title: Implantation of a reservoir for refractory chronic subdural hematoma.
abstract: OBJECTIVE
  Recurrence of chronic subdural hematoma is not rare. Among patients who experience recurrence, severe background disease may adversely influence the prognosis of chronic subdural hematoma. We treated patients with these refractory hematomas with an Ommaya cerebrospinal fluid (CSF) reservoir and analyzed the effectiveness of the treatment.
  
  
  METHODS
  Sixteen patients with refractory chronic subdural hematoma were studied. These patients had severe diseases that adversely influenced the clinical course of chronic subdural hematoma, including cerebral infarction, liver cirrhosis, thrombocytopenia, severe Parkinsonism, severe heart disease, psychiatric disease, and spinocerebellar degeneration. All patients were treated initially in the standard fashion: evacuation of the hematoma followed by irrigation and drainage of the hematoma cavity. In each patient, an Ommaya CSF reservoir was implanted after the hematoma recurred. Whenever the volume of the hematoma either decreased very slowly or increased, the reservoir was punctured.
  
  
  RESULTS
  The hematoma size decreased to less than 3 mm a median of 60 days after introduction of the reservoir. Postoperatively, 13 patients returned to their condition before the onset of hematoma. One patient died of myocardial infarction, and two patients with Parkinson's disease could not maintain their previous functional level; both remained in a partially dependent state. Complications consisted of minor bleeding in two patients and occlusion of the reservoir in two other patients.
  
  
  CONCLUSIONS
  By use of this method, reoperation was avoided and the patients were mobile early in the postoperative period. This method was suitable for refractory chronic subdural hematoma accompanied by severe disease that adversely influenced the clinical course.
authors.affiliation: Department of Neurosurgery, Toyonaka Municipal Hospital, Japan. ma-sato@ra2.so-net.ne.jp
authors.forename: M
authors.initials: M
authors.lastname: Sato
authors.forename: K
authors.initials: K
authors.lastname: Iwatsuki
authors.forename: C
authors.initials: C
authors.lastname: Akiyama
authors.forename: E
authors.initials: E
authors.lastname: Kumura
authors.forename: T
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006408:Hematoma, Subdural / Q000134:cerebrospinal fluid* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011677:Punctures / Q000009:adverse effects; D012008:Recurrence