Summary
The radiological aspect, pathology, treatment and results of 132 subdural haematomas observed in 100 patients, are discussed.
The majority of these cases were characterized by a nonhomogenous CT scan picture, resulting from repeated bleeding in a previous subdural haematoma evolving to chronicity, or in a pre-existent subdural hygroma. Taking aspirin may have constituted a predisposing factor in 16% of our patients, whilst coagulation disturbances, including anticoagulant treatment, were observed in another 6%; ethylism was present in 11%. A traumatic origin was ascertained in 80% of the patients.
The treatment consisted of burr hole evacuation and drainage in 91.5% of the haematomas, corresponding to 92% of the patients; it was eventually repeated once or twice in some cases. In 6% of the patients, a subduro-peritoneal drainage had to be placed ultimately and in 2%, a membranectomy had to be performed because the haematoma had become nearly completely fibrous. The necessity for repeated evacuation and eventual subduro-peritoneal drainage seems to depend mainly on a slow brain re-expansion in some elderly people, who are actually more frequently referred.
Two patients died; one was deeply comatose and another in poor general condition. Morbidity in the 96 remaining patients, 2 being lost to follow-up, was 11%: 5% related to the haematoma or to the causal trauma, and 6% from other concomitant neurological disease. The functional result was satisfactory in 85%.
Similar content being viewed by others
References
Aoki N (1984) Subdural tapping and irrigation for the treatment of chronic hematoma in adults. Neurosurgery 14: 545–548
Aoki N, Tsutsumi K (1990) Symptomatic subacute subdural haematoma following spontaneous acute subdural haematoma. Acta Neurochir (Wien) 102: 149–151
Bret P, Lecuire J, Lapras C, Deruty R, Desge M, Prudhon JL (1976) Hématome sous-dural et thérapeutique anticoagulante. Neurochirurgie 22: 603–620
Brodersen P, Gjerris F (1975) Regional cerebral blood flow in patients with chronic subdural hematomas. Acta Neurol Scand 51: 233–239
Christensen E (1956) Pathologie der intrakraniellen Blutungen. Haematoma subdurale chronicum. In: Olivecrona H, Tönnis W (eds) Handbuch der Neurochirurgie, III, Pathologische Anatomie der raumbeengenden intrakraniellen Prozesse. Springer, Berlin Göttingen Heidelberg, pp 708–722
Davis DH (1992) Discussion of Hasegawa Met al. Neurosurgery 31: 585
Destandau J, Dartigues JF, Cohadon F (1987) Hématome sousdural chronique de l'adulte. Facteurs prognostiques de la chirurgie. A propos de 100 cas. Neurochirurgie 33: 17–22
Ectors L (1963) Le phénomène de Montgolfier et le traitement chirurgical de l'hématome sous-dural chronique de la convexité chez l'adulte. Neurochirurgie 9: 219–228
Fogelholm R, Heiskanen O, Waltimo O (1975a) Chronic subdural hematoma in adults. Influence of patient's age on symptoms, signs and thickness of hematoma. J Neurosurg 42: 43–46
Fogelholm R, Waltimo O (1975b) Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien) 32: 247–250
Grisoli F, Graziani N, Peragut JC,et al (1988) Perioperative lumbar injection of Ringer's lactate solution in chronic subdural haematoma: a series of 100 cases. Neurosurgery 23: 616–621
Hamilton MG, Frizzell JB, Tranmer BI (1993) Chronic subdural hematoma: the role of craniotomy reevaluated. Neurosurgery 33: 67–72
Harders A, Weigel K, Gilsbach J, Eggert HR (1981) Follow up and results of external drainage therapy of chronic subdural hematomas. In: Schiefer W, Klinger M, Brock M (eds) Advanced in neurosurgery 9. Springer, Berlin Heidelberg New York, pp 388–390
Hasegawa M, Yamashima T, Yamashita J, Suzuki M, Shimada S (1992) Traumatic subdural hygroma: pathology and meningeal enhancement of magnetic resonance imaging. Neurosurgery 31: 580–585
Hashimoto N, Sakakibara T, Yamamoto K, Fujimoto M, Yamaki T (1992) Two fluid-blood density levels in chronic subdural hematoma. Case report. J Neurosurg 77: 310–311
Hashimoto N, Sakakibara T, Yamamoto K, Fujimoto M, Yamaki T (1993) Response to Drapkin AJ. J Neurosurg 78: 525–526
Horwitz NH (1992) Discussion of Hasegawa Met al. Neurosurgery 31: 585
Hosada K, Tamaki N, Masamura M, Matsumoto S, Maeda F (1987) Magnetic resonance images of chronic subdural hematomas. J Neurosurg 67: 677–683
Ito H, Maeda M, Uehara T, Yamamoto Sh, Tamura M, Takashima T (1984) Attenuation values of chronic subdural haematoma and subdural effusion in CT scans. Acta Neurochir (Wien) 72: 211–217
Ito H, Yamamoto S, Saito Ket al (1987) Quantitative estimation of hemorrhage in chronic subdural hematoma using the51Cr erythrocyte labeling method. J Neurosurg 66: 862–864
Jennett B, Teasdale G (1981) Chronic subdural hematoma. In: Management of head injuries, contemporary neurology series. Davis, Philadelphia, pp 184–187
Kao MC (1983) Sedimentation level in chronic subdural hematoma, visible on computerized tomography. J Neurosurg 58: 246–251
