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Bakhti S, Tighilt N, Djennas M. Open Drainage in Chronic Subdural Hematomas: A Prospective Study of 189 Cases. Iran J Neurosurg 2016; 2 (2) :15-19
URL: http://irjns.org/article-1-39-en.html
1- MD, Professor, Pediatric Neurosurgery Division, Mustapha Pacha University Hospital, Algiers Algeria
2- MD, Assistant Professor, Pediatric Neurosurgery Division, Mustapha Pacha University Hospital, Algiers, Algeria
3- MD, Professor, Chief Department of Neurosurgery, Mustapha Pacha University Hospital, Algiers, Algeria
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Background and Importance
Chronic subdural hematoma (CSH) is one of the most frequent intracranial hemorrhages (1). It is a common disease in the elderly (1,2). Its incidence increases gradually from 1 to 8.2 per 100.000 cases, each year in the sixth and seventh decades of life (3-7). The disease will be more frequent in coming years with increase of life expectancy (8,9). CSH is consecutive to trauma in a large proportion with a frequency varying from 56% to 80% (10-16). Other risk factors include coagulopathies, therapeutic anticoagulation, antiplatelet agents, alcohol abuse, epilepsy, and intracranial hypotension (6, 17-25). CSH has been described to arise in patients who had presented an acute subdural hematoma or hygroma (26-30); but the latter is more related to the disease. However, the real pathophysiology remains unclear. Although CSH is frequently observed, there is no gold standard for treatment. The most surgical techniques used are craniostomy by burr hole or twist drill with or without irrigation, and with or without drainage (2,4,25-43). Drainage seems to be a must for several authors (42,44-52). Closed system drainage is used since the mid of the 80’s because open drainage had been incriminated in high rates of infection (53-56). Yet, closed drainage requires material which may be unavailable or expensive in some instances particularly in low- and middle-income countries. In our department, we have reintroduced the open drainage in the mid of the 90’s because of economic crisis. We have observed good results and no increase of infections rate; that’s why we have conducted a prospective study to assess safety and efficacy of open drainage.

Case presentation
General features

The prospective study was conducted from January 2008 to December 2011. A total of 189 consecutive patients were managed by the same protocol. Age of patients varied from 18 to 96 years with a mean age of 69.4 years old. There was a male predominance (76.1%). Of all, 113 patients had associated disease including cardiovascular disease, diabetes, anticoagulation therapy and neoplastic formations. Trauma was the most common etiology with a frequency of 70.5%. We did not find any etiology in 32 patients (16%). Patients were clinically assessed using the Markwalder’s score (Table 1) and Glasgow coma scale. Grade 1 and 2 were present in 54% of cases, while grade 3 and 4 were present in 46% of them. All patients were explored by CT scan. The hematoma was bilateral in 20%. A total of 241 cavities were explored. The lesion was homogeneous (hypodense, isodense and hyperdense) in only 30.6%. The remaining cavities were heterogeneous (mixt, layered and compartmentalized).
 

 
Management
All patients were operated after stabilization including resuscitation in some cases and normalization of coagulation parameters. Patients underwent surgery in the operative room. Surgery was performed under local anesthesia associated to sedation in 102 patients (53.9%). The other patients were operated under general or local anesthesia. During surgery, patients were placed in supine position with head elevated and rotated 30 degrees to opposite side in cases of unilateral lesions. The head was not turned in bilateral hematomas. Bilateral hematomas were all operated simultaneously. Surgery consisted of one burr hole made on the thickest part of the hematoma according to the preoperative CT scan. Dura was coagulated and incised. Outer membrane was then coagulated and divided. After spontaneous evacuation of the hematoma, the drain constituted by a finger of sterile glove was then inserted (Figures 1&2). Skin was closed afterward. Drainage was open in the dress.
 


 

 
In the postoperative period, patients were hyper hydrated intravenously with 2000 ml of glucose solution 5% every 24 hours during 48 hours. Patients were kept at flat bed rest during this period. The dress was not manipulated during the 48 postoperative hours. We did not use prophylactic anticonvulsant therapy. The drain was removed after 48 hours; and patients were then discharged. Postoperative CT scan was not done systematically and was reserved only for patients with no improvement or neurological worsening.
All patients underwent a clinical and radiological assessment at 1 month after surgery. Diagnosis of recurrence was made in patients who presented a reappraisal or a worsening of the symptoms with a consequent radiologic image. All cases were reoperated using the same technique. Follow-up of patients was continued till 6 months after surgery. Results were then collected. 
 
Observation
A total of 29 patients presented postoperative complications with an overall rate of 15.34%. Some patients had more than one complication. Table 2 represents the different complications observed. Three patients presented acute subdural hematoma; all of them were reoperated. In all cases, bleeding was from the dura. Two of these patients died. Intraparenchymal hematomas were observed in 2 patients; all of them were medically managed. One of these patients died. Compressive pneumocephalus occurred in 4 cases; 2 patients were treated surgically and the 2 others by massive oxygentherapy. One of the patients treated surgically died. Infections were observed in 3 patients (1.58%); 2 of them, both with history of diabetes, had superficial wound infections and the third presented a meningitis. Infection was diagnosed within the first week after surgery in all cases. All patients with infectious complications were treated by intravenous antibiotherapy. The patient with meningitis also developed pneumonia and died despite an adapted treatment; he was 84 years old with a history of stroke. Postoperative seizures were observed in 2 patients (1.05%). The onset of seizure was within the 72 hours of surgery in the 2 cases. No complications due to traumatic handling of the drain were noticed. Postoperative mortality rate was 5.8% (11 patients). Table 3 illustrates the causes of mortality. Ten dead patients had presented postoperative complications.                                                                                                                         
Recurrences were observed in 27 patients (14.2%). Twenty-four patients were operated by the same technique and 3 by steroids. Recurrences were mainly observed in mixed lesions hyperdense with a recurrence rate of 2.7% for the hypodense lesions and 25% for hyperdense lesions; the difference was statistically significant (X² =6.64, p≤0.005).
 

