Author(s): Surendra Kumar Chellarapu1, Satya Vara Prasad Kadali2, Prahladu Patirla3, Rajasekhar Boddapati4
Chronic Subdural Haematomas (CSDH) is a frequently encountered condition in neurosurgical practice with increasing incidence because of ageing population particularly in those who use anticoagulants and antiplatelet agents. These are treated with evacuation of CSDH with burr holes, craniotomy and craniotomy after burr holes for recurrence or reaccumulation in few. The surgical procedure, need for additional surgical procedure, complications and outcome are assessed.
MATERIALS AND METHODS
During the period of 4 years 6 months from September 2012 to March 2017, 225 patients who presented with chronic subdural haematoma were treated. This is a retrospective study. These patients underwent non-contrast CT at the time of admission. Surgical evacuation of CSDH was done and patient outcome in terms of reaccumulation, recurrence, complications and final outcome are observed.
Out of total 225 cases, 183 are males and 42 are females, 81.33% and 18.66%, respectively. 167 cases are treated with burr-hole evacuation and 58 with craniotomy, 74.22% and 25.77%, respectively. 35 out of 167 patients treated with burr holes needed re-exploration of previous burr holes and evacuation in 24 cases and conversion to craniotomy in 11 cases. 6 out of 58 patients treated with craniotomy needed exploration for reaccumulation of SDH. The death rate is 6.7% (11 patients) in burr-hole cases and 10.3% (6 cases) in craniotomy cases.
Management of CSDH either with burr holes or craniotomy should be selected on case-by-case basis depending on radiographic findings like membrane thickness associated acute haemorrhage, multiple loculations, calcified membrane, underlying intracranial complications and general condition of the patient.