Peritoneal drainage of chronic subdural hematomas in older patients

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✓ Most patients with chronic subdural hematoma are successfully treated with trephination and external drainage. However, hematomas with thick membranes may persist or recur, needing reoperation or major surgery such as craniotomy with membranectomy. In 14 patients aged over 60 years, internal peritoneal drainage of the hematoma by a low-pressure shunt system proved to be a reliable method of treatment with the following advantages: rapid neurological improvement; immediate postoperative mobilization; little stress for the patient; no recurrence; disappearance of the membranes; and slow and well-tolerated cerebral reexpansion without hypotension. Successful use of this method has been reported previously in children, but not in adults.

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Address reprint requests to: Charles Probst, M.D., Neurochirurgische Klinik, Kantonsspital, 5001 Aarau, Switzerland.

© AANS, except where prohibited by US copyright law.

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    Computerized tomography scans in an 81-year-old man. Left: Preoperative scan showing a bilateral membranous chronic subdural hematoma. Right: Scan obtained 10 months after a bilateral subdural-peritoneal shunting procedure showing complete recovery.

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    Computerized tomography scans in an 83-year-old woman. Left: Preoperative scan showing a bilateral membranous chronic subdural hematoma. Right: Scan obtained 4 months after a bilateral subdural-peritoneal shunting procedure showing complete recovery.

References

1.

Aoki NMizutani HMasuzawa H: Unilateral subduralperitoneal shunting for bilateral chronic subdural hematomas in infancy. Report of three cases. J Neurosurg 63:1341371985Aoki N Mizutani H Masuzawa H: Unilateral subduralperitoneal shunting for bilateral chronic subdural hematomas in infancy. Report of three cases. J Neurosurg 63:134–137 1985

2.

Brotchi JBonnal J: Surgical treatment of subdural effusions in infants. Acta Neurochir 33:59671976Brotchi J Bonnal J: Surgical treatment of subdural effusions in infants. Acta Neurochir 33:59–67 1976

3.

Collins WFPucci GL: Peritoneal drainage of subdural hematomas in infants. J Pediatr 58:4824851961Collins WF Pucci GL: Peritoneal drainage of subdural hematomas in infants. J Pediatr 58:482–485 1961

4.

Eggert HRHarders AWeigel Ket al: Rezidive nach Bohrlochtrepanation chronischer Subduralhämatome. Neurochirurgia (Stuttg) 27:1411431984Eggert HR Harders A Weigel K et al: Rezidive nach Bohrlochtrepanation chronischer Subduralhämatome. Neurochirurgia (Stuttg) 27:141–143 1984

5.

Faulhauer KHerrmann HDLoew F: Operative treatment of extremely large bilateral subdural effusions in infancy. Acta Neurochir 28:1791871973Faulhauer K Herrmann HD Loew F: Operative treatment of extremely large bilateral subdural effusions in infancy. Acta Neurochir 28:179–187 1973

6.

Harders AEggert HRWeigel K: Behandlung des chronischen Subduralhämatoms mit externer geschlossener Drainage. Bericht über 100 konsekutive Fälle. Neurochirurgia (Stuttg) 25:1471521982Harders A Eggert HR Weigel K: Behandlung des chronischen Subduralhämatoms mit externer geschlossener Drainage. Bericht über 100 konsekutive Fälle. Neurochirurgia (Stuttg) 25:147–152 1982

7.

Hirsh LF: Intracranial air following subdural haematoma drainage with delayed recovery. Neurochirurgia (Stuttg) 23:55581980Hirsh LF: Intracranial air following subdural haematoma drainage with delayed recovery. Neurochirurgia (Stuttg) 23:55–58 1980

8.

Kaufman HHHandel SF: CT scanning after drainage of subdural haematoma: an unusual case. Acta Neurochir 45:2172241979Kaufman HH Handel SF: CT scanning after drainage of subdural haematoma: an unusual case. Acta Neurochir 45:217–224 1979

9.

Kretschmer H: Verlaufsdynamik und Frühprognose traumatischer intrakranieller Blutungen. Aktuel Traumatol 11:43511981Kretschmer H: Verlaufsdynamik und Frühprognose traumatischer intrakranieller Blutungen. Aktuel Traumatol 11:43–51 1981

10.

