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  • Perforated Craniotomy: A Novel Surgical Technique for the Treatment of Chronic Subdural Hematomas

    Final Number:
    1351

    Authors:
    Joel Sherman Katz DO; Jason Milton DO; Joseph F. Georges DO, PhD; Rudy D Marciano DO; Zubair Ahammad D.O.; John Entwistle DO; Victor Awuor; Brian Seaman DO; Chris S Karas; Kailash Narayan MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Chronic subdural hematomas are a common and rapidly increasing neurosurgical issue frequently complicated by use of anticoagulants. When hematoma membranes are present the recurrence rates can be high using traditional techniques. We present a novel technique that uses the ability of the galea to absorb blood continuously, thus reducing accumulation rates.

    Methods: We retrospectively reviewed cranial CT scans of patients for whom a perforated craniotomy and dural excision was utilized for the evacuation of a chronic subdural hematoma. Collected data included patient age, anti-coagulation status, post-operative drain placement and pre-operative and post-operative subdural size and midline shift measurements.

    Results: 38 patients with 47 subdural hematomas were reviewed; 23 male and 15 females with ages ranging from 27-89 years (mean 68±14.22). 27 located on the left side, 20 located on the right side including 8 bilateral subdural hematomas underwent a perforated craniotomy. Pre-operative subdural sizes ranged from 0.9-3.1 cm (mean 1.9±0.58), with midline shift ranging from 0-1.8 cm (mean 0.66±0.40). 16 patients were receiving anti-coagulation therapy at the time of diagnosis. 11 subdural drains were placed and 24 subgaleal drains were utilized post-operatively. Post-operative subdural sizes ranged from 0-1.7 cm (mean 0.49±0.45), with midline shift ranging from 0-0.6 cm (mean 0.04±0.13). Subdural sizes decreased by an average of 77% and midline shift improved by an average of 91% on follow up cranial CT imaging. Subdural re-accumulation requiring re-operation was required in only 1 instance.

    Conclusions: Perforated craniotomy with multiple burr holes and dural excision allows for subdural fluid evacuation and resection of the outer dural membranes, which are thought to instigate hematoma formation. Multiple burr holes provide additional channels for fluid resorption at the galeal level. Our series reports recurrence rates less than previously reported values.

    Patient Care: Perforated craniotomy with multiple burr holes and dural excision allows for subdural fluid evacuation and resection of the outer dural membranes, which are thought to instigate hematoma formation. Multiple burr holes provide additional channels for fluid resorption at the galeal level. Our series reports recurrence rates less than previously reported values.

    Learning Objectives: 1) Describe the importance of different techniques for the evacuation of cSDH , 2) Discuss, in small groups the limitations of different methods of cSDH evacuation, 3) Identify an effective surgical treatment for evacuation and non re-accumulation of cSD fluid.

    References:

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