Results of treatment for chronic subdural hematoma

INTRODUCTION. Chronic subdural hematoma (CSDH) is a common neurosurgical pathology, usually in elderly patients, and the main cause of which is traumatic brain injury. Analysis of epidemiological data shows that the incidence of CSDH is increasing due to the increased use of anticoagulants and the growing elderly population. Surgical treatment is the standard treatment for this category of patients, although the options for this treatment strategy are still controversial. AIM. To analyze clinical outcomes in patients with CSDH in retrospective material depending on the strategy of surgical treatment. MATERIALS AND METHODS. A total of 110 patients. There were 71 (64.5 %) men and 39 (35.5 %) women. The age ranged from 45 to 96 years, with a mean age of 73.8 years. CSDH was unilateral in 79 (71.8 %) patients and bilateral in 31 (28.2 %). The following surgeries were performed: craniostomy (twist drill) was performed in 7 (6.4 %) patients, burr-hole craniostomy in 83 (75.5 %) cases, craniotomy in 5 (4.5 %) patients, craniectomy in 2 (1.8 %) patients, middle meningeal artery embolization in 10 (9.1 %) cases, and combined treatment (craniostomy + embolization) in 3 (2.7 %) patients. RESULTS. When studying the GCS data, statistically significant improvement of the indicator in the postoperative period was revealed in most patients compared with the preoperative data (p=0.001); When assessing the neurological status, complete regression of neurological symptoms was achieved in 73 (66.4 %) patients, partial regression of neurological symptoms was observed in 20 (18.2 %) cases, no dynamics in the neurological status was noted in 8 (7.3 %) patients, an increase in neurological deficit was noted in 4 (3.6 %) cases, and 5 (4.5 %) patients died. Relapse was recorded in 13 (11.8 %) cases, and complications were found in 8 (7.3 %) patients. Patients with periosteal drainage had fewer relapses and a better neurological outcome in the early postoperative period compared to patients with subdural drainage. Patients who underwent middle meningeal artery embolization had no recurrence and fewer days of hospitalization. CONCLUSIONS. The choice of the optimal treatment method for CSDH is within the competence of the neurosurgeon and is determined for each patient individually; as a rule, such an individual approach will allow for the best result.