Controversies in Chronic Subdural Hematoma

Abstract

Background: Various surgical methods are recommended for the therapy of chronic subdural hematoma (CSH). In this study, burr-hole continuous drainage (CD) and burr-hole one-time drainage (OTD) methods for the treatment of CSH are retrospectively compared. Materials/Methods: Fifty patients with CSH referred to this clinic between July 1995 and December 2003 were selected for treatment. Twenty-one patients were treated by the burr-hole OTD method and 29 patients received burr-hole CD therapy. The recurrence rates and the extension of the hematoma were evaluated with respect to the period of postoperative hospitalization to evaluate the most effective method. Results: The postoperative hospitalization period was 7.9 days in the burr-hole continuous drainage group and 17 days in the burr-hole one-time drainage group. Recurrence developed in two cases (6.8%) in the CD group and in six cases (28.5%) in the OTD group. When the pre- and postoperative hematoma extension in the CD group were compared, a significant degree of decrease was observed on post-op day 1. Extension of the hematoma was found to be minimal in the days following the modification. The width of the hematoma in the OTD group was also reduced at post-op day 1; however, the degree of this decrease was not significant. Conclusions: Continuous drainage therapy for CSH is superior to the one-time drainage method due to the shorter time of post-op hospitalization and to the reduced rate of recurrence.