J Korean Neurosurg Soc.  2017 Nov;60(6):717-722. 10.3340/jkns.2017.0404.010.

Delayed Burr Hole Surgery in Patients with Acute Subdural Hematoma: Clinical Analysis

• Choi YH
• Han SR
• Lee CH
• Choi CY
• Sohn MJ
• Lee CH

• KMID: 2395792
• DOI: http://doi.org/10.3340/jkns.2017.0404.010

Abstract

OBJECTIVE
To evaluate the effectiveness and efficacy of delayed burr hole surgery in relation to the reduction of postoperative subdural hematoma (SDH) volume in patients with acute SDH.
METHODS
We retrospectively analyzed patients with acute SDH who received delayed burr hole surgery at our institute. Age, sex, Glasgow coma scale, maximal SDH thickness, volume of SDH, midline shifts, hounsfield unit (HU), and medical history of anticoagulant agent usage were recorded. Outcome measures were delayed operation day, reduction of SDH volume after operation, and the Glasgow outcome scale (GOS) score at discharge. The patients were divided two groups according to the post-operative reduction of volume of SDH (≥50%, group A; <50%, group B). We also analyzed variables and differences between two groups.
RESULTS
Eighteen patients were available for this analysis. The mean delayed of surgery was 13.9±7.5 days. Maximal thickness of SDH was changed from 10.0±3.5 mm to 12.2±3.7 mm. Volume of SDH was changed from 38.7±28.0 mL to 42.6±29.6 mL. Midline shifts were changed from 5.8±3.3 mm to 6.6±3.3 mm. HU were changed from 66.4±11.2 to 53.2±20.6. Post-operative reduction of SDH volume was 52.1±21.1%. Eleven patients (61%) had a discharge GOS score of 1 (good recovery). Ten patients (56%) were enrolled in group A. Midline shifting was greater in group A than in group B (7.4±3.3 vs. 3.0±2.4 mm; p<0.02). The delay of surgery was shorter for group A than group B (9.2±2.3 vs. 19.8±7.7 days; p<0.0008).
CONCLUSION
Among well selected patients, delayed burr hole surgery in patients with acute SDH may be effective for reduction of SDH volume. Further studies will be necessary to establish the effectiveness and safety of delayed burr hole surgery in patients with acute SDH.

Keyword

Subdural hematoma; Surgery

MeSH Terms

Glasgow Coma Scale
Glasgow Outcome Scale
Hematoma, Subdural
Hematoma, Subdural, Acute*
Humans
Outcome Assessment (Health Care)
Retrospective Studies

Figure

• 

  Fig. 1 Data of patients 1 and 14. Patient 1 (female/61): the initial CT image (A) shows a thick hyper-dense ASDH at the left frontotemporoparietal convexity. The follow-up CT (B), which was performed 1 weeks after conservative treatment, reveals a hypodense SDH with an increase of midline shift and volume of SDH. Postoperative CT (C) demonstrates reduction of SDH. Patient 14 (male/53): The initial CT image (D) reveals a thin hyperdense ASDH at the left parietoocipital convexity. The follow-up CT, which was performed 18 days, reveals a hypodense SDH with an increase of midline shift to the right hemisphere. Postoperative CT (F) shows reduction of SDH. CT: computed tomography, ASDH: acute subdural hematoma, SDH: subdural hematoma.

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  Fig. 2 Before operation, midline shifts were increased from 5.8±3.3 mm to 6.6±3.3 mm. The number of patients were matched to Table 1.

Reference

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