The role of craniectomy in the treatment of chronic subdural hematomas

George Tyson M.D.1, W. Ellis Strachan F.R.C.S.1, Peter Newman M.R.C.P.1, H. Richard Winn M.D.1, Albert Butler M.D.1, and John Jane M.D.1
View More View Less
  • 1 Department of Neurology (Surgical Division), Plymouth General Hospital (Freedom Fields), Plymouth, England, and Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

✓ A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1.

    Ambrosetto C: Post-traumatic subdural hematoma. Further observations on nonsurgical treatment. Arch Neurol 6:287292, 1962 Ambrosetto C: Post-traumatic subdural hematoma. Further observations on nonsurgical treatment. Arch Neurol 6:287–292, 1962

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Apfelbaum RI, , Guthkelch AN, & Shulman K: Experimental production of subdural hematomas. J Neurosurg 40:336346, 1974 Apfelbaum RI, Guthkelch AN, Shulman K: Experimental production of subdural hematomas. J Neurosurg 40:336–346, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Bender MB, & Christoff N: Nonsurgical treatment of subdural hematomas. Arch Neurol 31:7379, 1974 Bender MB, Christoff N: Nonsurgical treatment of subdural hematomas. Arch Neurol 31:73–79, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Browder J, & Rabiner AM: Regional swelling of the brain in subdural hematoma. Ann Surg 134:369375, 1951 Browder J, Rabiner AM: Regional swelling of the brain in subdural hematoma. Ann Surg 134:369–375, 1951

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Burton C: The management of chronic subdural hematoma using a compact hand twist drill. Milit Med 133:891895, 1968 Burton C: The management of chronic subdural hematoma using a compact hand twist drill. Milit Med 133:891–895, 1968

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Cook AW, , Browder EJ, & Carter WB: Cerebral swelling and ventricular alterations following evacuation of intracranial extracerebral hematoma. J Neurosurg 19:419423, 1962 Cook AW, Browder EJ, Carter WB: Cerebral swelling and ventricular alterations following evacuation of intracranial extracerebral hematoma. J Neurosurg 19:419–423, 1962

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Davies FL: Mental abnormalities following subdural haematoma. Lancet 1:13691370, 1960 Davies FL: Mental abnormalities following subdural haematoma. Lancet 1:1369–1370, 1960

    • Search Google Scholar
    • Export Citation
  • 8.

    Erculei F, & Walker AE: Posttraumatic epilepsy and early cranioplasty. J Neurosurg 20:10851089, 1963 Erculei F, Walker AE: Posttraumatic epilepsy and early cranioplasty. J Neurosurg 20:1085–1089, 1963

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Fox JL, & McCullough DC: The relative merits of different shunting devices, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 671685 Fox JL, McCullough DC: The relative merits of different shunting devices, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 671–685

    • Search Google Scholar
    • Export Citation
  • 10.

    Gaab M, , Pflughaupt KW, & Wodarz R, et al: Pathogenesis of chronic subdural hematoma: ICP, morphological, and biochemical findings. Neurosurgery 4:476, 1979 (Abstract) Gaab M, Pflughaupt KW, Wodarz R, et al: Pathogenesis of chronic subdural hematoma: ICP, morphological, and biochemical findings. Neurosurgery 4:476, 1979 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 11.

    Gjerris F: Intraventricular pressure in patients with chronic subdural hematomas before and after evacuation of the hematoma, in Beks JWF, , Bosch DA, & Brock M (eds): Intracranial Pressure III. Berlin/Heidelberg/New York: Springer-Verlag, 1976, pp 8587 Gjerris F: Intraventricular pressure in patients with chronic subdural hematomas before and after evacuation of the hematoma, in Beks JWF, Bosch DA, Brock M (eds): Intracranial Pressure III. Berlin/Heidelberg/New York: Springer-Verlag, 1976, pp 85–87

    • Search Google Scholar
    • Export Citation
  • 12.

    Gjerris F, & Schmidt K: Chronic subdural hematoma. Surgery or mannitol treatment. J Neurosurg 40:639642, 1974 Gjerris F, Schmidt K: Chronic subdural hematoma. Surgery or mannitol treatment. J Neurosurg 40:639–642, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Guido LJ, & Patterson RH Jr: Focal neurological deficits secondary to intraoperative CSF drainage: successful resolution with an epidural blood patch. Report of two cases. J Neurosurg 45: 348351, 1976 Guido LJ, Patterson RH Jr: Focal neurological deficits secondary to intraoperative CSF drainage: successful resolution with an epidural blood patch. Report of two cases. J Neurosurg 45: 348–351, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Jamieson KG, & Yelland JDN: Surgically treated traumatic subdural hematomas. J Neurosurg 37:137149, 1972 Jamieson KG, Yelland JDN: Surgically treated traumatic subdural hematomas. J Neurosurg 37:137–149, 1972

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 16.

    McKissock W, , Richardson A, & Bloom WH: Subdural hematoma. A review of 389 cases. Lancet 1:13651369, 1960 McKissock W, Richardson A, Bloom WH: Subdural hematoma. A review of 389 cases. Lancet 1:1365–1369, 1960

    • Search Google Scholar
    • Export Citation
  • 17.

    McLaurin RL: Contributions of angiography to the pathophysiology of subdural hematomas. Neurology 15:866873, 1965 McLaurin RL: Contributions of angiography to the pathophysiology of subdural hematomas. Neurology 15:866–873, 1965

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Negrón RA, , Tirado G, & Zapater C: Simple bedside technique for evacuating chronic subdural hematomas. Technical note. J Neurosurg 42:609611, 1975 Negrón RA, Tirado G, Zapater C: Simple bedside technique for evacuating chronic subdural hematomas. Technical note. J Neurosurg 42:609–611, 1975

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Smyth HS, & Livingston KE: Ventricular infusion in the operative management of subdural hematoma, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 566571 Smyth HS, Livingston KE: Ventricular infusion in the operative management of subdural hematoma, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 566–571

    • Search Google Scholar
    • Export Citation
  • 20.

    Suzuki J, & Takaku A: Nonsurgical treatment of chronic subdural hematoma. J Neurosurg 33:548553, 1970 Suzuki J, Takaku A: Nonsurgical treatment of chronic subdural hematoma. J Neurosurg 33:548–553, 1970

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Svien HJ, & Gelety JE: On the surgical management of encapsulated subdural hematoma. A comparison of the results of membranectomy and simple evacuation. J Neurosurg 21:172177, 1964 Svien HJ, Gelety JE: On the surgical management of encapsulated subdural hematoma. A comparison of the results of membranectomy and simple evacuation. J Neurosurg 21:172–177, 1964

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Tabaddor K: ICP and compliance in chronic subdural hematoma. Neurosurgery 4:476, 1979 (Abstract) Tabaddor K: ICP and compliance in chronic subdural hematoma. Neurosurgery 4:476, 1979 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 23.

    Tabaddor K, & LaMorgese J: Complication of a large cranial defect. Case report. J Neurosurg 44:506508, 1976 Tabaddor K, LaMorgese J: Complication of a large cranial defect. Case report. J Neurosurg 44:506–508, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Tabaddor K, & Shulman K: Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46:220226, 1977 Tabaddor K, Shulman K: Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46:220–226, 1977

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Yamaura A, & Makino H: Neurologic deficits following craniectomy. J Neurosurg 45:362, 1976 (Letter) Yamaura A, Makino H: Neurologic deficits following craniectomy. J Neurosurg 45:362, 1976 (Letter)

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 530 126 12
Full Text Views 210 8 0
PDF Downloads 171 7 0
EPUB Downloads 0 0 0