Which surgical procedure is effective for refractory chronic subdural hematoma? Analysis of our surgical procedures and literature review

Publication date: March 2018 Source:Journal of Clinical Neuroscience, Volume 49 Author(s): Hiroaki Matsumoto, Hiroaki Hanayama, Takashi Okada, Yasuo Sakurai, Hiroaki Minami, Atsushi Masuda, Shogo Tominaga, Katsuya Miyaji, Ikuya Yamaura, Yasuhisa Yoshida Refractory chronic subdural hematoma (CSDH) is rare but remains a difficulty for neurosurgeons, and no consensus on treatment procedures has been established. To discuss effective surgical procedures for refractory CSDH, we analyzed our surgical procedures and outcomes for refractory CSDH. We defined patients with refractory CSDH as those who presented with two or more recurrences. Fourteen patients with refractory CSDH were analyzed. Eight patients underwent burr-hole irrigation and closed-system drainage alone, four patients received embolization of the middle meningeal artery (MMA), and two patients with organized CSDH underwent large craniotomy with outer membranectomy as the third surgery. Two of the eight patients (25%) treated with burr-hole irrigation and drainage alone showed a third recurrence. No further recurrences were identified in patients treated with embolization of the MMA or craniotomy. However, statistical analysis showed no significant difference in cure rate between patients treated with burr-hole irrigation and drainage alone and patients treated with burr-hole irrigation and drainage with embolization of the MMA (P = .42). Similarly, no significant differences in cure rate were seen betw...

Source: Journal of Clinical Neuroscience - February 4, 2018 Category: Neuroscience Source Type: research