Skip to main content
Log in

Influence of neomembranous organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma—an analysis of 201 cases

  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

The post-operative clinical course of a series of 201 patients with chronic subdural haematoma has been analyzed with respect to neomembranous organisation, cortical expansion and subdural pressure in the form of a prospective (53 cases) and retrospective (148 cases) study. With the exception of one patient (primary craniotomy and membranectomy) all other 200 cases were treated according to a standarized treatment protocol consisting of burr-hole craniotomy with (170 cases) or without (30 cases) closed-system drainage.

Post-operative mortality (within one month after surgery) was 2%. There was a 4.5% recurrency rate and a 2% infection rate. Morbidity solely related to chronic subdural haematoma was 2% and was characterized by a mild neurological deficit. The level of subdural pressure had no influence on the post-operative clinical course, whereas marked intra-operative cerebral re-expansion favoured a more rapid clinical improvement. Although standard deviations were within a broad range, a nearly linear inverse relation could be assumed between the amount of peri-operative cerebral expansion and the degree of neomembranous organisation of the haematomas. Subdural neomembranes seem to represent the crucial opponents to cerebral re-expansion and they prolong the duration of neurological restitution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bender, M. B., Christoff, N., Nonsurgical treatment of subdural hematomas. Arch. Neurol.31 (1974), 73–79.

    PubMed  Google Scholar 

  2. Cameron, M. M., Chronic subdural hematoma: a review of 114 cases. J. Neurol. Neurosurg. Psychiat.41 (1978), 834–839.

    PubMed  Google Scholar 

  3. Gilsbach, J., Eggert, H. R., Harders, A., Externe geschlossene Drainagebehandlung des chronischen Subduralhaematoms nach Bohrloch-Trepanation. Unfallchirurgie6 (1980), 183–186.

    PubMed  Google Scholar 

  4. Gjerris, F., Brodersen, P., Regional cerebral blood flow in patients with chronic subdural hematoma before and after operation. Abstract. Acta Neurochir. (Wien)31 (1975), 267–268.

    Google Scholar 

  5. Harders, A., Eggert, H. R., Weigel, K., Behandlung des chronischen Subduralhaematoms mit externer geschlossener Drainage. Neurochirurgia25 (1982), 147–152.

    PubMed  Google Scholar 

  6. Hubschmann, O. R., Twist drill craniotomy in the treatment of chronic and subacute subdural hematomas in severely ill and elderly patients. Neurosurgery6 (1980), 233–236.

    PubMed  Google Scholar 

  7. Ito, H., Komai, T., Yamamoto, S., Fibrin and fibrinogen degradation products in chronic subdural hematoma. Neurol. Med. Chir. (Tokyo)15 (1975), 51–55.

    Google Scholar 

  8. Ito, H., Yamamoto, S., Komai, T., Mizukoshi, H., Role of local hyperfibrinolysis in the etiology of chronic subdural hematoma. J. Neurosurg.45 (1976), 26–31.

    PubMed  Google Scholar 

  9. Ito, H., Komai, T., Yamamoto, S., Fibrinolytic enzyme in the lining walls of chronic subdural hematoma. J. Neurosurg.48 (1978), 197–200.

    PubMed  Google Scholar 

  10. Jamieson, K. G., Yelland, J. D. N., Surgically treated traumatic subdural hematomas. J. Neurosurg.37 (1972), 137–149.

    PubMed  Google Scholar 

  11. Kao, M-C., Sedimentation level in chronic subdural hematoma visible on computerized tomography. J. Neurosurg.58 (1983), 246–251.

    PubMed  Google Scholar 

  12. Loew, F., Kivelitz, R., Chronic subdural hematomas. In: Handbook of Clinical Neurology (Vinken, P. J., Bruyn, G. W., eds.), Vol. 24, Part II. Amsterdam-Oxford: North Holland Publ. Co. and New York: American Elsevier Publ. Co. 1976.

    Google Scholar 

  13. Loew, F., Management of chronic subdural haematomas and hygromas. In: Advances and Technical Standards in Neurosurgery (Krayenbühl, H.,et al., eds.), Vol. 9, pp. 113–131. Wien-New York: Springer. 1982.

    Google Scholar 

  14. Markwalder, T. M., Chronic subdural hematomas: a review. J. Neurosurg.54 (1981), 637–645.

    PubMed  Google Scholar 

  15. Markwalder, T. M., Steinsiepe, K. F., Rohner, M., Reichenbach, W., Markwalder, H. M., The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J. Neurosurg.55 (1981), 390–396.

    PubMed  Google Scholar 

  16. Markwalder, T. M., Seiler, R. W., Chronic subdural hematoma: to drain or not to drain. Neurosurgery16 (1985), 185–188.

    PubMed  Google Scholar 

  17. McKissok, W., Richardson, A., Bloom, W. H., Subdural hematoma. A review of 389 cases. Lancet1 (1960), 1365–1369.

    Google Scholar 

  18. Ohaegbulam, S. C., Surgically treated traumatic subacute and chronic subdural hematomas: a review of 132 cases. Injury13 (1981), 23–26.

    PubMed  Google Scholar 

  19. Richter, H. P., Klein, H. J., Schäfer, M., Chronic subdural hematomas treated by enlarged burr-hole craniostomy and closed-system drainage. Retrospective study of 120 patients. Acta Neurochir. (Wien)71 (1984), 179–188.

    Google Scholar 

  20. Robinson, R. G., The treatment of subacute and chronic subdural hematomas. Br. Med. J.1 (1955), 21–22.

    Google Scholar 

  21. Robinson, R. G., Chronic subdural hematoma: surgical management in 133 patients. J. Neurosurg.61 (1984), 263–268.

    PubMed  Google Scholar 

  22. Scotti, G., Terbrugge, K., Melançon, D., Bélanger, G., Evaluation of the age of subdural hematomas by computerized tomography. J. Neurosurg.47(1977), 311–315.

    PubMed  Google Scholar 

  23. Svien, H. J., Gelety, J. E., On the surgical management of encapsulated subdural hematoma. A comparison of the results of membranectomy and simple evacuation. J. Neurosurg,21 (1964), 172–177.

    PubMed  Google Scholar 

  24. Tabaddor, K., Shulman, K., Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closedsystem drainage. J. Neurosurg.46 (1977), 220–226.

    PubMed  Google Scholar 

  25. Tyson, G., Strachan, W. E., Newman, P., Winn, H. R., Butler, A., Jane, J., The role of craniectomy in the treatment of chronic subdural hematomas. J. Neurosurg.52 (1980), 776–781.

    PubMed  Google Scholar 

  26. Vieth, R. G., Tindall, G. T., Odom, G. L., The use of tantalum dust as an adjunct in the post-operative management of subdural hematomas. J. Neurosurg.24 (1966), 514–519.

    PubMed  Google Scholar 

  27. Weir, B. K. A., Oncotic pressure of subdural fluids. J. Neurosurg.53 (1980), 512–515.

    PubMed  Google Scholar 

  28. Weir, B. K. A., Results of burr hole and open or closed suction drainage for chronic subdural hematomas in adults. Can. J. Neurol. Sci.10 (1983), 22–26.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Markwalder, T.M., Reulen, H.J. Influence of neomembranous organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma—an analysis of 201 cases. Acta neurochir 79, 100–106 (1986). https://doi.org/10.1007/BF01407452

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01407452

Keywords

Navigation