The Effect of Post-Operative Supine Position versus 30 Degree Head Elevation on Clinical Outcome and Recurrence Rate in Chronic Subdural Hematomas Treated by Burr Hole Drainage
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- Category: Vol. 85, March 2017
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The Effect of Post-Operative Supine Position versus 30 Degree Head Elevation on Clinical Outcome and Recurrence Rate in Chronic Subdural Hematomas Treated by Burr Hole Drainage, MOHAMED LOTFY, ASHRAF E. ZAGHLOUL and MOATAZ A. EL-AWADY
Abstract
Background: Chronic Subdural Hematoma (CSDH) occurs most frequently in the elderly population. Treatment options for this entity have remained controversial. The recurrence rate for CSDHs ranges from 5% to 33%.
Objective: To compare the effect of postoperative head position (supine position vs. 30º head elevation position) on clinical outcome and recurrence rate in CSDH treated by burr hole drainage.
Patients and Methods: This prospective study included all the patients admitted to Benha University Hospital from December 2010 to December 2014 with CSDHs and they were randomly assigned into 2 groups, Group (A) and (B). These patients were operated upon by two burr holes irrigation and subgleal drainage, and for 3 days after surgery patients of Group (A) were kept in a supine position while the patients of Group (B) their heads kept elevated by 30º and no restriction in patients' activities after that. Clinical follow-up and post-operative CT brain was done at discharge, 1 month, and 6 months post-operatively to evaluate the clinical outcome measured by improvement in Glasgow Coma Score (GCS) and the complications rate including the recurrence of CSDH and need for reoperation and death rate.
Results: Our study included 56 patients, all the patients showed improved postoperative GCS except 8 patients. In Group A 3 patients had recurrent CSDH and one died of acute myocardial infarction. While 4 patients in Group B had recurrent CSDH. The differences between both groups found insignificant regarding the improvement in post-operative GCS, the recurrence rate and need for reoperation, the com-plications and death rates.
Conclusion: According to the results, we think that the two studied post-operative head positions could be effective comparable options with insignificant difference in treating CSDHs by two burr holes irrigation and subgleal drainage.