International Journal of Neurosurgery

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Treatment of Chronic Subdural Hematoma in Adults at the University Hospital of Brazzaville (Congo)

Received: 21 September 2023    Accepted: 20 October 2023    Published: 31 October 2023
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Abstract

The aim of this study was to describe the treatment of chronic subdural hematoma (CSDH) in a neurosurgical setting, at the University Hospital Centre of Brazzaville. We conducted a descriptive study with retrospective data collection from 2014 to 2021 (a period of eight years). We included adult patients treated at the hospital for this condition. The variables studied were diagnostic, therapeutic and evolutionary. We selected 81 patients. They were over 60 years old in 49 cases (60.5%). The Glasgow coma scale was between 13 and 15 in 50 cases (61.7%). The Markwalder grade was 1 in 34 cases (42%) and 3 in 24 cases (29.6%). The hematoma was unilateral in 62 cases (76.6%) and bilateral in 19 cases (23.4%). The thickness of the hematoma was greater than or equal to 2 cm in 64 cases (79%). All patients underwent surgery. Single burr hole surgery was performed in 68 patients (84%). Drainage was placed in all the patients. The outcome was favourable in 43 cases (53.1%). Complications were noted in 38 cases (46.9%). Five patients (6.2%) died, including two cases of empyema, two cases of neurological deterioration and one case of postoperative sepsis. In univariate analysis, we found a statistically significant association between the Glasgow coma scale (P = 0.0004) and the thickness of the CSDH (P = 0.02) with the occurrence of complications. In multivariate analysis, the Glasgow Coma Scale and bilateral nature were factors influencing the occurrence of complications, adjusting for age and the hematoma thickness. Patient care may be improved by early surgical treatment in a patient with a favourable Glasgow score. Surgical techniques are varied, but postoperative drainage seems essential.

DOI 10.11648/j.ijn.20230702.15
Published in International Journal of Neurosurgery (Volume 7, Issue 2, December 2023)
Page(s) 41-45
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Chronic Subdural Hematoma, Surgery, Brazzaville

References
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[2] Moskala M, Goscinski I, Kaluza J, Polak J, Krupa M, Adamek D, Pitynski K, Miodonski AJ. Morphological aspects of the traumatic chronic subdural hematoma capsule: SEM studies. Microsc Microanal 2007; 13 (3): 211-9.
[3] Basaldella L, Perin A, Orvieto E, Marton E, Itskevich D, Dei Tos AP, Longatti P. A preliminary study of aquaporin 1 immunolocalization in chronic subdural hematoma mambranes. J Clin Neurosci 2010; 17 (7): 905-7.
[4] Feghali J, Yang W, Huang J. Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg 2020; 141: 339-45.
[5] Lee KS. How to treat chronic subdural hematoma? Past and now. J Korean Neurosurg Soc 2019; 62 (2): 144-52.
[6] Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Andersen KN, Sussman E, Carpenter A, Connolly Jr ES. The surgical management of chronic subdural hematoma. Neurosurg Rev 2012; 35 (2): 155-69.
[7] Ekouele Mbaki HB, Boukassa L, Ngackosso OB, Kinata Bambino SB, Elombila M, Moyikoua R. Neurosurgery at the university hospital of Brazzaville (Congo): 21 months of activity. Afr J of Neurol Sci 2016; 35 (1): 47-54.
[8] Dran G, Berthier F, Fontaine D, Rasenrarijao D, Paquis P. Efficacy of corticosteroid therapy in the adjuvant treatment of chronic subdural hematomas. Retrospective study on 198 cases. Neurochirurgie 2007; 53 (5): 477-82.
[9] Bah AB, Souaré IS, Diawara S, Boubane D, Saran KO. Surgical treatment of chronic subdural hematoma in Guinea: Analysis of 22 cases at the Kipe hospital of Conakry. Neurochirurgie 2019; 65: 83-8.
[10] Alliez J.-R., Balan C, Kaya J.-M, Leone M, Reynier Y, Alliez B. Chronic subdural hematoma in adults. EMC (Elsevier Masson SAS, Paris) Neurologie 2007; 17-585-A-30.
[11] Maiga AH, Sakho Y, Ba MC, Ndoye N, Thiam AB, Diallo M. Chronic subdural hematomas in Dakar. Clinical, diagnostic, therapeutic and evolutionary particularities in the era of scanners (about 88 cases). Mali Med 2008; 23 (4): 11-6.
[12] Nayil K, Ramzan A, Sajad A, Zahoor S, Wani A, Nizami F, Laharwal M, Kirmani A, Bhat R. Subdural hematomas: an analysis of 1181 kashmiri patients. World Neurosurg 2012; 77 (1): 103-10.
[13] Bakhti S, Tighilt N, Djennas M. Open drainage in chronic subdural hematomas: a prospective study of 189 cases. Iran J Neurosurg 2016; 2 (2): 15-9.
[14] Diallo M. Drainage of chronic subdural hematoma using the Foley catheter in a series of 74 cases: our experience. JNNPGuinée 2019; 2 (19): 66-70.
[15] Agaly H, Djerma I, Tounkara M, Kanikomo D, Sogoba B, Sogoba Y, Diallo O, Dama M, Coulibaly O, Singapire A. Epidemiological, clinical, therapeutic and prognostic studies of chronic subdural hematomas in the neurosurgery department of the CHU-Gabriel Toure. Health Sci Dis 2020; 21 (1): 38-42.
[16] Ekouele Mbaki HB, Boukassa L, Ngackosso OB, Otiobanda GF, Matali E, Moyikoua R, Ossou-Nguiet PM. Chronic subdural hematoma: management in the University Hospital of Brazzaville (Congo). Ann Univ M Ngouabi 2016; 16 (1): 19-26.
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    Ekouele Mbaki Hugues Brieux, Gapoula Syntiche Cécilia, Boukaka Kala Rel Gerald, Thouassa Gédéon Colin, Ngackosso Olivier Brice, et al. (2023). Treatment of Chronic Subdural Hematoma in Adults at the University Hospital of Brazzaville (Congo). International Journal of Neurosurgery, 7(2), 41-45. https://doi.org/10.11648/j.ijn.20230702.15

