A comparative study of the treatment of chronic subdural hematoma : irrigation versus drainage procedure

الملخص EN

Objectives : To report the experience of surgical treatment of chronic subdural hematoma and to determine the value of the most preferred surgical methods.

Methods: Fifty-eight patients with clinical and radiological (CT scan or MRI) diagnosis of chronic subdural hematoma who were treated surgically were included in a case series study conducted at the Neurosurgical Unit of the Mosul Teaching Hospital in Mosul, Iraq during the period from January 1997 to January 2004.

The patients were divided into two groups.

Group 1 included 41 patients who were treated by single (7 patients) or two burr- hole irrigationa and evacuation only (34 patients).

Group 2 included 17 patients treated by burr-hole evacuation plus closed-system drainage procedure.

Data were collected in relation to the age, clinical presentation, outcome and mortality.

Chi square test was used for statistical analysis.

Results: The mean age was 60 years.

Head trauma was noted in two-thirds of patients.

Headache and focal neurological deficits were the main clinical presentations.

Forty-five (77.5%) patients had unilateral hematoma.

Thirty-nine (95%) patients in Group 1 had complete improvement at the end of the first postoperative week.

Recurrence of the hematoma 3-6 weeks postoperatively occurred in six patients initially treated with single burr- hole evacuation.

Complications were noticed in one and mortality in two patients.

In contrast, all patients in Group 2 improved.

These differences between Group 1 and 2 were not significant.

However, within group 1, a statistically significant difference was noted regarding recurrence rate between patients who were treated by single burr-hole and those who were treated by two burr-holes (P = 0.001).

Conclusion : Two burr-hole irrigation and evacuation technique without closed-system drainage appears to be a safe, reliable, and effective surgical method of dealing with a clinically symptomatic chronic subdural hematoma.

Its results are comparable to those of drainage procedure.

To the best of our knowledge, this has not been fully addressed in the literature.