The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage

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Abstract
A consecutive series of 32 adult patients with chronic subdural hematoma was studied in respect to postoperative cerebral reexpansion (reduction in diameter of the subdural space) after burr-hole craniostomy and closed-system drainage. Patients with high subdural pressure showed the most rapid brain expansion and clinical improvement during the first 2 days. A computerized tomography (CT) scan performed on the 10th day after surgery demonstrated persisting subdural fluid in 78% of cases. After 40 days, the CT scan was normal in 27 of the 32 patients. There was no mortality and no significant morbidity. Well-developed subdural neomembranes could be the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10-20 days. Blood vessel dysfunction and impairment of cerebral blood flow may participate in delay in brain reexpansion. Additional surgical procedures, such as repeated tapping of the subdural fluid, craniotomy and membranectomy or even craniectomy, should not be evaluated earlier than 20 days after the initial surgical procedure unless the patient has deteriorated markedly.