INTRODUCTION: Purpose of the study is to evaluate a possible influence of subdural drainage duration and burr hole quantity on a relapse of a unilateral chronic subdural haematoma (CHSH). METHODS: Sixty - five patients who underwent evacuation of unilateral CHSH via 1 or 2 burr holes and subdural drainage during a period from January 2014 to December 2018 were retrospectively analyzed. Duration of the subdural drainage and the number of burr holes used were assessed in relation to an incidence of CHSH recurrence. According to the subdural drainage duration, we divided the patient cohort into two subgroups: with the subdural drainage duration of 1-3 days and 4-5 days. We also evaluated a possible influence of the subdural drainage duration on risk of postoperative infection. RESULTS: An overall incidence of CHSH recurrence was 18.5%. In 45 patients treated by means of a single burr hole the haematoma recurrence was observed in 10 patients (22.2%), in 22 patients with two burr holes recurrence occurred in 2 of them (9.1%). The difference was however, not statistically significant (p=0.3214). We did not observe any significant influence of age, gender and subdural drainage duration on the incidence of CHSH recurrence. The duration of subdural drainage had not significant impact on postoperative infection rate (p=0.0950). CONCLUSION: The number of burr holes used does not affect the rate of unilateral CHSH recurrence. Similarly the duration of subdural drainage affects neither the unilateral CHSH recurrence rate nor the incidence of postoperative infection.

• Klíčová slova
• burr hole, chronic subdural haematoma, postoperative infection, recurrence, risk factors, subdural drainage,
• MeSH
• chronický subdurální hematom chirurgie   MeSH
• drenáž MeSH
• lidé MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• trepanace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Surgical treatment is the method of choice in cases of chronic subdural haematoma--as a rule: trephination, drainage with lavage, or repeated drainage (drain reinsertion where the haematoma has been evacuated insufficiently). A poorly manageable but non-negligible group is made up of patients (about 5-12 % of all cases) where the less invasive methods of choice keep failing. The equally mini-invasive endoscopic technique appears to be one of the suitable therapeutical approaches before resorting to open-surgery revision. The adapted technique of rigid endoscope insertion permitting sufficient revision and treatment of the subdural space concerned is presented. The method is demonstrated on three case reports where routine trephination with lavage, drainage and repeated drain insertion failed. A very good improvement in clinical condition and graphic findings was achieved in two patients. In the remaining one, the neurological lesion improved ad integrum despite a tiny residual haematoma as visualized by CT. Two weeks later, a clinical relapse had developed and the patient was treated with new trephination and drain reinsertion. The technical aspects of the modification of the endoscopic technique are discussed: stressing the advantages or low-degree invasiveness, scope for keeping intact the inner membrane of the haematoma and avoiding direct invasion of the cerebral tissue. The limits of the method are discussed as well. The authors regard this method as a useful addition to the surgical armamentarium, especially in cases of chronic subdural haematomas resisting conventional approaches.

• MeSH
• chronický subdurální hematom chirurgie   MeSH
• lidé MeSH
• neuroendoskopie metody   MeSH
• neuroendoskopy * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

