J Korean Neurotraumatol Soc.  2011 Oct;7(2):99-102. 10.13004/jknts.2011.7.2.99.

Postoperative Lesion Side Down Posture in Patients with Chronic Subdural Hematoma: Its Impact on Hospital Stay and Recurrence Rate

• Rho YJ
• Choe WJ
• Chun YI
• Cho J
• Moon CT
• Chang SK
• Koh YC

• KMID: 2019922
• DOI: http://doi.org/10.13004/jknts.2011.7.2.99

Abstract

OBJECTIVE
Chronic subdural hematomas (CSDHs) are usually encountered in the elderly patients. There are a lot of studies covering surgical techniques but, studies regarding the prognosis depending on the patient's postoperative posture are few. This study was carried out to elucidate the efficiency of the lesion side down posture over the ordinary supine posture.
METHODS
The authors retrospectively analyzed the results of CSDHs in 78 patients without known risk factors of CSDHs recurrence. All patients underwent one burr-hole surgery with closed system drainage and were then allocated to Group A, who were kept in a lateral position with the operation site downward for 3-5 days after operation, and to Group B, who were kept in supine neutral position. Postoperative computed tomography scans were checked on postoperative day (POD) 1, POD 3, day of discharge, and on POD 90. The amount of CSDHs was assessed in each group on these postoperative CT scans.
RESULTS
In Group A, there was significant earlier brain re-expansion and hematoma drainage (p=0.02) and shorter hospital stay (p=0.01). Six (7.69%) patients underwent reoperation, two (2.56%) in Groups A and four (5.13%) in Group B. There was no significant difference between the two groups in recurrence rate (p=0.91).
CONCLUSION
Maintaining lesion side down posture in the early postoperative period in CSDHs seems to be beneficial in shortening hospitalization by earlier brain expansion and hematoma drainage.

Keyword

Chronic subdural hematoma; Posture; Recurrence; Hospitalization

MeSH Terms

Aged
Brain
Drainage
Hematoma
Hematoma, Subdural, Chronic
Hospitalization
Humans
Length of Stay
Postoperative Period
Posture
Prognosis
Recurrence
Reoperation
Retrospective Studies
Risk Factors

Figure

• 

  FIGURE 1 An illustrative case of recurrent chronic subdural hematoma. 70-year-old man visited emergency room with left hemiparesis. A, B: Before and after surgery. After surgery, patient discharged without neurologic deficit. One month later, patient visited hospital with gait disturbance. Brain computed tomography (CT) shows recollection of subdural hematoma (C). Reoperation was done. After surgery, patient discharged with mild headache (D).

Reference

1. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery. 2007; 61:794–797. discussion 797.

2. Asano Y, Hasuo M, Takahashi I, Shimosawa S. [Recurrent cases of chronic subdural hematoma--its clinical review and serial CT findings]. No To Shinkei. 1992; 44:827–831.

3. Cameron MM. Chronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiatry. 1978; 41:834–839.

4. Cucchiara BL, Kasner SE. Atherosclerotic Risk Factors in Patients with Ischemic Cerebrovascular Disease. Curr Treat Options Neurol. 2002; 4:445–453.

5. El-Kadi H, Miele VJ, Kaufman HH. Prognosis of chronic subdural hematomas. Neurosurg Clin N Am. 2000; 11:553–567.

6. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol. 1997; 48:220–225.

7. Fukuhara T, Gotoh M, Asari S, Ohmoto T, Akioka T. The relationship between brain surface elastance and brain reexpansion after evacuation of chronic subdural hematoma. Surg Neurol. 1996; 45:570–574.

8. Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases. J Clin Neurosci. 2010; 17:428–429.

9. Kotwica Z, Brzeziński J. Chronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients. Br J Neurosurg. 1991; 5:461–465.

10. Kwon TH, Park YK, Lim DJ, Cho TH, Chung YG, Chung HS, et al. Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume. J Neurosurg. 2000; 93:796–799.

11. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 1981; 54:637–645.

12. Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma--craniotomy versus burr hole trepanation. Br J Neurosurg. 2009; 23:612–616.

13. Nagata K, Basugi N, Fukushima T, Tango T, Kaminuma T, Suzuki I, et al. [The normal range of cerebral atrophy during aging: statistical analysis of 500 normal subjects]. No To Shinkei. 1986; 38:1019–1025.

14. Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg. 2001; 95:256–262.

15. Nakajima H, Yasui T, Nishikawa M, Kishi H, Kan M. The role of postoperative patient posture in the recurrence of chronic subdural hematoma: a prospective randomized trial. Surg Neurol. 2002; 58:385–387. discussion 387.

16. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir(Tokyo). 2001; 41:382–386.

17. Ramachandran R, Hegde T. Chronic subdural hematomas--causes of morbidity and mortality. Surg Neurol. 2007; 67:367–372. discussion 372-373.

18. Robinson RG. surgical management in 133 patients. J Neurosurg. 1984; 61:263–268.

19. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S. Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. J Neurosurg. 2003; 98:1217–1221.