Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults

Objectives-Although there is general agreement that surgery is the best tre atment for chronic subdural haematoma (CSDH), the extent of the surgical in tervention is not well defined. Methods-The less invasive surgical technique of bedside percutaneous subdur al tapping and spontaneous haematoma efflux after twist drill craniostomy u nder local anaesthesia was prospectively analysed in 118 adult patients, 99 with unilateral and 19 with bilateral CSDH. Results-The mean number of subdural tappings was 3.2. Ninety two of the pat ients with unilateral CSDH were successfully treated by up to five subdural tappings, 95% of the patients with bilateral CSDH were successfully treate d by up to 10 subdural tappings. The mean duration of inpatient treatment w as 12 days. In 11 patients (9%) the treatment protocol had to be abandoned because of two acute subdural bleedings, two subdural empyemas, and seven c ases of insufficient haematoma efflux and no neurological improvement. The only significant predictor for failure of the described treatment protocol was septation visible on preoperative CT. Conclusions-The described therapy protocol is-apart from a purely conservat ive treatment-the least invasive presently available surgical technique for treating chronic subdural haematoma. Its results are comparable with other modern treatment protocols. Thus, it can be recommended in all patients as a first and minimally invasive therapy, especially in patients in a poor g eneral condition. Patients with septation visible on preoperative CT should be excluded from this form of treatment.