Clinical Feactures Of Chronic Subdural Hematom And Causes Of Postoperative Complications After Borr-hole Craniostomy With Closed-system Drainage

Objective: To improve the understanding of chronic subdural hematoma(CSDH) by analysis the etiology,clinical manifestation and neuroimaging diagnosis and the cause of postoperative complications after burr-hole craniostomy.Methods: We retrospectively analyzed the clinical data of 216 patients with CSDH treated by burr-hole craniostomy in First Affiliated hospital of Suzhou University between January 1,1996 and December 31,2001.Results:1l.The etiology could be determined in the most of patients .151 patients presented with the history of head injury and 6 patients associated with coagulopathies and cerebrospinal fluid shunts respectively. It remained unclear in 53 patients. 2. The leading symptom in the younger patients(<60 years) was elevated intracranial pressure such as headaches ,nause,vomiting wherease the most frequent symptom in elder patients (>60 years) were numbness or hemiparesis. 3. All patients underwent head CT examinations. Contract-enhanced CT scans and MRI were performed in 3 patients and 2 patients respectively. The CSDH were classified into five groups according to their density and appearance on CT scans: high-,low-,iso-,mixed-density and layered. Eight patients were misdiagnosised and all in isodense group.Seven patients were misdiagnosised as cerebral ischemia and one patient as glioma. 4. Clinical outcome was satifactory. 213 patients completely recovered after burr-hole craniostomy.Three cases of patients died. 13patients encounted the postoperative complications. There were 8 patients of hematoma recurrence, 1 of subdural tension pneumocephalus and 2 of epilepsy and stroke respectively.Conclusions:1.The etiology of CSDH could be determined in most of patients. About twenty-four point five percents of patients whose etiology remained unclear. 2. The presentation of CSDH is differented between younger(<60years) and older patients (>60 years) and there is no special presentation of CSDH. 3. There are five types of appearance on CT scans of CSDH and isodense type is more likely to be misdiagnosised. A contract-enhanced CT scans or MRJ examination may be necessary in the evaluation of isodense CSDH. 4. Although the treatment of CSDH with burr-hole craniostomy is a safe and simple method, postoperative complications may be encounted and motality still exist in some patients.