotomy versus Twist Drill Craniostomy (TDC) and craniotomy], the advantage of 2 perforated holes over one, the location of drainage, the impact of irrigation of the hematoma, and the duration of post-operative immobilization.
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Type of Study: Review | Subject: Neuroscience

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