Chettinad Hospital and Research Institute,India
Chronic subdural haematoma (CSDH) is one of the common problems seen in Neurosurgical practice. There are many surgical options available including twist drill drainage, burr hole drainage and craniotomy. Majority of neurosurgeons use burr hole drainage. Even in this, there is a controversy whether to use single or two burr holes, whether to use irrigation or not, whether to use drains or not and the type of drain and so on. Only very few studies using the subgaleal drain for treatment of CSDH are available in the literature.
Thirty two cases of Chronic Subdural Haematoma have been analysed in this prospective observational study over a three year period. The use of Subgaleal drainage system was utilised in all the cases and the various pros and cons of the use the subgaleal drain in the treatment of Chronic Subdural Haematoma were analysed and it was concluded that Subgaleal drainage system should be considered as a safe, simple and effective alternate to Subdural, Subperiosteal Drainage system in the treatment of Chronic Subdural Haematoma.
This is only the third study in available literature for the use of subgaleal closed system drainage for Chronic Subdural Haematoma.
Chronic subdural haematoma (CSDH) is an encapsulated collection of old blood between the dura mater and subarachnoid caused by tear of bridging veins. Repeated bleeding from external membrane capillaries facilitated by fibrin degradation products leads to its expansion7. Chronic subdural haematoma (CSDH) is one of the common problems seen in Neurosurgical practice, especially in the elderly with incidence ranging between 1.73 to 13.18 per 100,000 population. This population is also likely to have other associated co- morbidities that can impact on immediate postoperative outcome and overall survival.
Known risk factors for chronic subdural haematoma include coagulopathy, alcoholism, trauma and low intracranial pressures for example after lumbar drainage or ventricular peritoneal shunt.
Clinical presentation is varied but patient commonly presents with headaches, confusion, drowsiness, vomiting, seizures, ataxia among other presentations and on examination, patient have various neurological deficits including a low Glasgow coma scale, ophthalmoplegia, hemi paresis/hemiplegia among other deficits.
Diagnosis is confirmed by non-contrast CT scan head as study of choice although in some instances MRI may be indicated. The imaging pattern has a direct influence on post-operative outcome especially in terms of recurrence.12
Symtomatic Chronic Subdural haematoma are managed surgically. In surgery the various options available are twist drill drainage, burr hole drainage system and craniotomy. Majority of neurosurgeons use burr hole drainage. Even in this, there is a controversy whether to use single or two burr holes, whether to use irrigation or not, whether to use drains or not and the type of drain (conventional vs tube drain, open vs closed drain) and so on.
Conventional method of drainage is to keep the drain in the subdural space. With a subdural drain, there is always a potential risk of drainage tube coming in contact with the brain causing seizures or haemorrhage due to direct injury and there is increased risk of infection spreading into the intracranial compartment. In subgaleal placement of the drain, with the tip of the drain near the burrhole site subgaleally, the potential complications associated with the placement of subdural drain can be avoided. Only limited experience using the subgaleal drain for treatment of CSDH are available in the literature.