 
Final results were collected after 6 months. One-hundred and sixty-three patients were cured (86.2%), 15 patients presented disabilities (7.9%) and 11 patients died (5.8%); mortality was observed in the early postoperative period. No other patients died during follow-up.
Final results were collected after 6 months. One-hundred and sixty-three patients were cured (86.2%), 15 patients presented disabilities (7.9%) and 11 patients died (5.8%); mortality was observed in the early postoperative period. No other patients died during follow-up. 
 

 
Discussion
Multiple modalities of treatment of CSH exist. Standard approaches include craniostomy by either burr hole or twist drill, evacuation of the hematoma with or without irrigation and in most instances drainage. Defenders of drainage argued that this latter will allow brain expansion by progressive evacuation of residual fluid after spontaneous evacuation or irrigation of the cavity; also it seems to diminish early complications (42,44,46-48,50-52). Since the mid of the 80’s, all series reporting treatment with drainage used a system of closed-drainage. This attitude was adopted because open drainage has been incriminated in high rates of postoperative infections (53-56). In our series the rates of superficial and deep infections were 1.05% and 0.5%, respectively. The rate of superficial infections ranged from 0.2% to 1.5% in literature (27,33,36,56,57), while the rate of deep infections varied from 0.7% to 5.5% (4,12,35,41,56,58-62). Deep infections can be life-threatening as it was the case in our series. In the present series, rates of infections were consistent with those of literature in spite of using open drainage. We assumed that it was due to the fact that the dress was made under aseptic conditions in the operative room and was not manipulated till the ablation of the drain; but large studies are needed to confirm our explanation. Postoperative seizures are reported to occur in 0.5% to 8% of cases (1,41,61-64). In our study, the rate was 1.05%. Some studies have incriminated drains in occurrence of postoperative seizures (39,50,65,66). According to our conclusions, the rate observed in the present series was related to the very soft nature of the drain. Indeed, other complications can occur with classical drains such as bleeding from capsules or cortex, occlusion, and exceptionally rupture (33,39,67-69). It is noteworthy to mention that we did not observe complications associated with the drain. A review of the literature reported recurrence rates in 0% to 37% of patients (5,6,17,21,35,39,41,43,49,50,57,61,70-75). We observed 14.2% of recurrences; they were mainly observed in mixt and hyperdense lesions. Recurrences seemed to be in relation with the preoperative density of the lesion and consequently with the inflammatory status of the hematoma as observed by some authors (4,5,76-78). Overall results of the present series were in total concordance with those of large series of the literature (6,10,12,15,16,27,35,36,43,59-61,67,79,80).

Conclusion 
CSH is one of the most frequent disorders encountered in daily practice of neurosurgery. In spite of this issue, there is a little consensus on its treatments. Several approaches are described with equivalent results. One burr hole craniostomy combined with open drainage is an effective, safe and easy technique. The overall rates of complications and outcome of this procedure are good among other forms of treatments. It is also a cost-effective modality of treatment for CSH; so it can be a very interesting method for treatment of CSH regarding health care expenditure particularly in middle- and low-income countries. However, studies with wider scopes and sample size are needed to confirm our results.

Funding
None.

Conflicts of Interest
The authors declare that they have no conflicts of interest.

Authors' Contribution
Souad Bakhti: Conductor of the prospective study, data collection. Nabila Tighilt: Data collection. Mohamed Djennas: Supervisor of the prospective study, chief of department. 


