Prognosis Factors in the Treatment of Chronic Subdural Hematomas at the Mamadou Gueye Clinic of Fann Teaching Hospital: Review of 205 Cases

Introduction: Subdural hematoma is a collection of blood and blood degradation products in the intracranial subdural space that liquefies over time. The objective of this work is to highlight the prognostic factors of patients with chronic subdural hematomas (cSDH).
Patients and Method: This is a study that concerned 205 patient files collected and followed up in the Neurosurgery Department of the Mamadou Gueye clinic at Fann Teaching Hospital for the management of chronic subdural hematoma during a period from September 2017 to September 2021, i.e., 4 years, having benefited from a follow-up of at least three months.
Results: During this study we received 163 men and 42 women (sex ratio: 3.88). The predominant age group was 65 years and over found in 48.8%. Minor head trauma, following a fall, was the most frequent cause (22.9%). The average duration of symptom evolution was greater than 3 weeks in 27.8%. The intracranial hypertension syndrome was constant, complicated by memory disorders in 31.7% of cases, consciousness disorders in 33.2% of cases, and even a deficit syndrome in 68.3% of cases (n=140). The radiological diagnosis was made with CT in 96.6% of cases, and with MRI in 3.4% of cases. 174 patients were operated (84.8%). Surgical techniques essentially consisted of making a burr hole in 86.2% of cases (n=150), and two burr holes in 13.8% of cases (n=24) associated with rinsing of the cavity followed by drainage for 48 hours. Complementary medical treatment, aimed at promoting postoperative cerebral expansion, was administered. The average follow-up was 6 months with 76.1% of patients cured. 22.4% of patients had intellectual or motor sequelae. 1.5% of patients died.
Conclusion: The treatment of cSDH is mainly neurosurgical and must be early, to reduce mortality and morbidity. Evacuation of the hematoma through one or two burr holes is the most common technique.

Keywords:Chronic subdural hematoma; Surgical treatment; Follow-up of at least three months; Fann teaching hospital