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    ACS Style

    Ekouele Mbaki Hugues Brieux; Gapoula Syntiche Cécilia; Boukaka Kala Rel Gerald; Thouassa Gédéon Colin; Ngackosso Olivier Brice, et al. Treatment of Chronic Subdural Hematoma in Adults at the University Hospital of Brazzaville (Congo). Int. J. Neurosurg. 2023, 7(2), 41-45. doi: 10.11648/j.ijn.20230702.15

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    AMA Style

    Ekouele Mbaki Hugues Brieux, Gapoula Syntiche Cécilia, Boukaka Kala Rel Gerald, Thouassa Gédéon Colin, Ngackosso Olivier Brice, et al. Treatment of Chronic Subdural Hematoma in Adults at the University Hospital of Brazzaville (Congo). Int J Neurosurg. 2023;7(2):41-45. doi: 10.11648/j.ijn.20230702.15

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  • @article{10.11648/j.ijn.20230702.15,
      author = {Ekouele Mbaki Hugues Brieux and Gapoula Syntiche Cécilia and Boukaka Kala Rel Gerald and Thouassa Gédéon Colin and Ngackosso Olivier Brice and Kinata Bambino Sinclair Brice and Boukassa Léon and Otiobanda Gilbert Fabrice},
      title = {Treatment of Chronic Subdural Hematoma in Adults at the University Hospital of Brazzaville (Congo)},
      journal = {International Journal of Neurosurgery},
      volume = {7},
      number = {2},
      pages = {41-45},
      doi = {10.11648/j.ijn.20230702.15},
      url = {https://doi.org/10.11648/j.ijn.20230702.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20230702.15},
      abstract = {The aim of this study was to describe the treatment of chronic subdural hematoma (CSDH) in a neurosurgical setting, at the University Hospital Centre of Brazzaville. We conducted a descriptive study with retrospective data collection from 2014 to 2021 (a period of eight years). We included adult patients treated at the hospital for this condition. The variables studied were diagnostic, therapeutic and evolutionary. We selected 81 patients. They were over 60 years old in 49 cases (60.5%). The Glasgow coma scale was between 13 and 15 in 50 cases (61.7%). The Markwalder grade was 1 in 34 cases (42%) and 3 in 24 cases (29.6%). The hematoma was unilateral in 62 cases (76.6%) and bilateral in 19 cases (23.4%). The thickness of the hematoma was greater than or equal to 2 cm in 64 cases (79%). All patients underwent surgery. Single burr hole surgery was performed in 68 patients (84%). Drainage was placed in all the patients. The outcome was favourable in 43 cases (53.1%). Complications were noted in 38 cases (46.9%). Five patients (6.2%) died, including two cases of empyema, two cases of neurological deterioration and one case of postoperative sepsis. In univariate analysis, we found a statistically significant association between the Glasgow coma scale (P = 0.0004) and the thickness of the CSDH (P = 0.02) with the occurrence of complications. In multivariate analysis, the Glasgow Coma Scale and bilateral nature were factors influencing the occurrence of complications, adjusting for age and the hematoma thickness. Patient care may be improved by early surgical treatment in a patient with a favourable Glasgow score. Surgical techniques are varied, but postoperative drainage seems essential.
    },
     year = {2023}
    }
    

