J Korean Neurotraumatol Soc JKNTS Journal of Korean Neurotraumatology Society 1738-8708 Korean Neurotraumatology Society 10.13004/jknts.2010.6.1.33 Clinical Article Prediction of Postoperative Drainage Volume and Brain Expansion of Chronic Subdural Hematoma: Supplementary Study-Clinical Study Kim Ji Yong MD Hyun Dong-Keun MD Yoon Seung-Hwan MD Park Hyeon-Seon MD Kim Eunyoung MD Park Hyeong-Chun MD Park Chong-Oon MD Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea. Address for correspondence: Dong-Keun Hyun, MD. Department of Neurosurgery, College of Medicine, Inha University, 7-206 Sinheung-dong 3-ga, Jung-gu, Incheon 400-711, Korea. Tel: +82-32-890-3502, Fax: +82-32-890-2947, dkhyun@inha.ac.kr 06 2010 30 06 2010 6 1 33 37 06 02 2010 11 03 2010 25 05 2010 Copyright © 2010 Journal of Korean Neurotraumatology Society 2010 Objective

The authors studied the factors associated with postoperative drainage volume after burr-hole craniostomy for chronic subdural hematoma (CSDH) to predict real postoperative drainage volume, and the relation between brain expansion and drained hematoma volume.

 Methods

During the last 7 years, 75 patients with CSDH had been undertaken burrhole drainage. For these, demographical and radiological data regarding CSDH were gathered and reviewed, including hematoma density, volume, and parameters of brain compliance on computed tomography (CT) scan. We estimated the brain expansion using the degree of frontal horn compression and midline shifting by the B/A ratios, and made statistical analyses for relation with the postoperative drainage volume.

 Results

In a whole, the estimated volume was 139 mL, mean real drainage volume was 261 mL, and mean B/A ratio was 0.53. There was no statistical significance between estimated and real drainage volumes. Among 4 groups, low density subgroup showed the largest difference between estimated volume (128 mL) and mean real drainage volume (214 mL), and lowest mean B/A ratio of 0.5. B/A ratio had inverse relationship with real drainage volume (p<0.05).

 Conclusion

The postoperative drainage volume after operation of CSDH was affected by brain expansion. Postoperative drainage volume was decreased as the B/A ratio was increased, and vice versa. Postoperative drainage volume of CSDH, in some extent, can be predicted with the density types of CSDH and the degree of frontal horn compression.

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Chronic subdural hematoma is classified according to its density on brain computed tomography scans. A: High/Iso mixed type. B: Iso type. C: Iso/Low mixed type. D: Low type.

This diagram shows parameters to predict the postoperative drainage volume and the brain re-expansion after drainage of chronic subdural hematoma, B/A ratio. A: The distance between both inner skull table at the level of frontal horn of lateral ventricle. B: The distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A.

This diagram shows parameters to estimate the volume of chronic subdural hematoma, according to Sucu method. X: maximal diameter of chronic subdural hematoma in base, midportion, and vertex of brain, Y: maximal width of chronic subdural hematoma, Z: height of chronic subdural hematoma, estimated hematoma volume: XYZ/2.

This scatterplot shows the inverse relation between the B/A ratio and the postoperative drainage volume of chronic subdural hematoma. CSDH: chronic subdural hematoma, A: the distance between both inner skull table at the level of frontal horn of lateral ventricle. B: the distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A.

Summary of postoperative drainage volume (mL), B/A ratio and estimated volume according to age and sex in chronic subdural hematoma patients. Postoperative drainage volume was decreased as the B/A ratio was increased, and vice versa. Estimated volume was not related with real drainage volume

A: the distance between both inner skull table at the level of frontal horn of lateral ventricle. B: the distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A

Postoperative drainage volume (mL) and clinical values in various density type of chronic subdural hematoma on brain computed tomography scans. Postoperative drainage volume was decreased as the B/A ratio was increased, and vice versa. Estimated volume was not related with real drainage volume

High: high density, Iso: iso density, Low: low density, A: the distance between both inner skull table at the level of frontal horn of lateral ventricle. B: the distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A