Ishiyama N

Development and Treatment of Chronic Subdural Hematoma

One hundred eleven adult patients with chronic subdural hematoma (SDH) were reviewed. In 28% of the cases it was observed that traumatic subdural fluid collection (SFC) developed into chronic SDH in successive computed tomographic (CT) scans after the initial head injury. In 43% of the cases which had not been followed up after their head injury, it was assumed that there was also traumatic SFC initially which later developed into chronic SDH, considering the similarity in temporal course with the former group. It was proposed that traumatic SFC played an important role in the development of chronic SDH. As for treatment, 99 cases were operated upon; 31 patients underwent craniotomy and evacuation with membranectomy and later 68 patients had burr-hole and continuous drainage (simple drainage). Both methods produced comparable good results, clinically and radiographically. The advantages of simple drainage, i.e., gradual decompression and simplicity of the procedure make this method a first operative procedure. A theoretical basis supporting simple drainage is discussed.