MANAGEMENT OF CHRONIC SUBDURAL HAEMATOMA

Objective: The objective of this study was to assess the management strategy of chronic subdural haematoma and to find out the best treatment option.Material and Methods: The study was conducted in the Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar. Duration of study was 6 months from lsl July, to 31st December, 2004. All the cases were included. It was a prospective observational study. No patient was excluded from this study. Both the sexes and all ages were included. After relevant investigation all patients were operated by performing single/double Burr hole or craniotomy. Out come of patients was recorded.Results: The age range of our patients was from 1 year to 90 years. There were 13 males and 4 females and ratio was 4:1. Ten (58.8%) patients had features of raised intracranial pressure in the form of headache and vomiting and nine (52.9%) patients had come with focal neurological deficit. The GCS of patients was from 13 to 15 in fifteen (29.4%) patients, from 8 to 12 in ten (58.8%) patients, and two (11.8%) patients had GCS below 8.Head injury was the cause in thirteen (76.5%) patients. Brain atrophy was seen in two (11.8%) cases and one patient (5.9%) had bleeding disorder. Subdural haematoma was unilateral in fifteen (88.2%) patients and bilateral in two (12%). All the patients were operated upon and two burr holes were performed in the majority (59%). Single burr hole was the other method done in five (29.4%) patients and craniotomy was done in two cases (11.8%), as the second line treatment. Respiration was done in three (17.6%) cases. Post-operative complications were recollection (17.6%), seizures (35%) and two (11.8%) had post-operative wound infection, fifteen (88.23%) patients improved after treatment and two (12%) remained static. None of them deteriorated and the mortality was nil.Conclusion: Burr hole aspiration can be reasonably used as a first line of treatment for chronic subdural haematoma.