Atif Mehmood Kazmi, Adil Aziz Khan, Mirza Faisal Ahmed Rafiq, Sameen Sajjad.
Double burrholes for unilateral and bilateral Chronic subdural haematomas; experience and outcome.
Pak J Surg Jan ;30(4):315-9.

Objective: Th e objective of this study is to determine; the age mostly aff ected with chronic subdural haematomas (CSDH), to evaluate potential risk factors (age, gender, falls and anticoagulation/antithrombotic therapy) that could play an essential role in the development of CSDH, common and rare clinical presentations seen with subdural haematomas (SDH), and the complication rate aft er treatment with double burrholes, for unilateral and bilateral CSDH. Study design: It was an interventional study. Place and duration: Th is study enrolled 36 consecutive patients with CSDHs managed at Fauji Foundation Hospital Rawalpindi, Pakistan, for duration of two years from January 2012 to May 2014. Methodology: Characteristics studied were, age, gender, associated risk factors, clinical presentation, CT scan brain fi ndings, and its associated complications. Four potential risk factors were assessed: gender, age, trauma and anticoagulation/antithrombotic medication (warfarin, aspirin and its derivatives). Diagnosis was based on clinical assessment and confi rmed with CT scan (with contrast) of the brain.Th e hematoma was removed surgically by double burr-holes, irrigation and close system drainage. All patients were followed up to one month, aft er discharge. Results: Th e study included 36 patients, 26 males(72%) and 10(26%) females. 86 % of the patients were aged between; 60-80 yrs.Risk factors associated with the formation of CSDH in our study was as follows:there was no history of trauma in 80% of the patients,15% of patients had history of minor fall ,RTA in 5% of the patients was present among these patients 10% were on aspirin and 5% had been taking warfarin .Th e remainder patients had spontaneously developed hematoma without known cause. Computed tomography of the brain, showed unilateral collection in 63.9% of patients and bilateral in 36.1% in which, Frontal CSDH as 61.1% and FrontoParietal CSDH were 38.9%. Patients presented with variable symptoms, but most commonly presenting with headache, hemiparesis, aphasia, impaired consciousness. Unilateral double burr-hole craniotomy was performed in 63.9% of the patients, while bilateral was done in 36.1%. In the postoperative follow up 97.2% of the patients had an uneventful recovery (n=35/36). Two patients developed complications in the form of postoperative recurrence with a recurrence rate of 2 %( n=34/36) in our study. One patient died (n=1) with a mortality rate of 2.8% in our study. Conclusion: Our study concluded that among the general population, men, in their 6th and 7th decade, using warfarin,aspirin /harboring a coagulation defect, were more likely to have an intracranial surgical lesion, such as a chronic subdural hematoma. Th e indication for these medications, especially in elderly patients at risk for falls, should be carefully evaluated and controlled. Our study also concluded that CSDH are eff ectively treated with double burr holes and closed drainage, whether the collection is unilateral or bilateral.

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