References
  1. Adhyaman V, Asghar M, Ganeshram KN, Bohwmick K: Chronic subdural haematoma in the elderly. Postgraduate Medical Journal. 2002:78:71-75.
  2. Amirjamshidi A, Eftekar B, Abouzari M, Rashidi A. The relationship between Glasgow coma/outcome scores and abnormal CT scan findings in chronic subdural hematomas. Clinical Neurology and Neurosurgery. 2007;109:152-7. 
  3. Amirjamishidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, et al. Outcomes and recurrence rates in chronic subdural hematoma. British Journal of Neurosurgery. 2007;21:272-5. 
  4. Asfora W, Schwebach L. A modified technique to treat chronic and subacute subdural hematoma: technical note. Surgical Neurology. 2003;59:329-32. 
  5. Beatty RA. Subdural hematomas in the elderly: experience with treatment by trephine craniotomy and not closing the dura or replacing the bone plate. British Journal of Neurosurgery. 1999;13: 60-64.
  6. Benes L, Eggers F, Alberti O, Bertalanfy H. A new screw catheter kit for the bedside treatment of chronic subdural hematomas. Journal of Trauma. 2002;52:591-4.
  7. Benzel EC, Bridges RM Jr, Hadden TA, Orrisson WW. The single burr-hole technique for the evacuation of non-acute subdural hematomas. Journal of Trauma. 1994;36:190-4.
  8. Borger V, Vatter H, Oszvald A, Murquardt G, Seifert V, Güresir E. Chronic subdural hematomas in elderly: a retrospectiv
  9. Bourgeois Ph, Sleiman M, Louis E, Haddad G, Touzet A, Fichten A, et al. L’hématome sous dural chez les patients de plus de 80 ans. Neurochirurgieurgie.1999;45:124-8.
  10. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist drill craniostomy with continuous catheter drainage. Journal of Neurosurgery. 1986;65:183-7. 
  11. Camel M, Grubb Jr RL. Treatment of chronic subdural hematoma by twist-drill craniostomy with continuous catheter drainage. Journal of neurosurgery. 1986;65(2):183-7.
  12. Cameron MM: Chronic subdural haematoma: a review of 114 cases. Journal Neurology Neurosurgery Psychiatry. 1978;41:834-839.
  13. Chen JC, Levy ML. Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurgery clinics of North America. 2000;11(3):399. sis of 322 cases patients between ages of 65-94 years. Acta Neurochirurgieurgie. 2012;154: 1549-54. 
  14. Chen CW, Kuo JR, Lin HJ, Yeh CH, Wong BS, Kao CH, et al. Early postoperative seizures after burr-hole drainage for chronic subdural hematoma: correlations with brain CT findings. Journal of Clinical Neuroscience. 2004;11:706-9. 
  15. Chon KH, Lee JM, Koh EJ, Choi HY: Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochirurgieurgie (Wienn). 2012;154: 1541-48. 
  16. Dakurah TK, Idrissu M, Wepeda G, Nuamah I. Chronic subdural hematoma: review of 96 cases attending the Korle Bi teaching hospital, Accra. West African Journal of Medicine. 2005:24:283-6.
  17. De Noronha RJ, Sharrack B, Hadjivassilou M, Romanowski AJ. Subdural hematoma: a potentially serious consequence of spontaneous intracranial hypotenion. Journal of Neurology and Neurosurgery Psychiatry. 2003:74:752-5.
  18. Dran G, Berthier F, Fontaine D, Rasenrarijae D, Pasquis P : Efficacité de la corticothérapie dans le traitement adjuvant des hématomes sous duraux chroniques. Etude rétrospective de 198 cas. Neurochirurgieurgie. 2007;53:477-482. 
  19. Drapkin AJ. Chronic subdural hematoma: pathophysiological basis for treatment. British journal of neurosurgery. 1991;1;5(5):467-73.
  20. El-Kadi H, Miele VJ, Kaufman HH. Prognosis of chronic subdural hematomas. Neurosurgery Clinics of North America. 2000;11(3):553. 
  21. Edmonds N, Hassier WE: New device to treat chronic subdural hematoma – hollow screw. Neurology Resource. 1999;21: 77-78.
  22. Ernestus RJ, Beldzinski P, Langermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surgery Neurology. 1997;48: 220-5.
  23. Fogelholm R, Waltimo O. Epidemiology of chronic subdural haematoma. Acta Neurochirurgieurgie (Wien). 32: 247-250, 1975.
  24. Frati A, Salvati M, Mainiro F, Ippoliti F, Rocchi G, Raco Caroli E, et al. Inflammation markers and risk factors for recurrence in 35 patients with post traumatic chronic subdural hematoma. Journal of Neurosurgery. 2004;100: 24-32. 
  25. Gazzeri R, Galerza M, Neroni M, Canova A, Refice GM, Esposito S: Continous subgaleal suction drainage for the treatment of chronic subdural haematoma. Acta Neurochirurgie (Wienn). 2007;149:487-493.
  26. Gelabert-Gonzalez M, Galerza M, Neroni M, Canova A, Refice GM, Esposito S. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clinical Neurology and Neurosurgery. 2005;107: 223-9.
  27. Grisoli F, Graziani N, Peragut JC, Fabrizi AP, Caruzo G, Bellard S. Perioperative lumbar injection of Ringer’s lactate solution in chronic subdural hematoma: a series of 100 cases. Neurosurgery. 1988;23: 616-21.
