Korean J Neurotrauma.  2012 Oct;8(2):134-138. 10.13004/kjnt.2012.8.2.134.

The Influence of Postoperative Lesion-Down Head Position on the Recurrence Rate in Chronic Subdural Hematoma after Burr-Hole Surgery

• Bae GS
• Choi SW
• Kwon HJ
• Kim SH
• Koh HS
• Youm JY
• Song SH

• KMID: 1427727
• DOI: http://doi.org/10.13004/kjnt.2012.8.2.134

Abstract

OBJECTIVE
Chronic subdural hematoma is a common disorder observed in neurosurgical care and the recurrence rate is relatively high. In this report, we evaluated the relationship between the recurrence rate of chronic subdural hematoma and the postoperative head position of the patient.
METHODS
We conducted a retrospective study of 72 patients with unilateral chronic subdural hematoma treated by burr hole surgery with closed system drainage from October 2009 to May 2011. In group A, there was no restriction in head position for days keeping the catheter. In group B, the patients were placed with the lesion side of the head downward after the operation. We analyzed the recurrence rate, amount of postoperative drainage and changes in computed tomography finding of group A and B.
RESULTS
Group A and group B consisted of 36 cases, respectively. The mean amount of total postoperative drainage was 248.8+/-127.2 mL in group A and 176.3+/-98.9 mL in group B (p=0.01). The improvement rates of midline shifting before and after surgery showed 60.5+/-25.6% in group A and 73.4+/-26.3% in group B (p=0.039). The total recurrence rate in group A was 11.1% and 5.6% in group B.
CONCLUSION
By facing the lesion downward after surgical treatment, chronic subdural hematoma is thought to help reexpand the brain and to prohibit cerebrospinal fluid from flowing into subdural space and to decrease the recurrence rate better than having a free position.

Keyword

Subdural hematoma; Chronic; Recurrence

MeSH Terms

Brain
Catheters
Diphtheria Toxoid
Drainage
Haemophilus Vaccines
Head
Hematoma, Subdural
Hematoma, Subdural, Chronic
Humans
Recurrence
Retrospective Studies
Subdural Space
Diphtheria Toxoid
Haemophilus Vaccines

Figure

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  FIGURE 1. The improvement rate of maximum width (A) and midline shift (B) before and after the surgery in brain CT was higher in group B. ∗improvement rate: (1-value of 24 h after surgery/pre-operative value)×100.

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  FIGURE 2. The mean cumulative drainage in 6 hours, 12 hours and 24 hours and total amount after surgery were larger in group A than in group B (∗p＜0.05).

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  FIGURE 3. Proportion of cumulative volume to total volume in 6 hours, 12 hours and 24 hours of postoperative drainage didn’t show statistically significant differences (p＞0.05). Proportion to total vol.: cumulative vol./total vol.×100.

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  FIGURE 4. Placing the head lesion-downward after surgery can effectively re-expand the brain with the help of gravity. It can also prohibit CSF from flowing into subdural space.

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