A Prospective Study To Evaluate Role of Closed Drainage To Reduce Recurrence and Improve Outcome of Chronic Subdural Hematoma Cases At A Tertiary Care Centre of Bihar

Abstract

Introduction: Chronic subdural hematoma (CSDH) is one of the most common types of intra-cranial hematoma, and often occurs in the elderly. Its incidence is about 5/100,000/year in the general population, but is higher for those aged 70 years and older; 58/100,000. Surgical treatment has been widely accepted as the most effective way to manage CSDH. In this study, we have compared the postoperative recurrence rates after burr-hole drainage (BHD) of CSDH with and without subdural drain. We have also compared the mortality and morbidity between two groups. Methodology: During the period of 12 month from March 2021 to February 2022, all the patients of symptomatic CSDH) proven by computed tomography (CT) scan admitted to Department of Neurosurgery were allocated randomly in two groups using random allocation software: Group A included patients who were treated by burr-hole craniostomy with closed-system drainage, and Group B included those patients who were treated with burr-hole craniostomy without closed-system drainage. Based on these criteria, a total of 100 cases were enrolled for the study with 50 cases in each group. Result: Of the 100 patients, 90 patients had unilateral CSDH and rest 10 patients had bilateral CSDH. Of the unilateral CSDH, 49 were on the right side. Homogeneous collection was more common than heterogeneous one (72 and 28, respectively). The most common homogeneous collection was hypodense CSDH on NCCT head. The common clinical symptoms were headache and hemiparesis. Patients were evaluated for other co-morbid conditions. Brain atrophy, history of head trauma, and hypertension were common. Conclusion: In this study, the recurrence rate of CSDH is significantly lower. Hence, we would like to conclude that the use of a subdural drain reduces the recurrence rate in CSDH without any significant increase in complications and should be routinely placed after BHD.