AVOIDABLE FACTORS THAT CONTRIBUTE TO COMPLICATIONS IN THE SURGICAL-TREATMENT OF CHRONIC SUBDURAL-HEMATOMA

The results of a personal series of 44 consecutive patients undergoing burrhole evacuation and closed system suction drainage for chronic su bdural haematoma are presented. 43 patients made a complete recovery a nd one was left with moderate disability. Contralateral weakness in on e patient, recurrence of haematoma in another, and a new contralateral haematoma in a third were the only complications. The operative proce dures responsible for the rather low complication rate in this series are described. It is concluded that to avoid complications following s urgical treatment of chronic subdural haematoma, attention must be pai d to the following factors: evacuation of the haematoma through two bu rrholes overlying the subdural collection; attention to ensure free co mmunication through the subdural space between the two burrholes; iden tification and opening of additional loculations overlying the cortex; irrigation of the subdural space to ensure as complete an evacuation of the subdural collection as possible and the use of closed system su ction drainage, nursing the patient flat, and intravenous hydration of the patient for three days. In addition, in patients with coagulopath y, correction of these disorders before surgery is most essential.