  28. Gurelik M, Aslan A, Gurelik B, Ozum U, Karadag Ö, Kars HZ. A safe and effective method for treatment of chronic subdural haematoma. The Canadian Journal of Neurological Sciences. 2007;1;34(01):84-7.
  29. Hamilton MG, Bevan Frizzel J, Bruce I. Chronic subdural hematoma: the role of craniotomy reevaluated. Neurosurgery. 1993:33:67-72.
  30. Henning R, Kloster R: Burr hole evacuation of chronic subdural hematomas followed by continuous inflow and outflow irrigation. Acta Neurochirurgie (Wienn). 1999;141:171-6.
  31. Horns EM, Freiz-Erfen I, Bristol RE, Spetzler RF, Harrington TR. Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surgical Neurology. 2006;65:150-4.
  32. Kitakami A, Ogawa A, Hakozaki S, Kidogushi J, Obonal C, Kubo N. Carbon dioxyd gas replacement of chronic subdural hematoma using single burr-hole irrigation. Surgical Neurology. 1995;43:574-7. 
  33. Kiymaz N, Yilmaz N, Mumcu C. Controversies in chronic subdural hematoma: continuous drainage versus one-time drainage. Medical science monitor. 2007 May 4;13(5):CR240-3. 
  34. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical analysis of risk factors related to recurrent chronic subdural hematoma. Journal of Korean Neurosurgical Society. 2008;1;43(1):11-5.
  35. Kotwica Z, Brzezinski J. Chronic subdural hematoma treated by burr holes and closed system drainage: personal experience with 131 patients. British Journalof Neurosurgery. 1991;5:461-5.
  36. Krupp WF, Jans PJ. Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage. British journal of neurosurgery. 1995;1;9(5):619-28.
  37. Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N. Chronic subdural hematoma in elderly people. Present status on Awaji islands and epidemiological prospect. Neurology Medical Chir (Tokyo). 1992;32: 207-9. 
  38. Kuroki T, Katsume M, Harada N, Yamazaki T, Aoki K, Takasu N. Strict closed- system drainage for treating chronic subdural haematoma. Acta Neurochirurgie (Wienn). 2001;143:1041-4.
  39. Lee K, Bae WK, Doh JW, Bae HG, Yun IG. Review origin of chronic subdural haematoma and relation to traumatic subdural lesions. Brain Inj. 1998;12:901-10. 
  40. Lee JY, Ebel H, Ernestus RI, Kug N. Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary?Surgical Neurology. 2004;61:523-8.
  41. Lind CR, Lind CJ, Mee EW. Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains. Journal of neurosurgery. 2003;99(1):44-6. 
  42. Loew R, Kiveletz R: Chronic subdural hematomas. In Hand Book of Clinical Neurology edited by Vinken PJ and Bruyn GW. North Holland Publishing Company Amsterdam Oxford. 1976, Vol 24, pp297-328.
  43. Markwalder TM, Steinsepe, Rohner M, Reinchenbach W, Markwalder H: The course of chronic subdural hematomas after burr holecraniostomy and closed drainage. Journal of Neurosurgery. 1981;55: 390-396. 
  44. Markwalder TM, Seiler RW. Chronic subdural hematomas: to drain or not drain? Neurosurgery. 1985;16:185-8.
  45. Markwalder TM. The course of chronic subdural hematomas after burr-hole craniostomy with and without closed-system drainage. Neurosurgery Clinics of North America. 2000;11(3):541. 
  46. Mellegard P, Wisten O. Operations and reoperations for chronic subdural hematomas during 25 years period in a well-defined population. Acta Neurochirurgie (Wienn). 1996;138:708-13.
  47. MORI K, MAEDA M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurologia medico-chirurgica. 2001;41(8):371-81.
  48. Murakami M, Morikawa K, Matsuno A, Kaneda K, Nagashima T. Spontaneous intracranial hypotension associated with bilateral chronic subdural hematomas. Neurologia medico-chirurgica (Tokyo).2000;40: 484-8. 
  49. Murata K: Chronic subdural hematoma may be preceded by persistent traumatic subdural effusion. Neurologia medico-chirurgica (Tokyo).1993;33:691-6. 
  50. Muzii VF, Bistazzoni S, Zalaffi A, Carangelo B. Chronic subdural hematoma: comparison of two surgical techniques: Preliminary results of a prospective randomized study/Comments. Journal of neurosurgical sciences. 2005;1;49(2):41.
  51. Naganami K, Takeuchi S, Sakakibara F, Otani N, Nawashiro H. Radiological factors related to recurrence of chronic subdural hematoma. Acta Neurochirurgie (Wienn). 2011;153:1713.
  52. Nakajima H, Yasui T, Nishikawa M, Kishi H, Kan M. The role of postoperative patient posture in the recurrence of chronic subdural hematoma: a prospective randomized trial. Surgical neurology. 2002;31;58(6):385-7. 
  53. Ohno K, Suzuki R, Masaoka H, Matsushima Y, Inaba Y, Monma S. Chronic subdural haematoma preceded by persistent traumatic subdural fluid collection. Journal of Neurology, Neurosurgery & Psychiatry. 1987;1;50(12):1694-7. 
