Chronic subdural hematoma (CSDH) is predominantly a disease of the elderly. It usually follows minor trauma. The common manifestations are altered mental state and focal neurological deficit. Neurological state at the time of diagnosis is the most important prognostic factor. Treatment options for this entity have remained controversial. Objective: to evaluate the results of four debated Steps applied in management of bilateral CSDH, where two burr-holes done on each side for drainage, intraoperative irrigation with warm isotonic saline until the effluents were clear, a closed subgaleal drainage system used for 48-72 hours post-operatively and the patients were kept in a supine position for 3 days post-operatively. Patients and Methods: This prospective study of thirty four properly selected symptomatic patients with diagnosis of bilateral CSDH based on CT brain underwent surgical procedures in Benha university hospital and Mabarra hospital from March 2009 through October 2013 and followed-up for at least 6 months post-operatively. The patients included are 25 men (73.5%) and 9 women (26.4%) aged from 18 to 82 years (mean age 74 years). Results: 2 patients were lost to follow-up. Therefore, we analyzed the results of 32 patients. 27 patients (84.3%) had post-operative GCS 14-15 (good outcome). 3 cases (9.3%) had symptomatic recurrence needed reoperation. 2
cases died with a mortality rate (6.2%).Conclusion the results of this technique with its four debated Steps proved its efficacy in surgical management of bilateral CSDH so we believe it is a good, Successful and recommended technique for surgical management of bilateral CSDH.
|
