| Reappraisal of Keyhole Surgical Technique for the Prevention of Subdural Hygroma in Elderly Unruptured Aneurysm Patients |
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Jung Koo Lee, Ik Seong Park |
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Department of Neurosurgery, Bucheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea |
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| Abstract |
Objective
Subdural hygroma after keyhole craniotomy is a frequent complication in elderly patients due to brain atrophy. We investigated the surgery-related complications in elderly patients and reappraise the surgical technique for the prevention of subdural hygroma.
Methods
This was a retrospective cohort study, using data of patients who underwent keyhole surgery for supratentorial unruptured intracranial aneurysms collected from a single institute between 2001 and 2014. We analyzed surgical outcomes, length of hospital stay, and surgery-related complications. We also investigated the effect of customized minimal arachnoid dissection and loose dural closure, which was performed in the last 8 years, in preventing post-operative subdural hygroma and chronic subdural hematoma(CSDH).
Results
Total of 108 patients underwent keyhole surgery. Female patients were dominant with 87 to 21. Mean age was 66 years old(77-61). There were total of 9(8.3%) surgery-related complications, which included 2(1.9%) perforator infar- ctions, 1(0.9%) intracerebral hemorrhage, 4(3.7%) subdural hygroma or CSDH who needed a burr hole drain, and 2(1.9%) delayed wound healing. Only one patient remained modified Rankin Score(mRS) 2 and all others recovered without mortality. All the subdural hygromas and CSDH occurred in the early series of surgery, before the modified surgical procedure.
Conclusion
Surgical complication rate of elderly with keyhole surgery was not high compared with general population. Sub- dural hygroma is a rare complication with our reappraised technique. Customized minimal arachnoid dissection and loose dural closure is effective technique for the prevention of subdural hygroma and CSDH in keyhole surgery of elderly. |
| Key Words:
Hygroma, Intracranial aneurysm, Minimally invasive surgical procedures |
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