Surgical treatment and outcome of 195 cases of non acute subdural haematoma at the Youndé Central Hospital: The need for landmarked burr holes

Background Chronic subdural hematoma (CSDH) is frequent neurosurgical pathology but many issues related to the surgical procedure are still discussed. Objective To present our experience in the treatment of Non Acute Subdural Hematoma (NASH). Methodology This retrospective study included patients operated for NASH at the Yaounde Central Hospital from January 2000 to September 2008. Surgery consisted of one burr hole (92.4%), 2 burr holes (3.6%), trephine or craniotomy (4%). All patients underwent per operative irrigation, a 48 hour-postoperative drainage and supine position. The burr hole was performed at the thickest point of the hematoma which in most cases corresponded to the intersection between the superior temporal line and the coronal suture. Results One hundred and ninety five consecutive patients were included: 155 males and 40 females. The mean age was 55 years. The past medical history revealed head injury (81.5%), alcoholism (12.9%), epilepsy (4.1%) or anticoagulation therapy (1.5%). The collection was unilateral (72.8%), bilateral (26.7%) or interhemispheric (1 case). On CT scan, the lesion was hypodense (79.9%), isodense (17.4%) or mixed (2.7%). The mortality rate was 2.5% while the recurrence rate was 3.7% after a 6 to 9 months follow-up period. The main recurrence factor was the inappropriate location of the burr hole. Conclusion One burr hole drainage is an effective and safe method for the treatment of NASH. The location of the burr hole is an important factor of recurrence. There is a need for Landmarked burr holes.