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    T1  - Treatment of Chronic Subdural Hematoma in Adults at the University Hospital of Brazzaville (Congo)
    AU  - Ekouele Mbaki Hugues Brieux
    AU  - Gapoula Syntiche Cécilia
    AU  - Boukaka Kala Rel Gerald
    AU  - Thouassa Gédéon Colin
    AU  - Ngackosso Olivier Brice
    AU  - Kinata Bambino Sinclair Brice
    AU  - Boukassa Léon
    AU  - Otiobanda Gilbert Fabrice
    Y1  - 2023/10/31
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ijn.20230702.15
    DO  - 10.11648/j.ijn.20230702.15
    T2  - International Journal of Neurosurgery
    JF  - International Journal of Neurosurgery
    JO  - International Journal of Neurosurgery
    SP  - 41
    EP  - 45
    PB  - Science Publishing Group
    SN  - 2640-1959
    UR  - https://doi.org/10.11648/j.ijn.20230702.15
    AB  - The aim of this study was to describe the treatment of chronic subdural hematoma (CSDH) in a neurosurgical setting, at the University Hospital Centre of Brazzaville. We conducted a descriptive study with retrospective data collection from 2014 to 2021 (a period of eight years). We included adult patients treated at the hospital for this condition. The variables studied were diagnostic, therapeutic and evolutionary. We selected 81 patients. They were over 60 years old in 49 cases (60.5%). The Glasgow coma scale was between 13 and 15 in 50 cases (61.7%). The Markwalder grade was 1 in 34 cases (42%) and 3 in 24 cases (29.6%). The hematoma was unilateral in 62 cases (76.6%) and bilateral in 19 cases (23.4%). The thickness of the hematoma was greater than or equal to 2 cm in 64 cases (79%). All patients underwent surgery. Single burr hole surgery was performed in 68 patients (84%). Drainage was placed in all the patients. The outcome was favourable in 43 cases (53.1%). Complications were noted in 38 cases (46.9%). Five patients (6.2%) died, including two cases of empyema, two cases of neurological deterioration and one case of postoperative sepsis. In univariate analysis, we found a statistically significant association between the Glasgow coma scale (P = 0.0004) and the thickness of the CSDH (P = 0.02) with the occurrence of complications. In multivariate analysis, the Glasgow Coma Scale and bilateral nature were factors influencing the occurrence of complications, adjusting for age and the hematoma thickness. Patient care may be improved by early surgical treatment in a patient with a favourable Glasgow score. Surgical techniques are varied, but postoperative drainage seems essential.
    
    VL  - 7
    IS  - 2
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Author Information
  • Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo; Department of Multipurpose Surgery, University Hospital Center of Brazzaville, Brazzaville, Congo

  • Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo

  • Department of Multipurpose Surgery, University Hospital Center of Brazzaville, Brazzaville, Congo

  • Department of Multipurpose Surgery, University Hospital Center of Brazzaville, Brazzaville, Congo

  • Department of Multipurpose Surgery, University Hospital Center of Brazzaville, Brazzaville, Congo

  • Department of Multipurpose Surgery, University Hospital Center of Brazzaville, Brazzaville, Congo

  • Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo; Department of Multipurpose Surgery, University Hospital Center of Brazzaville, Brazzaville, Congo

  • Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo; Department of Intensive Care, University Hospital of Brazzaville, Brazzaville, Congo

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