| Bilateral Chronic Subdural Hematoma: Is it Really Need Bilateral Burr Hole Trephination? |
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Sang-Bae Chae , Chan-Jong Yoo , Woo-Kyung Kim , Eun-Young Kim , Jae-Myung Kim , Cheol-Wan Park |
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Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, South Korea |
| 양측성 만성 경막하 혈종: 양측 천공술은 꼭 필요한가? |
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채상배ㆍ유찬종ㆍ김우경ㆍ김은영ㆍ김재명ㆍ박철완 |
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가천의과학대학교 신경외과학교실 |
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| Abstract |
Objective
The diagnosis and treatment of chronic subdural hematoma are well established, but bilateral subdural hematoma are not completely understood. This study evaluates the surgical treatment of bilateral chronic subdural hematoma.
Methods
Among the 409 burr hole trephination patients with chronic subdural hematoma from April 2004 to September 2010, 48 patients were diagnosed bilateral chronic subdural hematoma. We divided 48 patients in two groups. Each group was a bilateral burr hole trephination group in 28 patients and unilateral trephination group in 20 patients. We compared the age, symptoms before operation and thickness difference of bilateral hematoma, midline shifting, density of hematoma, dominant side of hematoma in brain CT. And we evaluated prognosis of patients (GCS, recurrence, duration of brain expansion) via each factors.
Results
At the end of the follow up period, no difference were observed in age, symptom before operation, density of hematoma, dominant site of hematoma, pre operative and post operative GCS, duration of brain expansion on both groups. Only midline shifting and thickness difference of hematoma (TDH) were significantly different on both groups. Midline shifting and TDH were 11.24±7.12 mm (2.62-18.99), 10.35± 7.36 mm (3.31-23.12) in unilateral burr hole trephination group. Midline shifting and TDH were 5.32±4.53 mm (0.01-11.76), 6.27±3.88 mm (0.01-13.55) in bilateral burr hole trephination group. Total 3 patients recurred in unilateral group. And midline shifting and TDH were 4.16±2.34 mm (2.62-6.50), 5.32±3.84 mm (3.31-7.59) in recurrence group, 13.48±6.75 mm (7.12-18.99), 13.66±8.87 mm (9.83-23.12) in no recurrence group among the unilateral burr hole trephination group. The recurrence group in unilateral burr hole trephination patients, midline shifting and TDH were significantly smaller than no recurrence group in unilateral burr hole trephination patients. If midline shifting and TDH is smaller than 5 mm, there tends to be more recurrence. But, there is no significant difference between recurrence group and no recurrence group in bilateral burr hole trephination patients.
Conclusion
Unilateral burr hole trephination is enough treatment in bilateral chronic subdural hematoma patients, because there is no significant difference about prognosis.But, we have to concern bilateral burr hole trephination if midline shifting and thickness of hematoma difference is smaller than 5mm in the pre operative brain CT. |
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