CEREBRAL COLLAPSE ASSOCIATED WITH CHRONIC SUBDURAL HAEMATOMA IN ADULTS: A COMPARISON OF TWO METHODS OF TREATMENT

Treatment of hemispheric collapse and herniation beneath the falx in a case of shunted hydrocephalus

A successfully treated case of inversion and herniation of a cerebral hemisphere beneath the falx is reported. This condition resulted from large subdural hematomas as a complication of shunting in advanced hydrocephalus. The subdural collections were evacuated gradually while ventricular cerebrospinal fluid was replenished through the externalized ventricular catheter. The patient showed substantial recovery of neurological function. Tolerance of such massive cerebral herniation demonstrates a remarkable ability of the thin hydrocephalic cortical mantle to function after extreme distortion.

Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma: report of seven cases

We present seven cases of tension pneumocephalus developing after burr hole evacuation of chronic subdural haematoma. After a careful review of the literature we discuss the physiopathology, the diagnosis and the treatment of this complication of chronic subdural haematoma surgery.

Tension pneumocephalus following evacuation of chronic subdural haematoma

Five cases of a rare complication of tension pneumocephalus following evacuation of chronic subdural haematoma are described. This occurred in 8% of all cases of chronic subdural haematoma treated following installation of a CT scanner. The chronically compressed brain contributes to the ingress of this intracranial air. The increase in the brain bulk and gradual re-expansion of the brain, in the early postoperative period, competes with the trapped subdural air resulting in a rise in intracranial pressure leading to neurological deterioration. Twist drill craniostomy and aspiration, using a brain cannula with a three-way connector, has produced excellent results.

Chronic subdural hematoma: surgical management in 133 patients

One hundred and thirty-three patients with chronic subdural hematoma were treated surgically between 1943 and 1980. The patients, aged 5 to 84 years, were graded retrospectively according to the Bender scale; 28% were in Grades 3 and 4. There were 107 unilateral and 26 bilateral hematomas. The clots were removed mostly via burr-holes without drainage. The treatment of 121 patients included an active policy of brain expansion at operation and the postoperative management of intracranial hypotension by lumbar injection. Two patients died, for a mortality rate of 1.5%. The patients who died were 54 and 59 years old, both from among the 26 cases with bilateral lesions; 107 unilateral lesions were treated, with no deaths. None of 51 patients who were aged 61 years and over died. The mean postoperative stay was 17.2 days, and at 3 weeks 77% had been discharged home. Fifteen percent of survivors had permanent disabilities. The common residual deficits were personality and memory disorders, and there was hemiparesis in Grade 4 cases. The high-risk groups of chronic subdural hematoma were those in Grades 3 and 4, bilateral hematomas, and the elderly. These seemed to be benefited by brain inflation and lumbar injections for intracranial hypotension.

Results of burr hole and open or closed suction drainage for chronic subdural hematomas in adults

Chronic subdural hematomas in adults are not technically difficult to treat. They probably constitute one of the most common potentially curable lesions with which the average neurosurgeon deals. Despite this (or perhaps because of it) numerous treatments, radically differing from one another, have been advocated. Fine judgment is called for in deciding whether or not to operate in the first instance, make a flap or one or more burr or twist drill holes, use a drain, employ suction, inflate the brain, leave the bone flap out. In a personal series of 71 chronic subdural hematomas, 46 were treated with a red rubber catheter drain through a burr hole and 23 with a closed system suction drain. The results of this series suggest that closed system suction drainage through a single burr hole is the better of the two techniques. It has important theoretical advantages and the procedure is simple and fast. The complication rate is low and patients have a shortened postoperative hospital stay.

Chronic subdural hematomas: a review

✓ Present knowledge of the still controversial pathogenetic, ultrastructural, diagnostic, and treatment aspects of chronic subdural hematomas is reviewed.