J Korean Neurotraumatol Soc.  2010 Jun;6(1):38-42. 10.13004/jknts.2010.6.1.38.

Analysis of the Computed Tomographic Findings Related with the Mean Duration of Brain Expansion after the Operation of Chronic Subdural Hematoma

• Kim DJ
• Kim TW
• Park KH
• Chi MP
• Kim JO

• KMID: 2192361
• DOI: http://doi.org/10.13004/jknts.2010.6.1.38

Abstract

OBJECTIVE
The purpose of this study is evaluate the radiological factors related with the mean duration of brain expansion for after chronic subdural hematoma surgery.
METHODS
From January 2007 to June 2009, 44 patients were taken operation for chronic subdural hematoma using burr hole on our hospital. Among them, seven patients were excluded. One was taken craniotomy after burr hole drainage due to subdural abscess and the remaining six patients whose brains failed to show complete expansion postoperatively in at least three months of follow-up. We retrospectively analyzed the mean duration of brain expansion by following five aspects: the maximal thickness of preoperative hematoma, degree of midline shift, density of preoperative hematoma, presence or absence of contralateral side hematoma, and degree of postoperative pneumocephalus.
RESULTS
When preoperative or postoperative computed tomographic images were put into analysis, the radiologic factors such as preoperative hematoma with the maximal thickness more than 20 mm, midline shifting more than 10 mm, hematoma of mixed density, presence of contralateral side hematoma, postoperative large air collection had taken more time for their brains to expand. Four out of six patients with contralateral side hematoma whose maximal thickness were more than 10 mm on the preoperative computed tomographic images have needed additional surgery on the contralateral side after initial burr hole trephination with hematoma drainage.
CONCLUSION
Among the factors been analyzed for brain expansion in this study, the presence of contralateral side hematoma and postoperative large pneumocephalus were proven to be statistically significant radiologic factors for delaying the expansion of the brains. Thus, the efforts to reduce postoperative air collection should be made as surgeons' aspect. In addition, bilateral surgery simultaneously should also be recommended, especially when the maximal thickness of contralateral hematoma is more than 10 mm, even though this specific thickness of hematoma was not tested statistically.

Keyword

Chronic subdural hematoma; Brain; Expansion

MeSH Terms

Abscess
Brain
Craniotomy
Drainage
Follow-Up Studies
Hematoma
Hematoma, Subdural, Chronic
Humans
Pneumocephalus
Retrospective Studies

Figure

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  FIGURE 1 Postoperative CT scan showing slit-like pneumocephalus.

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  FIGURE 2 Postoperative CT scan showing large pneumocephalus.

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