Markwalder TMSteinsiepe KFRohner Met al: The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 55:3903961981Markwalder TM Steinsiepe KF Rohner M et al: The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 55:390–396 1981

11.

Moringlane JRSamii M: Beitrag zur operativen Behandlung des chronischen subduralen Hämatoms und Hygroms des Erwachsenen. Neurochirurgia (Stuttg) 24:1581621981Moringlane JR Samii M: Beitrag zur operativen Behandlung des chronischen subduralen Hämatoms und Hygroms des Erwachsenen. Neurochirurgia (Stuttg) 24:158–162 1981

12.

Moyes PDThompson GBCluff JW: Subdural peritoneal shunts in the treatment of subdural effusions in infants. J Neurosurg 23:5845871965Moyes PD Thompson GB Cluff JW: Subdural peritoneal shunts in the treatment of subdural effusions in infants. J Neurosurg 23:584–587 1965

13.

Oku YTakimoto NYamamoto Ket al: Trial of a new operative method for recurrent chronic subdural hematoma. J Neurosurg 61:2692721984Oku Y Takimoto N Yamamoto K et al: Trial of a new operative method for recurrent chronic subdural hematoma. J Neurosurg 61:269–272 1984

14.

Posnikoff J: Technique for transfontanelle subdural peritoneal shunting in subdural fluid collections of infancy. Technical note. J Neurosurg 28:1691721968Posnikoff J: Technique for transfontanelle subdural peritoneal shunting in subdural fluid collections of infancy. Technical note. J Neurosurg 28:169–172 1968

15.

Ransohoff J: Ransohoff J: Chronic subdural hematoma treated by subdural-pleural shunt. Pediatrics 20:5615641957Ransohoff J: Chronic subdural hematoma treated by subdural-pleural shunt. Pediatrics 20:561–564 1957

16.

Rayport MReiss J: Hydrodynamic properties of certain shunt assemblies for the treatment of hydrocephalus. Part 1: Report of a case of communicating hydrocephalus with increased cerebrospinal fluid production treated by duplication of shunting device. Part 2: Pressure-flow characteristics of the Spitz-Holter, Pudenz-Heyer, and Cordis-Hakim shunt system. J Neurosurg 30:4554671969Rayport M Reiss J: Hydrodynamic properties of certain shunt assemblies for the treatment of hydrocephalus. Part 1: Report of a case of communicating hydrocephalus with increased cerebrospinal fluid production treated by duplication of shunting device. Part 2: Pressure-flow characteristics of the Spitz-Holter Pudenz-Heyer and Cordis-Hakim shunt system. J Neurosurg 30:455–467 1969

17.

Richter HPKlein HJSchäfer M: Chronic subdural haematomas treated by enlarged burr-hole craniotomy and closed system drainage. Retrospective study of 120 patients. Acta Neurochir 71:1791881984Richter HP Klein HJ Schäfer M: Chronic subdural haematomas treated by enlarged burr-hole craniotomy and closed system drainage. Retrospective study of 120 patients. Acta Neurochir 71:179–188 1984

18.

Shulman KRansohoff J: Subdural hematoma in children. The fate of children with retained membranes. J Neurosurg 18:1751811961Shulman K Ransohoff J: Subdural hematoma in children. The fate of children with retained membranes. J Neurosurg 18:175–181 1961

19.

Tabaddor KShulman K: Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46:2202261977Tabaddor K Shulman K: Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46:220–226 1977

20.

Tyson GStrachan WENewman Pet al: The role of craniectomy in the treatment of chronic subdural hematomas. J Neurosurg 52:7767811980Tyson G Strachan WE Newman P et al: The role of craniectomy in the treatment of chronic subdural hematomas. J Neurosurg 52:776–781 1980

21.

Weber GHeyser JRosenmund Het al: Subdurale Hämatome. Schweiz Med Wochensch 94:5415481964Weber G Heyser J Rosenmund H et al: Subdurale Hämatome. Schweiz Med Wochensch 94:541–548 1964

22.

Yashon DWhite RJBryk JPet al: Simplified supplementary treatment of chronic subdural fluid collections. Neurochirurgia (Stuttg) 14:8131971Yashon D White RJ Bryk JP et al: Simplified supplementary treatment of chronic subdural fluid collections. Neurochirurgia (Stuttg) 14:8–13 1971

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