Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
6 (
2
); 255-256

Commentary

Department of Neurosurgery, Christian Doppler Klinik, Salzburg, Austria
Address for correspondence: Dr. Stephan Emich, Department of Neurosurgery, Christian Doppler Klinik, PMU Salzburg, Ignaz Harrer Street 79, Salzburg - 5020, Austria. E-mail: s.emich@salk.at

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Savardekar and Salunke presented a very interesting case report of a seldom complication after evacuation of a chronic subdural hematoma (cSDH).[1] A 65-year-old male suffering from headache for 10 days underwent an uneventful operation and developed an ipsilateral bleeding immediately post-surgery. Based on a normal coagulation and stable hemodynamics several causative mechanisms are discussed.

The most probable mechanism is that a rapid intraoperative parenchymal shift damaged vessels at the boundary layer between the intracranial solid and liquid components. Therefore, this event should be considered as a technical complication. The authors performed two burr holes, irrigated until the hematoma was washed out and kept the dural opening patent instead of inserting a drainage—so far a well-known procedure.

The hematoma fluid was under high pressure and drained off uncontrolledly, which is in the nature of this intervention. Only an intermittent covering and stepwise drainage, as the authors suggested, would have prevented from this bleeding.

It should be considered that in the absence of vascular diseases and brain atrophy the brain can still be expandable at 65 years.[23] This is aggravated by a relatively short time of the space occupying effect of the cSDH, because the clinical symptoms lasted only for 10 days. Intraoperatively the proof of a re-expanding brain is given by the high pressure, under which the fluid has been drained.

Regarding to the surgical procedure following strategy has become apparent: The first-line treatment for most cSDH is a burr hole craniostomy. In contrast to a twist drill craniostomy burr holes have a lower reoperation rate and offer the best cure to complication ratio.[45] Santarius found a significant advantage for the use of a drain compared to a sole burrhole craniostomy. Because of a significant reduction of recurrence this randomized trial was even stopped early.[6]

Further, residual free air impedes brain from re-expanding, too.[3]

Thus, a closed-way technique[7] avoids to get air drawn into the subdural space. The surgical approach should be over the thickest part of the hematoma. Additionally the patient is positioned in a way, that the single burr hole comes to the highest point in order to avoid pneumocephalus again.

Despite the rarity of such a complication this article encourages surgeons not to underestimate a beginners operation.

References

  1. , , . Subependymal Hemorrhage following drainage of chronic subdural hematoma. Probable causative mechanisms and prevention strategies. J Neurosci Rural Pract. 2015;6:252-54.
    [Google Scholar]
  2. , , , , , , . The impact of aging and gender on brain viscoelasticity. Neuroimage. 2009;46:652-7.
    [Google Scholar]
  3. , , . Surgical treatment of chronic subdural hematoma in 500 consecutive cases: Clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001;41:371-81.
    [Google Scholar]
  4. , , , . Outcome of contemporary surgery for chronic subdural haematoma: Evidence based review. J Neurol Neurosurg Psychiatry. 2003;74:937-43.
    [Google Scholar]
  5. , , , , , . Choosing the best operation for chronic subdural hematoma: A decision analysis. J Neurosurg. 2010;113:615-21.
    [Google Scholar]
  6. , , , , , , . Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: A randomised controlled trial. Lancet. 2009;374:1067-73.
    [Google Scholar]
  7. , , , , , , . Critical classification of craniostomy for chronic subdural hematoma; safer technique for hematoma aspiration. Neurol Med Chir (Tokyo). 2013;53:273-8.
    [Google Scholar]

    Fulltext Views
    530

    PDF downloads
    140
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections