J Korean Neurotraumatol Soc.  2010 Jun;6(1):33-37. 10.13004/jknts.2010.6.1.33.

Prediction of Postoperative Drainage Volume and Brain Expansion of Chronic Subdural Hematoma: Supplementary Study-Clinical Study

• Kim JY
• Hyun DK
• Yoon SH
• Park HS
• Kim E
• Park HC
• Park CO

• KMID: 2192359
• DOI: http://doi.org/10.13004/jknts.2010.6.1.33

Abstract

OBJECTIVE
The authors studied the factors associated with postoperative drainage volume after burr-hole craniostomy for chronic subdural hematoma (CSDH) to predict real postoperative drainage volume, and the relation between brain expansion and drained hematoma volume.
METHODS
During the last 7 years, 75 patients with CSDH had been undertaken burrhole drainage. For these, demographical and radiological data regarding CSDH were gathered and reviewed, including hematoma density, volume, and parameters of brain compliance on computed tomography (CT) scan. We estimated the brain expansion using the degree of frontal horn compression and midline shifting by the B/A ratios, and made statistical analyses for relation with the postoperative drainage volume.
RESULTS
In a whole, the estimated volume was 139 mL, mean real drainage volume was 261 mL, and mean B/A ratio was 0.53. There was no statistical significance between estimated and real drainage volumes. Among 4 groups, low density subgroup showed the largest difference between estimated volume (128 mL) and mean real drainage volume (214 mL), and lowest mean B/A ratio of 0.5. B/A ratio had inverse relationship with real drainage volume (p<0.05).
CONCLUSION
The postoperative drainage volume after operation of CSDH was affected by brain expansion. Postoperative drainage volume was decreased as the B/A ratio was increased, and vice versa. Postoperative drainage volume of CSDH, in some extent, can be predicted with the density types of CSDH and the degree of frontal horn compression.

Keyword

Chronic subdural hematoma; Elasticity; Subdural drainage

MeSH Terms

Animals
Brain
Compliance
Drainage
Elasticity
Hematoma
Hematoma, Subdural, Chronic
Horns
Humans

Figure

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  FIGURE 1 Chronic subdural hematoma is classified according to its density on brain computed tomography scans. A: High/Iso mixed type. B: Iso type. C: Iso/Low mixed type. D: Low type.

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  FIGURE 2 This diagram shows parameters to predict the postoperative drainage volume and the brain re-expansion after drainage of chronic subdural hematoma, B/A ratio. A: The distance between both inner skull table at the level of frontal horn of lateral ventricle. B: The distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A.

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  FIGURE 3 This diagram shows parameters to estimate the volume of chronic subdural hematoma, according to Sucu method. X: maximal diameter of chronic subdural hematoma in base, midportion, and vertex of brain, Y: maximal width of chronic subdural hematoma, Z: height of chronic subdural hematoma, estimated hematoma volume: XYZ/2.

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  FIGURE 4 This scatterplot shows the inverse relation between the B/A ratio and the postoperative drainage volume of chronic subdural hematoma. CSDH: chronic subdural hematoma, A: the distance between both inner skull table at the level of frontal horn of lateral ventricle. B: the distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A.

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