Investigation Of The Surgical Approach And Effects For Organized Chronic Subdural Hematoma

Objective:To explore the diagnosis and surgical characteristics of organized chronic subdural hematoma.Methods27consecutive patients from January2008to December2013in our department with OCSDHs were analyzed, and the related literatures were reviewed. In these cases,1patient underwent a second craniotomy after the first burr hole.1patient underwent a burr hole in local hospital, then underwent a second craniotomy in our department.11patients were treated at the same surgery with craniotomy as the first treatment, and14patients underwent a neuroendoscope-assisted small bone window craniotomy. We compared the surgery with craniotomy and the neuroendoscope-assisted small bone window craniotomy for treating the organized CSDHs in complications, postoperative hospital stay, and Markwalder nerve function score that was used to assess these two surgical methods in both preoperative and postoperative. ResultsThe preoperative neurological grading score for OCSDH as proposed by Markwalder for both the surgery with craniotomy and the neuroendoscope-assisted small bone window craniotomy was not statistically significant (P>0.05). The postoperative grading score of two kinds of operation methods were improved significantly, there was significant differences (P<0.05). And the postoperative Markwalder nerve function scores of two kinds of operation method was no significant difference (P>0.05).2cases underwent the surgery with craniotomy appeared secondary epilepsy after surgery,1case appeared aphasia, and1case was not seen obviously improve headache situation. And the prognosis of patients with the operative method of neuroendoscope-assisted small bone window craniotomy for removing organized CSDHs seemed a better trend. The postoperative hospital stay time in patients with the surgery with craniotomy was15.08days on average, while the neuroendoscope-assisted small bone window craniotomy in the patients with postoperative hospital stay was5.86days on average. There is significant difference (P <0.05). All patients had a full recovery without recurrence follow up until March2014.ConclusionsThe operative method of neuroendoscope-assisted small bone window craniotomy for removing organized CSDHs we presented is safer and more effective. But more research is needed to further improve the diagnosis and treatment of organized chronic subdural hematoma.