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Journal of Trauma and Injury 2012;25(4):209-216.
Evolution of Chronic Subdural Hematoma based on Brain CT findings and Appropriate Treatment Methods
Young Bae Lee
Department of Neurosurgery, Dongguk University Gyeongju Hospital, Gyeongju, Korea. leeyb@dongguk.ac.kr
만성 경막하 혈종의 성장에 대한 뇌 CT 소견 및 치료 방침
이 영 배
동국대학교 의과대학 경주병원 신경외과학교실
Received: 25 October 2012   • Revised: 3 December 2012   • Accepted: 3 December 2012
Abstract
PURPOSE
The objectives of this study are to classify chronic subdural hematomas based on brain computerized tomographic scan (CT scan) findings and to determine the mechanism of evolution and treatment methods.
METHODS
One hundred thirty-nine patients who were diagnosed with a chronic subdural hematoma and who available for follow up assessment 6 months post-surgery were analyzed retrospectively. The presence of trauma and past medical history were reviewed and evaluation criteria based on brain CT scan findings were examined.
RESULTS
Initial brain CT scans revealed a chronic subdural hematoma in 106 patients, a subdural hygroma in 24 patients, and an acute subdural hematoma in 9 patients. In all cases where the initial acute subdural hematoma had progressed to a chronic subdural hematoma, final was a hypo-density chronic subdural hematoma. In case where the initial subdural hygroma had progressed to a chronic subdural hematoma, the most cases of hematoma were hyper-density and mixed-density chronic subdural hematoma. In total, 173 surgeries were performed, and they consisted of 97 one burr-hole drainages, 70 two burr-hole drainages and 6 craniotomies.
CONCLUSION
This study demonstrates that rebleeding and osmotic effects are mechanisms for enlarging of a chronic subdural hematoma. In most cases, one burr-hole drainage is a sufficient for treatment. However, in cases of mixed or acute-on-chronic subdural hematomas, other appropriate treatment strategies are required.
Key Words: Chronic subdural hematoma; CT scan findings; Rebleeding; Osmotic effect; Burr-hole drainage
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