Surgical treatment of chronic subdural hematoma based on intrahematomal membrane structure on MRI.
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| Abstract | BACKGROUND: To determine the optimal surgical management of chronic subdural hematoma (CSDH), we assessed which operative procedure, burr holes or small craniotomy, was more effective on 49 consecutive patients. METHOD: We retrospectively classified all cases into two groups according to the intrahematomal membrane structure of CSDH on T2*-weighted magnetic resonance (MR) imaging. The first group, labeled type B, included hematomas which had no intrahematomal membrane and/or were monolayer multilobule. The second group, labeled type C, consisted of hematomas which were divided into multiple layers by the intrahematomal membrane. FINDINGS: The outcome of type C patients treated with burr holes was significantly inferior to that of those who underwent a small craniotomy in terms of the relative outcome of neurological grading. re-operation ratio, and postoperative hospital stay (p < 0.05). Type C hematomas treated with burr holes also had inferior outcome compared with a small craniotomy in terms of the duration of hematoma until disappearance on postoperative CT (p < 0.05). INTERPRETATION: We concluded that a considerable number of cases appeared to need craniotomy and resection of intrahematomal membrane for complete recovery in CSDH, and that T2*-weighted MR imaging could be used as a basis for selecting the operative procedure for CSDH.
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| Authors | M Tanikawa, M Mase, K Yamada, N Yamashita, T Matsumoto, T Banno, T Miyati |
| Journal | Acta neurochirurgica (Acta Neurochir (Wien)) Vol. 143 Issue 6 Pg. 613-618; discussion 618-9 ( 2001) ISSN: 0001-6268 [Print] Austria |
| PMID | 11534679 (Publication Type: Comparative Study, Evaluation Study, Journal Article) |
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