Implantation of a reservoir for refractory chronic subdural hematoma

OBJECTIVE: Recurrence of chronic subdural hematoma is not rare. Among patie nts who experience recurrence, severe background disease may adversely infl uence the prognosis of chronic subdural hematoma. We treated patients with these refractory hematomas with an Ommaya cerebrospinal fluid (CSF) reservo ir and analyzed the effectiveness of the treatment. METHODS: Sixteen patients with refractory chronic subdural hematoma were st udied. These patients had severe diseases that adversely influenced the cli nical courser of chronic subdural hematoma, including cerebral infarction, liver cirrhosis, thrombocytopenia, severe Parkinsonism, severe heart diseas e, psychiatric disease, and spinocerebellar degeneration. All patients were treated initially in the standard fashion: evacuation of the hematoma foll owed by irrigation and drainage of the hematoma cavity. In each patient, an Ommaya CSF reservoir was implanted after the hematoma recurred. Whenever t he volume of the hematoma either decreased very slowly or increased, the re servoir was punctured. RESULTS: The hematoma size decreased to less than 3 mm a median of 60 days after introduction of the reservoir. Postoperatively, 13 patients returned to their condition before the onset of hematoma. One patient died of myocar dial infarction, and two patients with Parkinson's disease could not mainta in their previous functional level; both remained in a partially dependent state. Complications consisted of minor bleeding in two patients and occlus ion of the reservoir in two other patients. CONCLUSION: By use of this method, reoperation was avoided and the patients were mobile early in the postoperative period. This method was suitable fo r refractory chronic subdural hematoma accompanied by severe disease that a dversely influenced the clinical course.