  54. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurologia medico-chirurgica (Tokyo). 2001;41:382-6.
  55. Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H. A comparative study of the treatment of chronic subdural hematoma—burr hole drainage versus burr hole irrigation. Surgical neurology. 2002;30;57(6):405-9.
  56. Pahatouridis D, Alexiou GA, Fotakopoulos G, Mihos E, Zigouris A, Drosos D, Voulgaris S. Chronic subdural haematomas: a comparative study of an enlarged single burr hole versus double burr hole drainage. Neurosurgical review. 2013;1;36(1):151-5. 
  57. Probst C. Peritoneal drainage of chronic subdural hematomas in older patients. Journal of neurosurgery. 1988;68(6):908-11.
  58. Ram Z, Hadani M, Sahar A, Spiegelmann R. Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial. Acta neurochirurgica. 1993;1;120(1-2):40-3.
  59. Ramachandran R, Hegde T: Chronic subdural hematomas – Causes of morbidity and mortality. Surgical Neurology. 2007;67:367-373. 
  60. Reinges MH, Hasselberg I, Rohde V, Küker W, Gilsbach JM. Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. Journal of Neurology, Neurosurgery & Psychiatry. 2000;1;69(1):40-7. 
  61. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. Journal of Neurosurgery. 1984;61:263-268.
  62. Rohde V, Graf G, Hassler W: Complications of burr-hole craniostomyand closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurgical Review. 2002;25: 89-94. 
  63. Rust T, Kiemer N, Erasmus A: Chronic subdural haematomas and anticoagulation or antithrombic therapy. Journal of Clinical Neuroscience. 2006;13: 823-7.
  64. Rychlicki F, Recchioni A, Burchianti M, Marcolini P, Messori A. Percutaneous twist drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochirurgie (Wienn). 1991;113:38-41. 
  65. Sabatier P. Traitement percutané des hématomes sous-duraux chroniques par Twist-Drill et drainage continu: Etude rétrospective de 65 cas: L'hématome sous-dural chronique. Neuro-chirurgie. 2001;47(5):488-90.
  66. Sabo RA, Hanigan WC, Aldag JC. Chronic subdural hematomas and seizures: the role of prophylactic anticonvulsive medication. Surgical neurology. 1995;30;43(6):579-82.
  67. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surgical neurology. 1997;31;47(5):418-22.
  68. Santarius T, Hutchinson PJ. Chronic subdural haematoma: time to rationalize treatment? British Journal of Neurosurgery. 2004;18: 328-332. 
  69. Smely C, Madlinger A, Scheremet R. Chronic subdural hematoma – A comparison of two different modalities. Acta Neurochirurgie (Wienn). 1997;139:818-826. 
  70. Strootbandt G, Fransen P, Thauvoy C, Menard E. Pathogenic factors in chronic subdural hematoma and causes of recurrence after drainage. Acta Neurochirurgie (Wienn). 1995;137: 6-14.
  71. Suzuki K, Sujita K, Akai T, Takahata T, Sanobe M . Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surgical Neurology. 1998;50:231-34.
  72. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yagamata S. Independent predictors factors for recurrence of chronic subdural hematoma. Neurosurgery. 2008;63:1125-29. 
  73. Van Havenbergh T, Van Calenbergh F, Goffin J, Plets C. Outcome of chronic subdural haematoma: analysis of prognostic. British Journal of Neurosurgery. 1996;1:35-39. 
  74. Voelker JL. Nonoperative treatment of chronic subdural hematoma. Neurosurgery Clinics of North America. 2000;11(3):507-13.
  75. Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiari C, Njai M. Efficacy of closed-system drainage in treating chronic subdural hematoma: A prospective study. Neurosurgery. 1990;26:771-73. 
  76. Weisse A, Berney J. Chronic subdural haematomas.Results of a closed drainage method in adults. Acta Neurochirurgie (Wienn). 1994;127:37-40.
  77. Williams GR, Baskaya MK, Menendez J, Polin R, Willis B, Nanda A. Burr-hole versus twist-drill drainage for theevacuation of chronic subdural haematoma: a comparison of clinical results. Journal of clinical neuroscience. 2001;30;8(6):551-4.
  78. Yamada H, Watanabe T, Murata S, Shibui S, Nikei H. Developmental process of chronic subdural collections of fluid based on CT-Scan findings. Surgical Neurology. 1988;13: 444-48. 
  79. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origusa H, Endo S: Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. Journal of Neurosurgery. 2003;98:1217-221. 
  80. Zakaria AM, Adnan JS, Haspani MS, Naing NN, Abdullah JM. Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia: an analysis. Surgical Neurology. 2008;69: 608-615.​ 
Type of Study: Case report | Subject: Gamma Knife Radiosurgery

