Effect of Head Positioning on Outcome after Burr Hole Craniostomy for Chronic Subdural Haematoma

Objective: To determine the effect of position of the patient's head after burr hole craniostomy on the outcome of chronic subdural haematoma, in terms of haematoma efflux, hospital stay and recurrence rate. Study Design: Quasi experimental. Place and Duration of Study: Combined Military Hospital, Rawalpindi, from February 2007 to February 2008. Methodology: Sixty patients were divided in two equal groups of 30 patients each. Group A patients were kept flat after the burr hole craniostomy and group B patients were kept with head end of bed elevated by 30 degrees. The results were statistically analysed through software SPSS 14. Results: The mean age was 59.98 +/- 13.7 years. There was predominance of males (M:F=3.2:1). The location of haematoma was frontoparietal in majority (72%), right sided in 31 (51.6%), left sided in 20 (30%) and bilateral in 9 (15%) patients. Average daily output was 152 ml in group A and 142 ml in group B. Haematoma efflux was found to be sufficient in 26 (86.6%) patients of group A and 27 (90%) of group B. Wound infection occurred in 2 patients of group A and 1 in group B. Seizures occurred in 2 patients of group A and 3 of group B. Although, there was longer hospital stay for group A vs. group B (p=0.002), recurrence rate was insignificant amongst the two groups as 10% vs. 13% (p=0.688). Conclusion: Assuming a 300 head up position soon after operation in cases of chronic subdural haematoma does not significantly affect the outcome and recurrence.