[Clinical study of reaccumulation and persistence of chronic subdural hematoma; setting an Ommaya reservoir].
We treated 57 cases of chronic subdural hematoma by aspiration via the Ommaya reservoir following burr hole opening and irrigation of the hematoma in order to reduce the reaccumulation and persistence of the hematoma. An Ommaya reservoir was placed on the following patients: (1) the volume of hematoma was more than 100 ml and/or (2) expansion of the brain after evacuation of the hematoma was poor. However in spite of these techniques there were 6 cases (10.5%) of recurrence and 21 cases (36.8%) with persistence of the hematoma cavity for longer than 2 months after the first operation. The recurrence was due to occlusion of the Ommaya reservoir by massive rebleeding into the hematoma cavity in cases with a large subdural hematoma and/or an immature external membrane. Persistence of the hematoma cavity for longer than 2 months after the first operation was due to minor rebleeding and CSF inflow into the hematoma cavity through the damaged inner membrane in cases of acute onset and/or or coexisting intracranial disease (brain atrophy, cerebral infarction and subdural effusion). The most suitable cases for application of this technique were those with poor expansion of the brain after evacuation of the hematoma, or those with a mature external membrane and a medium-size hematoma.
Department of Neurosurgery, Kitakyushu City Yahata Hospital.
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Horimoto
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Miyazaki
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Miyazaki
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Kawano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005069:Evaluation Studies as Topic; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D012008:Recurrence; D013396:Suction / Q000379:methods; D014057:Tomography, X-Ray Computed