References
1. Adhyaman V, Asghar M, Ganeshram KN, Bohwmick K: Chronic subdural haematoma in the elderly. Postgraduate Medical Journal. 2002:78:71-75. [DOI:10.1136/pmj.78.916.71] [PMCID]
2. Amirjamshidi A, Eftekar B, Abouzari M, Rashidi A. The relationship between Glasgow coma/outcome scores and abnormal CT scan findings in chronic subdural hematomas. Clinical Neurology and Neurosurgery. 2007;109:152-7. [DOI:10.1016/j.clineuro.2006.07.007] [PMID]
3. Amirjamishidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, et al. Outcomes and recurrence rates in chronic subdural hematoma. British Journal of Neurosurgery. 2007;21:272-5. [DOI:10.1080/02688690701272232] [PMID]
4. Asfora W, Schwebach L. A modified technique to treat chronic and subacute subdural hematoma: technical note. Surgical Neurology. 2003;59:329-32. [DOI:10.1016/S0090-3019(03)00039-9]
5. Beatty RA. Subdural hematomas in the elderly: experience with treatment by trephine craniotomy and not closing the dura or replacing the bone plate. British Journal of Neurosurgery. 1999;13: 60-64. [DOI:10.1080/02688699944203] [PMID]
6. Benes L, Eggers F, Alberti O, Bertalanfy H. A new screw catheter kit for the bedside treatment of chronic subdural hematomas. Journal of Trauma. 2002;52:591-4. [DOI:10.1097/00005373-200203000-00035]
7. Benzel EC, Bridges RM Jr, Hadden TA, Orrisson WW. The single burr-hole technique for the evacuation of non-acute subdural hematomas. Journal of Trauma. 1994;36:190-4. [DOI:10.1097/00005373-199402000-00007] [PMID]
8. Borger V, Vatter H, Oszvald A, Murquardt G, Seifert V, Güresir E. Chronic subdural hematomas in elderly: a retrospectiv
9. Bourgeois Ph, Sleiman M, Louis E, Haddad G, Touzet A, Fichten A, et al. L'hématome sous dural chez les patients de plus de 80 ans. Neurochirurgieurgie.1999;45:124-8.
10. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist drill craniostomy with continuous catheter drainage. Journal of Neurosurgery. 1986;65:183-7. [DOI:10.3171/jns.1986.65.2.0183] [PMID]
11. Camel M, Grubb Jr RL. Treatment of chronic subdural hematoma by twist-drill craniostomy with continuous catheter drainage. Journal of neurosurgery. 1986;65(2):183-7. [DOI:10.3171/jns.1986.65.2.0183] [PMID]
12. Cameron MM: Chronic subdural haematoma: a review of 114 cases. Journal Neurology Neurosurgery Psychiatry. 1978;41:834-839. [DOI:10.1136/jnnp.41.9.834]
13. Chen JC, Levy ML. Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurgery clinics of North America. 2000;11(3):399. sis of 322 cases patients between ages of 65-94 years. Acta Neurochirurgieurgie. 2012;154: 1549-54.
14. Chen CW, Kuo JR, Lin HJ, Yeh CH, Wong BS, Kao CH, et al. Early postoperative seizures after burr-hole drainage for chronic subdural hematoma: correlations with brain CT findings. Journal of Clinical Neuroscience. 2004;11:706-9. [DOI:10.1016/j.jocn.2004.03.019] [PMID]
15. Chon KH, Lee JM, Koh EJ, Choi HY: Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochirurgieurgie (Wienn). 2012;154: 1541-48. [DOI:10.1007/s00701-012-1399-9] [PMID]
16. Dakurah TK, Idrissu M, Wepeda G, Nuamah I. Chronic subdural hematoma: review of 96 cases attending the Korle Bi teaching hospital, Accra. West African Journal of Medicine. 2005:24:283-6. [PMID]
17. De Noronha RJ, Sharrack B, Hadjivassilou M, Romanowski AJ. Subdural hematoma: a potentially serious consequence of spontaneous intracranial hypotenion. Journal of Neurology and Neurosurgery Psychiatry. 2003:74:752-5. [DOI:10.1136/jnnp.74.6.752] [PMID] [PMCID]
18. Dran G, Berthier F, Fontaine D, Rasenrarijae D, Pasquis P : Efficacité de la corticothérapie dans le traitement adjuvant des hématomes sous duraux chroniques. Etude rétrospective de 198 cas. Neurochirurgieurgie. 2007;53:477-482. [DOI:10.1016/j.neuchi.2007.09.146] [PMID]
19. Drapkin AJ. Chronic subdural hematoma: pathophysiological basis for treatment. British journal of neurosurgery. 1991;1;5(5):467-73.
20. El-Kadi H, Miele VJ, Kaufman HH. Prognosis of chronic subdural hematomas. Neurosurgery Clinics of North America. 2000;11(3):553. [DOI:10.1016/S1042-3680(18)30122-0]
21. Edmonds N, Hassier WE: New device to treat chronic subdural hematoma – hollow screw. Neurology Resource. 1999;21: 77-78. [DOI:10.1080/01616412.1999.11740897]
22. Ernestus RJ, Beldzinski P, Langermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surgery Neurology. 1997;48: 220-5. [DOI:10.1016/S0090-3019(97)80031-6]
23. Fogelholm R, Waltimo O. Epidemiology of chronic subdural haematoma. Acta Neurochirurgieurgie (Wien). 32: 247-250, 1975. [DOI:10.1007/BF01405457]
24. Frati A, Salvati M, Mainiro F, Ippoliti F, Rocchi G, Raco Caroli E, et al. Inflammation markers and risk factors for recurrence in 35 patients with post traumatic chronic subdural hematoma. Journal of Neurosurgery. 2004;100: 24-32. [DOI:10.3171/jns.2004.100.1.0024] [PMID]
25. Gazzeri R, Galerza M, Neroni M, Canova A, Refice GM, Esposito S: Continous subgaleal suction drainage for the treatment of chronic subdural haematoma. Acta Neurochirurgie (Wienn). 2007;149:487-493. [DOI:10.1007/s00701-007-1139-8] [PMID]
26. Gelabert-Gonzalez M, Galerza M, Neroni M, Canova A, Refice GM, Esposito S. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clinical Neurology and Neurosurgery. 2005;107: 223-9. [DOI:10.1016/j.clineuro.2004.09.015] [PMID]
