Chronic subdural haematoma. Presentation and therapeutic attitudes

INTRODUCTION: The chronic subdural haematoma (CSH) is a present pathology in the day by day of any Neurosurgical Department, and even in the beginning of the xxi century, the different therapeutic options are of current debate. OBJECTIVE: To compare retrospectively the results obtained by different types of surgical techniques, different modalities of drainage systems, and the application or not of perioperative intrathecal solutions. PATIENTS AND METHODS: The data have been obtained by the review of 109 clinical cases treated of CSH between 1996 and 2000 in the Department of Neurosurgery of the Hospital de Cruces (Bilbao). We have analysed the age, sex, background, presenting symptomatology, type of treatment, evolution and mean hospital stay. RESULTS: The report is centred in the analysis of the recurrence rate of the CSH, its principal feature, and so, according to the type of evacuation technique, a burr hole presents 17,2% recurrences, two burr holes 31%, a small craniotomy 50%, and an ordinary craniotomy 66%. According to the drainage system, the subgaleal shunt presents 33,3% recurrences, the subdural 24,5%, and the subdural subgaleal 15,4%. The intrathecal solutions present 37% recurrences. CONCLUSION: After studying all the data, we can conclude that for the treatment of the CSH, the choice of a burr hole and subdural subgaleal shunt and intrathecal solution, can result beneficial in relation to other techniques, although with a minimum difference over the subdural shunt.