AIMS: Angiotensin converting enzyme inhibitors (ACEI) have been recently discussed in connection with the medical treatment of chronic subdural haematoma (CSDH). They may improve the treatment results. The objective of our study was to evaluate the impact of ACEI on the development of CSDH. The first question was to assess the impact of ACEI on postoperative CSDH healing. The second was to assess the impact of ACEI on the development of CSDH as such. PATIENTS AND METHODS: The study recruited patients treated surgically for CSDH at our department in the 2013-2018 period. Based on medical records, we retrospectively evaluated the clinical condition of the patients, their history (mainly pharmacological - the use of ACEI) and the course of treatment focussing on the reoccurrence of disease necessitating further therapeutic interventions. For the purpose of evaluating the impact of ACEI on postoperative CSDH healing, the patients were divided into two groups: those using ACEI and those without this medication. The results were compared. We also compared the prevalence of ACEI use in patients with CSDH with the prevalence of ACEI in the comparable population. The difference of the rates allowed us to evaluate the impact of ACEI on the development of CSDH itself. RESULTS: Of the 217 patients after surgery for CSDH, 79 continued the use of ACEI; the remaining 138 patients did not use this medication. Patients using ACEI after the surgery experienced a recurrence in 24 (30.4%) cases; patients without ACEI in 37 (26.8%) cases. A negligibly higher number of recurrences was recorded in patients with postoperative use of ACEI, but this difference was not statistically significant (P=0.574). Of a total of 230 patients who underwent surgery for CSDH, 81 were using ACEI chronically (35.2%). In the control group of 100 patients, 38 (38.0%) patients used ACEI. The difference was not statistically significant (P=0.629), so it is not possible to assume that ACEIs influence the development of CSDH as such. CONCLUSION: The initial high hopes for a positive ACEI effect on the healing of CSDH are now waived after the publication of several recent studies. According to our present knowledge, the development of CSDH does not appear to be influenced by ACEI use.

• Klíčová slova
• angiotensin converting enzyme inhibitors, burr hole drainage, chronic subdural haematoma, recurrence,
• MeSH
• chronický subdurální hematom * farmakoterapie   etiologie   MeSH
• drenáž MeSH
• inhibitory ACE škodlivé účinky   MeSH
• lidé MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• inhibitory ACE MeSH

• Klíčová slova
• DURA MATER *, HEMATOMA *,
• MeSH
• chronický subdurální hematom * MeSH
• dura mater * MeSH
• hematom * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• ADOLESCENCE *, AGING *, HEMATOMA, SUBDURAL *, NEUROSURGERY *,
• MeSH
• chronický subdurální hematom * MeSH
• hematom * MeSH
• lidé MeSH
• mladiství MeSH
• neurochirurgie * MeSH
• stárnutí * MeSH
• subdurální hematom * MeSH
• subdurální prostor * MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Chronic subdural haematoma is a potentially threatening disease, affecting mainly advanced age patients often with frequent serious complicating diseases and extensive concomitant medication including antiaggregation and anticoagulation treatment. Surgery is indicated in symptomatic patients, with haematoma evacuation and subdural drainage via simple skull trephination in the majority of cases. The study aims to analyse the influence of presurgical anticoagulation and antiaggregation treatment on the severity of pre-surgical clinical status and final surgical outcome including the incidence of complications and haematoma recurrence. MATERIAL AND METHODS: The paper retrospectively analyses a group of 132 patients operated on from 2008 to 2013 for chronic subdural haematoma. The following parameters characterising pre-surgical clinical condition were studied: age, anticoagulation and antiaggregation treatment administered, other haemocoagulation problems, interval between the probable injury and surgery, duration of symptoms, the patients pre-surgical clinical condition (Glasgow Coma Scale) and the presence of a speech disorder or at least moderate limb paresis. In the postoperative period and subsequent follow- up, the type of surgery, haematoma recurrence, reoperation technique, postoperative complications and final outcome (Glasgow Outcome Scale) were analysed. RESULTS: 64 patients (42 males, 22 females) without antiaggregation and anticoagulation treatment or other medication potentially altering haemocoagulation with normal coagulation parameters (control group), 20 patients (13 males, 7 females) on anticoagulation and 37 patients (30 males, 7 females) on antiaggregation met study inclusion criteria. Anticoagulated patients and patients on antiaggregation were significantly older than the control group patients. Statistical analysis also proved a shorter duration of clinical symptoms and worse clinical condition (GCS) in anticoagulated patients than in the control group. Skull trephination with drainage was the primary surgery indicated in all but one patient, in patients with anticoagulation or antiaggregation after adequate haematological treatment. Although the incidence of reoperation due to haematoma recurrence and postoperative complications was the highest in anticoagulated patients, this difference from the control group did not reach the level of statistical significance. The analysis of clinical outcome (>2 months after surgery) shows a similar proportion of patients with good outcome (Glasgow Outcome Scale 4.5) in all studied groups - control group 82.8%, anticoagulation treatment 80%, antiaggregation treatment 83.8%. CONCLUSION: Study results did not confirm statistically a significant negative effect of antiaggregation or anticoagulation treatment after adequate pre-surgical preparation on surgical outcomes in chronic subdural haematoma patients (Glasgow Outcome Scale). The highest incidence of complications and haematoma recurrencies was found in anticoagulated patients, although the difference does not reach the level of statistical significance.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• chronický subdurální hematom farmakoterapie   chirurgie   MeSH
• drenáž metody   MeSH
• inhibitory agregace trombocytů terapeutické užití   MeSH
• lidé MeSH
• předoperační období MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antikoagulancia MeSH
• inhibitory agregace trombocytů MeSH