27. Grisoli F, Graziani N, Peragut JC, Fabrizi AP, Caruzo G, Bellard S. Perioperative lumbar injection of Ringer's lactate solution in chronic subdural hematoma: a series of 100 cases. Neurosurgery. 1988;23: 616-21. https://doi.org/10.1097/00006123-198811000-00012 [DOI:10.1227/00006123-198811000-00012] [PMID]
28. Gurelik M, Aslan A, Gurelik B, Ozum U, Karadag Ö, Kars HZ. A safe and effective method for treatment of chronic subdural haematoma. The Canadian Journal of Neurological Sciences. 2007;1;34(01):84-7.
29. Hamilton MG, Bevan Frizzel J, Bruce I. Chronic subdural hematoma: the role of craniotomy reevaluated. Neurosurgery. 1993:33:67-72. https://doi.org/10.1227/00006123-199307000-00010 [DOI:10.1097/00006123-199307000-00010] [PMID]
30. Henning R, Kloster R: Burr hole evacuation of chronic subdural hematomas followed by continuous inflow and outflow irrigation. Acta Neurochirurgie (Wienn). 1999;141:171-6. [DOI:10.1007/s007010050282]
31. Horns EM, Freiz-Erfen I, Bristol RE, Spetzler RF, Harrington TR. Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surgical Neurology. 2006;65:150-4. [DOI:10.1016/j.surneu.2005.05.030] [PMID]
32. Kitakami A, Ogawa A, Hakozaki S, Kidogushi J, Obonal C, Kubo N. Carbon dioxyd gas replacement of chronic subdural hematoma using single burr-hole irrigation. Surgical Neurology. 1995;43:574-7. [DOI:10.1016/0090-3019(95)00020-8]
33. Kiymaz N, Yilmaz N, Mumcu C. Controversies in chronic subdural hematoma: continuous drainage versus one-time drainage. Medical science monitor. 2007 May 4;13(5):CR240-3. [PMID]
34. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical analysis of risk factors related to recurrent chronic subdural hematoma. Journal of Korean Neurosurgical Society. 2008;1;43(1):11-5.
35. Kotwica Z, Brzezinski J. Chronic subdural hematoma treated by burr holes and closed system drainage: personal experience with 131 patients. British Journalof Neurosurgery. 1991;5:461-5. [DOI:10.3109/02688699108998474]
36. Krupp WF, Jans PJ. Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage. British journal of neurosurgery. 1995;1;9(5):619-28.
37. Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N. Chronic subdural hematoma in elderly people. Present status on Awaji islands and epidemiological prospect. Neurology Medical Chir (Tokyo). 1992;32: 207-9. [DOI:10.2176/nmc.32.207]
38. Kuroki T, Katsume M, Harada N, Yamazaki T, Aoki K, Takasu N. Strict closed- system drainage for treating chronic subdural haematoma. Acta Neurochirurgie (Wienn). 2001;143:1041-4. [DOI:10.1007/s007010170010]
39. Lee K, Bae WK, Doh JW, Bae HG, Yun IG. Review origin of chronic subdural haematoma and relation to traumatic subdural lesions. Brain Inj. 1998;12:901-10. [DOI:10.1080/026990598121972] [PMID]
40. Lee JY, Ebel H, Ernestus RI, Kug N. Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary?Surgical Neurology. 2004;61:523-8. [DOI:10.1016/j.surneu.2003.10.026] [PMID]
41. Lind CR, Lind CJ, Mee EW. Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains. Journal of neurosurgery. 2003;99(1):44-6. [DOI:10.3171/jns.2003.99.1.0044] [PMID]
42. Loew R, Kiveletz R: Chronic subdural hematomas. In Hand Book of Clinical Neurology edited by Vinken PJ and Bruyn GW. North Holland Publishing Company Amsterdam Oxford. 1976, Vol 24, pp297-328.
43. Markwalder TM, Steinsepe, Rohner M, Reinchenbach W, Markwalder H: The course of chronic subdural hematomas after burr holecraniostomy and closed drainage. Journal of Neurosurgery. 1981;55: 390-396. [DOI:10.3171/jns.1981.55.3.0390] [PMID]
44. Markwalder TM, Seiler RW. Chronic subdural hematomas: to drain or not drain? Neurosurgery. 1985;16:185-8. https://doi.org/10.1227/00006123-198502000-00010 [DOI:10.1097/00006123-198502000-00010] [PMID]
45. Markwalder TM. The course of chronic subdural hematomas after burr-hole craniostomy with and without closed-system drainage. Neurosurgery Clinics of North America. 2000;11(3):541. [DOI:10.1016/S1042-3680(18)30120-7]
46. Mellegard P, Wisten O. Operations and reoperations for chronic subdural hematomas during 25 years period in a well-defined population. Acta Neurochirurgie (Wienn). 1996;138:708-13. [DOI:10.1007/BF01411476]
47. MORI K, MAEDA M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurologia medico-chirurgica. 2001;41(8):371-81. [DOI:10.2176/nmc.41.371] [PMID]
48. Murakami M, Morikawa K, Matsuno A, Kaneda K, Nagashima T. Spontaneous intracranial hypotension associated with bilateral chronic subdural hematomas. Neurologia medico-chirurgica (Tokyo).2000;40: 484-8. [DOI:10.2176/nmc.40.484]
49. Murata K: Chronic subdural hematoma may be preceded by persistent traumatic subdural effusion. Neurologia medico-chirurgica (Tokyo).1993;33:691-6. [DOI:10.2176/nmc.33.691]
50. Muzii VF, Bistazzoni S, Zalaffi A, Carangelo B. Chronic subdural hematoma: comparison of two surgical techniques: Preliminary results of a prospective randomized study/Comments. Journal of neurosurgical sciences. 2005;1;49(2):41.
51. Naganami K, Takeuchi S, Sakakibara F, Otani N, Nawashiro H. Radiological factors related to recurrence of chronic subdural hematoma. Acta Neurochirurgie (Wienn). 2011;153:1713. [DOI:10.1007/s00701-011-0971-z] [PMID]
52. Nakajima H, Yasui T, Nishikawa M, Kishi H, Kan M. The role of postoperative patient posture in the recurrence of chronic subdural hematoma: a prospective randomized trial. Surgical neurology. 2002;31;58(6):385-7.
