| dc.description.abstracteng | The chronic subdural haematoma is a bleeding between dura mater and arachnoidea and builds a pathological subdural space.
It is caused by a bleeding from bridging vessels. The most frequent cause is a minor trauma under anticoagulation of elderly patients (Cameron 1978; Sambasavian 1997; Fogelholm et al. 1975). With the brain atrophy in old age bridging veins are likely to be stretched building a bigger subdural space.
With the chronic subdural haematoma being a typical clinical picture of elderly patients it has an increasing appearance in times of an ageing society in neurosurgical practice.
Due to increasing availability of diagnostic methods, especially the CAT scan, an earlier diagnosis is possible.
In this retrospective study patient data was analysed of patients being treated with a subacute or acute subdural haematoma with the operation method of bedsinde percutaneous subdural tappings (BPST) at the Universitätsklinikum Göttingen, department of neurosurgery, between the years from 2005 to 2013. Initially the data of 251 patients was analyzed, after exclusion of incomplete data 117 patients with 133 subdural haematoma were included in the study.
The medical discharge report as well as preoperative CAT scan reports were looked at.
Treatment with BPST was categorized as successful if the neurological symptoms related to the haematoma receded completely after surgical intervention and the centerline relocation was declining.
The average age was 75,28 years. Initial symptoms were headache (n=32), hemiparesis (n=30), difficulties in walking and falls (n=26), vigilance dysfunction (n=22), speech disorder (n=21), states of confusion and concentration disorders (n=19), psychomotor slowdown (n=7), nausea and vomiting (n=5).
88 patients (75%) had suffered of no complications during the hospital stay. 5 (4%) of the patients died.
The haematoma was located on the left side of the brain at 52 % (n=62) of patients and 34% (n=40) had in on the right side, 14 % (n=16) had it on both sides.
43 haematomas were septated, 38 picures showed a sedimentation and 17 haematomas had both features. Acute parts were seen at 51 haematomas. There could be no link established between sedimented or septated haematomas and success of the operation (𝜙- coefficient 0,09, p= 0,384) as same as there was no relation between sedimented and at the same time septated haematomas and success of the operation (𝜙- coefficient 0,034, p=0,797). Acute parts had no influence on a successful operation (𝜙- coefficient 0,04, p= 0,722).
In 64 cases the method of BPST was successful, in 69 cases it was not.
In 44 % of all cases ( n=59) one burrhole was sufficient, in 34 % (n=45) two burrholes were needed and in 22 % (n=30) three burrholes were performed.
No limit value could be determined for a densitiy above or below an operation seems promising. The average Hounfield Unit in the haematoma and the maximum Hounfield Unit are not suitable for making a prediction of the success of the operation (HU mean: AUC = 0,414 und p = 0,088; HU max: AUC = 0,439 und p = 0,225).
This study shows on the one hand that no prediction about the success of a minimum invasive burr hole trepanation can be made by CAT scan criteria.
Moreover the efficiency of the minimum invasive burr hole trepanation could not be proved. The level of evacuation of the haematoma with this operation method seems to be not sufficient to improve clinical symptoms of patients in many cases. | de |