Management and outcome of chronic subdural haematoma in a low-resource neurosurgical centre: a prospective cohort study from northeastern nigeria

Abstract

Abstract Objective Although the frequency of chronic subdural haematoma is increasing worldwide, there is a paucity of data from Northeastern Nigeria. This study aims to fill that gap and evaluate the management outcomes of the various treatment modalities for chronic subdural hematoma in a low-resource setting. Methods This is a 2 year, single-centre, prospective cohort study conducted in patients with a clinico-radiologically diagnosed chronic subdural hematoma. The variables studied were socio-demographics, personal medical history, clinical and radiological features, intraoperative findings, and postoperative outcomes. Statistical analysis and data processing were performed with the software STATA 13. A multivariable analysis was conducted using the Chi-square test of independence to assess relationships between categorical variables and Student's t-test to compare pre- and post-operative means of Glasgow Coma Scale (GCS) scores and motor power, evaluating significant differences following surgical intervention. A p-value of less than 0.05 was deemed significant. Results Seventy-seven patients were recruited with a mean age of 56.29 ± 16.83 years. Men were significantly affected (87.01%; p = 0.035). 50.56% had a background of hypertension (p > 0.05). Few patients had a previous history of chronic subdural hematoma, while 84.42% reported a prior history of trauma, and 55.84% presented with headaches. The mean pre-op GCS and motor power were 13.14 ± 2.63 and 3.78 ± 1.27, respectively, with 68.83% of participants having a motor deficit. 58.44% of the hematomas were left-sided, with a significant amount having no membranes (75.32%; p = 0.005) and midline shift (67.53%; p = 0.025). One patient was managed conservatively. Seventy-six patients had either single or double burr holes of various combinations. 98.68% had subgaleal drain (p > 0.05), and 89.61% were operated under general anaesthesia. The type of anaesthesia had no significant effect on the outcome of surgery (p > 0.05). Anticoagulation use was a significant risk factor for recurrence (p = 0.014). The recurrence rate was 18.18%, with all recurrent cases undergoing redo surgery. The absence of a membrane contributes to a satisfactory surgical outcome. The mean follow-up was 10.29 ± 9.03 months, with substantial improvement (p = 0.003) in the patients’ Markwalder grading. One patient died on the 3rd postoperative day. Conclusions Surgical interventions, particularly burr hole drainage with subgaleal drain placement, are effective in managing CSDH in low-resource settings. Careful patient selection for medical therapy, and further research is needed to optimize treatment strategies.