53. Ohno K, Suzuki R, Masaoka H, Matsushima Y, Inaba Y, Monma S. Chronic subdural haematoma preceded by persistent traumatic subdural fluid collection. Journal of Neurology, Neurosurgery & Psychiatry. 1987;1;50(12):1694-7.
54. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurologia medico-chirurgica (Tokyo). 2001;41:382-6. [DOI:10.2176/nmc.41.382]
55. Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H. A comparative study of the treatment of chronic subdural hematoma—burr hole drainage versus burr hole irrigation. Surgical neurology. 2002;30;57(6):405-9.
56. Pahatouridis D, Alexiou GA, Fotakopoulos G, Mihos E, Zigouris A, Drosos D, Voulgaris S. Chronic subdural haematomas: a comparative study of an enlarged single burr hole versus double burr hole drainage. Neurosurgical review. 2013;1;36(1):151-5.
57. Probst C. Peritoneal drainage of chronic subdural hematomas in older patients. Journal of neurosurgery. 1988;68(6):908-11. [DOI:10.3171/jns.1988.68.6.0908] [PMID]
58. Ram Z, Hadani M, Sahar A, Spiegelmann R. Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial. Acta neurochirurgica. 1993;1;120(1-2):40-3.
59. Ramachandran R, Hegde T: Chronic subdural hematomas – Causes of morbidity and mortality. Surgical Neurology. 2007;67:367-373. [DOI:10.1016/j.surneu.2006.07.022] [PMID]
60. Reinges MH, Hasselberg I, Rohde V, Küker W, Gilsbach JM. Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. Journal of Neurology, Neurosurgery & Psychiatry. 2000;1;69(1):40-7.
61. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. Journal of Neurosurgery. 1984;61:263-268. [DOI:10.3171/jns.1984.61.2.0263] [PMID]
62. Rohde V, Graf G, Hassler W: Complications of burr-hole craniostomyand closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurgical Review. 2002;25: 89-94. [DOI:10.1007/s101430100182]
63. Rust T, Kiemer N, Erasmus A: Chronic subdural haematomas and anticoagulation or antithrombic therapy. Journal of Clinical Neuroscience. 2006;13: 823-7. [DOI:10.1016/j.jocn.2004.12.013] [PMID]
64. Rychlicki F, Recchioni A, Burchianti M, Marcolini P, Messori A. Percutaneous twist drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochirurgie (Wienn). 1991;113:38-41. [DOI:10.1007/BF01402112]
65. Sabatier P. Traitement percutané des hématomes sous-duraux chroniques par Twist-Drill et drainage continu: Etude rétrospective de 65 cas: L'hématome sous-dural chronique. Neuro-chirurgie. 2001;47(5):488-90. [PMID]
66. Sabo RA, Hanigan WC, Aldag JC. Chronic subdural hematomas and seizures: the role of prophylactic anticonvulsive medication. Surgical neurology. 1995;30;43(6):579-82.
67. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surgical neurology. 1997;31;47(5):418-22.
68. Santarius T, Hutchinson PJ. Chronic subdural haematoma: time to rationalize treatment? British Journal of Neurosurgery. 2004;18: 328-332. [DOI:10.1080/02688690400004845] [PMID]
69. Smely C, Madlinger A, Scheremet R. Chronic subdural hematoma – A comparison of two different modalities. Acta Neurochirurgie (Wienn). 1997;139:818-826. [DOI:10.1007/BF01411399]
70. Strootbandt G, Fransen P, Thauvoy C, Menard E. Pathogenic factors in chronic subdural hematoma and causes of recurrence after drainage. Acta Neurochirurgie (Wienn). 1995;137: 6-14. [DOI:10.1007/BF02188772]
71. Suzuki K, Sujita K, Akai T, Takahata T, Sanobe M . Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surgical Neurology. 1998;50:231-34. [DOI:10.1016/S0090-3019(97)00339-X]
72. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yagamata S. Independent predictors factors for recurrence of chronic subdural hematoma. Neurosurgery. 2008;63:1125-29. [DOI:10.1227/01.NEU.0000335782.60059.17] [PMID]
73. Van Havenbergh T, Van Calenbergh F, Goffin J, Plets C. Outcome of chronic subdural haematoma: analysis of prognostic. British Journal of Neurosurgery. 1996;1:35-39. [DOI:10.1080/02688699650040502]
74. Voelker JL. Nonoperative treatment of chronic subdural hematoma. Neurosurgery Clinics of North America. 2000;11(3):507-13. https://doi.org/10.1016/S1042-3680(18)30115-3 [DOI:10.1016/S1042-3680(18)30119-0]
75. Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiari C, Njai M. Efficacy of closed-system drainage in treating chronic subdural hematoma: A prospective study. Neurosurgery. 1990;26:771-73. https://doi.org/10.1097/00006123-199005000-00006 [DOI:10.1227/00006123-199005000-00006] [PMID]
76. Weisse A, Berney J. Chronic subdural haematomas.Results of a closed drainage method in adults. Acta Neurochirurgie (Wienn). 1994;127:37-40. [DOI:10.1007/BF01808544]
77. Williams GR, Baskaya MK, Menendez J, Polin R, Willis B, Nanda A. Burr-hole versus twist-drill drainage for theevacuation of chronic subdural haematoma: a comparison of clinical results. Journal of clinical neuroscience. 2001;30;8(6):551-4.
78. Yamada H, Watanabe T, Murata S, Shibui S, Nikei H. Developmental process of chronic subdural collections of fluid based on CT-Scan findings. Surgical Neurology. 1988;13: 444-48.
79. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origusa H, Endo S: Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. Journal of Neurosurgery. 2003;98:1217-221. [DOI:10.3171/jns.2003.98.6.1217] [PMID]
80. Zakaria AM, Adnan JS, Haspani MS, Naing NN, Abdullah JM. Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia: an analysis. Surgical Neurology. 2008;69: 608-615. [DOI:10.1016/j.surneu.2007.01.054] [PMID]

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