• Klíčová slova
• CEREBRAL ANGIOGRAPHY *, CHILD *, ELECTROENCEPHALOGRAPHY *, HEMATOMA, SUBDURAL *, INFANT *, VENTRICULOGRAPHY *,
• MeSH
• chronický subdurální hematom * MeSH
• dítě MeSH
• elektroencefalografie * MeSH
• hematom * MeSH
• kojenec MeSH
• lidé MeSH
• mozková angiografie * MeSH
• radiografie * MeSH
• subdurální hematom * MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The authors evaluate a group of 92 patients with the diagnosis of chronic subdural haematoma confirmed by CT. All patients were operated from two trepanation bores with insertion of drainage into the subdural space and its connection with the closed drainage system. They used three types of drainage systems. The best clinical results were obtained with the negative pressure suction system of Braun Co in 92%. This system was switched on intermittently only till the patient developed signs of headache. Attention is focused on possible types of complications in different systems. In the remaining 13 patients who did not improve reinsertion of the drain was used, or craniotomy with membranectomy with a 60% improvement. The mentioned negative pressure drainage system in treatment in chSDH seems most suitable and is associated with the least number of complications.

• MeSH
• chronická nemoc MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• odsávání přístrojové vybavení   metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• subdurální hematom diagnóza   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The authors evaluate a group of 72 patients with the diagnosis of chronic subdural haematoma (cSDH). All subdural collections were confirmed on a computer tomograph. Sixty-nine patients were operated by trepanation and drainage into a closed system which was maintained for a maximum of five days. Three patients with a hyperdense CT finding were subjected to extended trepanation or craniectomy with membranectomy. The CT picture made on the 2nd-4th day after operation revealed a persisting subdural collection in 35% of the patients subjected to trephination. The authors were concerned with the problem whether this percentage makes trephination with drainage controversial as the only universal therapeutic method in cSDH. Nevertheless successful reinsertion of the drain (85%) is in favour of trephination although drainage from the first trephination in not always the definite solution. Conversely revision by craniotomy was a failure in 7 patients where the drainage method was not successful. Radical surgery proved useful only in the initial period in patients who despite a chronic course had on CT a hyperdense collection. The influence of the site, volume of collection, lateral overpressure and possibly a subsidiary CT finding could not be proved on a statistically significant scale, therefore the authors did not use these CT markers when selecting surgical intervention.

• MeSH
• chronická nemoc MeSH
• dospělí MeSH
• drenáž MeSH
• lidé středního věku MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• subdurální hematom diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• BRAIN DAMAGE, CHRONIC *, ELECTROENCEPHALOGRAPHY *, EYE MANIFESTATIONS *, HEMATOMA, SUBDURAL *, INFANT *, NEUROLOGIC MANIFESTATIONS *, NEUROSURGERY *,
• MeSH
• chronické poškození mozku * MeSH
• elektroencefalografie * MeSH
• hematom * MeSH
• kojenec MeSH
• lidé MeSH
• mozek * MeSH
• neurochirurgie * MeSH
• neurologické manifestace * MeSH
• oční symptomy * MeSH
• poranění mozku * MeSH
• subdurální hematom * MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH