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Comparative Study on Preoperative and Postoperative Radiological Findings in Chronic Subdural Hematoma

Thanapal , Ponnaiyan Natesan1 , Sengottuvel Thanapal2

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International Journal of Neurology and Neurosurgery 11(1):p 58-62, January-March 2019. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.11119.9

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Abstract

Introduction: Chronic Subdural Hematoma (Chronic SDH) is one of the most common clinical entities faced by neurosurgeons in their day to day practice. It is more common in old age where brain atrophy with increased space between the brain and skull facilitates of Chronic SDH. Burr hole craniostomy is accepted as the most common treatment especially in the older patients with pulmonary and cardiac complications and the aim will be minimal intervention with minimal anesthesia. Aim of the Study: To Evaluate Pre –Operative And Post Operative Radiological Findings in Chronic Subdural Hematoma Patients Who Under Gone Burr-Hole Surgery. Materials and Methods: We selected 100 cases with chronic subdural hematoma who were admitted in Emergency head injury ward of Department of Neurosurgery, Government Mohan Kumaramangalam Medical College, Salem and all underwent double burr hole craniostomy. Based on the CT scan findings, persistent midline shift of 5 mm and/or residual hematoma thickness +10 mm was considered an indication for reexploration. All the patients were followed up with a CT scan of the brain taken on the 4th postoperative day. The CT scan was perused for residual hematoma and midline shift. Results: There was a significant reduction in the midlan line shift with a standard deviation of 3.39 in patients who underwent evacuation of CSDH with drain whereas the other group yielded a standard deviation of 3.14 with a significant p-value of less than 0.033. the clot thickness prior to and after surgery in patients who underwent without drain was 5.22 and 3.79 with a p-value of equal to 0.001 thus proving the former the better and statistically significant. Out of 52 of those who underwent surgery with drain, 10 developed pneumocephalus of which 2 were of moderate severity. On the other hand, out of 48 of those who underwent surgery without drain, 27 marked an incidence of pneumocephalus, which is almost more than 50% thus establishing the superiority of the drains over no drains in terms of preventing recurrence. Conclusion: The reduction in the hematoma thickness and midline shift was also marked and the difference was statistically significant in those with drains than in the other. The recurrence rate was markedly less and the difference was statistically significant in those with drains than in the other. The rate of occurrence of pneumocephalus was definitely very low and was statistically significant in those with drains than in the other.

Keywords: Pneumocephalus; Chronic Subdural Hematoma; Midline Shift; Clot Thickness.   

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.11119.9

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