Modified Nakaguchi Classification: Is it a New Way to Measure Outcome of Chronic Subrural Hematoma through GCOSE?

Objective: The ? value of the Modified Nakaguchi classification is 0.78, the highest from other available classification systems for CSDH. The main objective of this study was to evaluate the outcome of CSDH concerning the type of CSDH according to the modified Nakaguchi classification. Material and Methods: It is a single cohort study conducted at Liaquat University Hospital Hyderabad and Jamshoro in the Neurosurgical Department. The patient's known case of chronic subdural hematoma was included in the study after evaluation of inclusion and exclusion criteria and variables like type of CSDH and GCS and GCOSE on discharge were noted on the pre-designed Questionnaire. Results: A total number of 63 patients were included in the study, with 69.8% being male and 30.2% female, and the overall mean age was 58.3 years. The most common presentation according to the Modified Nakaguchi Classification was Hypo-dense (30%) and Graded (27%) type. The mean pre-operative GCS was 10.98 and the post-operative GCS mean was 12.87 with a significance of 0.001. A total of 50.8% of patients had upper good recovery on Discharge GCOSE out of which 28.13% of Hypodense and Graded type. Total mortality was 22.2% out of which 28.6% was hypodense and Graded type respectively. The recurrence of CSDH was 11.1% and the most common type was Hypodense (57%). Conclusion: The Modified Nakaguchi Classification doesn’t define the outcome significantly, however, the surgical intervention related to its specific type is significantly associated with the outcome of the patient on the Glasgow coma outcome scale extended.