Kremiansky J (1868) Quoted by Putnam TJ and Cushing H (1925) Chronic subdural hematoma. Its pathology, its relation to pachymeningitis hemorrhagica and its surgical treatment. Arch Surg 11: 329–393
Lesoin F, Villette L, Rousseaux M, Pruvo JP, Jomin M (1986) Drainage continu, progressif, à circuit fermé dans les hématomes sous-duraux chroniques. Neurochirurgie 32: 316–319
Loew F, Kivelitz R (1976) Chronic subdural haematomas. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, Vol 24. North Holland and Elsevier, Amsterdam New York, pp 297–327
Loew F (1982) Management of chronic subdural haematomas and hygromas. In: Krayenbühlet al (eds) Advances and technical standards in neurosurgery, Vol 9. Springer, Wien New York, pp 113–131
Lozes G, Fawaz A, Jomin M,et al (1987) Traitement des hématomes sous-duraux chroniques de l'adulte par ponction lavage “fermée” (méthode d'Aoki). Neurochirurgie 33: 429–431
Markwalder TM (1981) Chronic subdural hematomas: a review. J Neurosurg 54: 637–645
Markwalder TM, Reulen HJ (1986) Influence of neomembranous organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma. An analysis of 201 cases. Acta Neurochir (Wien) 79: 100–106
Maurice-Williams RS (1975) Surimposed chronic subdural hygromas. Report of two cases. J Neurosurg 43: 623–626
Moussa A, Josky N (1982) The impact of computed tomography on the treatment of chronic subdural haematoma. J Neurol Neurosurg Psychiatry 45: 1156–1158
Nathan PE, Sonenblick D, Chakote V, Wolf R, Sacchi TJ (1994) Headache, thrombolytic therapy and chronic subdural hemorrhage: a case report. Angiology 45: 77–80
Oku Y, Takimoto N, Yamamoto K, Onishi T (1984) Trial of a new operative method for recurrent chronic subdural hematoma. J Neurosurg 61: 269–272
Park CK, Choi KH, Kim MC, Kang JK, Choi CR (1994) Spontaneous evolution of posttraumatic subdural hygroma into chronic subdural haematoma. Acta Neurochir (Wien) 127: 41–47
Probst C (1988) Peritoneal drainage of chronic subdural hematomas in older patients. J Neurosurg 68: 908–911
Ram Z, Hadani M, Sahar A, Spiegelmann R (1993) Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial. Acta Neurochir (Wien) 120: 40–43
Reymond MA, Marbet G, Radü EW, Gratzl O (1992) Aspirin as a risk factor for hemorrhage in patients with head injuries. Neurosurg Rev 15: 21–25
Richter HP, Klein H, Schäfer M (1984) Chronic subdural hematomas treated by enlarged burr-hole craniotomy and closed system drainage. Retrospective study of 120 patients. Acta Neurochir (Wien) 71: 179–188
Robinson RG (1984) Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg 61: 263–268
Rubin G, Rappaport ZH (1993) Epilepsy in chronic subdural haematoma. Acta Neurochir (Wien) 123: 39–42
Rychlicki F, Recchioni MA, Burchianti M, Marcolini P, Messori A, Papo I (1991) Percutaneous twist drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 113: 38–41
Saito K, Ito H, Hasegawa T, Yamamoto S (1989) Plasmin-α2 plasmin inhibitor complex and α2-plasmin inhibitor in chronic subdural hematoma. J Neurosurg 70: 68–72
Sato S, Suzuki J (1975) Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 43: 569–578
Scotti G, Terbrugge K, Melancon D, Bélanger G (1977) Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg 47: 311–315
Stroobandt G (1989) Les localisations des épanchements péricérébraux du nourrisson. Neurochirurgie 35: 407–409
Svien HJ, Gelety JE (1964) On the surgical management of encapsulated subdural hematoma. A comparison of the results of membranectomy and simple evacuation. J Neurosurg 21: 172–177
Tabaddor K, Shulman K (1977) Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46: 220–226
Trotter W (1914) Chronic subdural haemorrhage of traumatic origin, and its relation to pachymeningitis haemorrhagica interna. Br J Surg 2: 271–291
Tyson G, Strachan WE, Newman P, Winn R, Butler A, Jane J (1980) The role of craniectomy in the treatment of chronic subdural hematomas. J Neurosurg 52: 776–781
Virchow R (1857) Quoted by Putnam TJ and Cushing H (1925) Chronic subdural hematoma. Its pathology, its relation to pachymeningitis hemorrhagica and its surgical treatment. Arch Surg 11: 329–393
Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M (1990) Efficacy of closed system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurg 26: 771–773
Weir B, Gordon P (1983) Factors affecting coagulation: fibrinolysis in chronic subdural fluid collections. J Neurosurg 58: 242–245
Weisse A, Berney J (1994) Chronic subdural haematomas. Results of a closed drainage method in adults. Acta Neurochir (Wien) 127: 37–40
Yamada I, Watanabe T, Murata S,et al (1980) Developmental process of chronic subdural collections of fluid based on CT-scan findings. Surg Neurol 13: 441–448
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stroobandt, G., Fransen, P., Thauvoy, C. et al. Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. Acta neurochir 137, 6–14 (1995). https://doi.org/10.1007/BF02188772
Issue Date:
DOI: https://doi.org/10.1007/BF02188772