A Clinicopathological study of subdural membranes

Background: One of the most common neurosurgical entities is chronic subdural hematoma and its characteristic presence of enveloping subdural membranes. The membrane study acts as a rough guide to estimate the time since injury, the nature of the entity and the associated clinical condition. Aim and objectives: To study the demographics, incidence, symptomatology, neurological status, histopathology, risk factors, diagnosis, treatment and outcome of the patients presenting with subdural membranes. Materials and methods: The study was conducted in the Department of Neurosurgery, Government General Hospital (GGH), Kakinada (referral teaching hospital of Rangaraya Medical College). The study population comprised of all patients from both sexes who were diagnosed to have subdural collections with membranes that presented in GGH during the study period. Patients who met inclusion criteria had their independent variables ascertained were included in the study. The study was designed as prospective study. Neurological status, symptomatology, histopathology and Postoperative outcome were assessed immediately after surgery in the ward, and then two weeks and one month afterwards in the OPD. Relevant investigations were done as patient‘s condition dictated. Results: A total of 19 patients were included in the study for the final analysis. All the patients presenting with the diagnosis of Chronic Subdural Hematoma, or diagnosed after screening for symptoms suggestive of subdural collections were included in the study. CT/ MRI scan was used for diagnosis and preoperative evaluation of the patients. After procedure the specimen was sent for pathological evaluation. All the patients were thoroughly examined clinically and findings noted. The Pathological reports according to Nagahori, et al was followed and was noted. Surgical management was offered for all the patients. All the patients were evaluated preoperatively for any co-morbidity and managed accordingly, to be fit for surgical procedure. Adequate blood was reserved. Patient and attendants were explained in detail about the nature history of the disease, the prognosis and the need for surgery with its associated complications. Informed consent was obtained for surgery. Post operatively, antibiotics were given and patients observed for any CSF leaks, wound infection or meningitis. Patients were discharged after 7-9 days post-operatively. Neurological status was assessed at discharge and follow up. It was noted that most common age group affected was between 61-70 years, males were more commonly affected than females. Most common risk factors were hypertension 47.38% followed by diabetes 21.05%. Most commonly associated risk factor noted in the present study was both alcoholism with smoking. Most common presenting symptom was hemiparesis 52.6% followed by headache 29.41%. Most common type of membrane in our study was Type III 68.38% followed by Type II 15.58%. Most common type of membrane in our study was Type III 68.38% followed by Type II 15.58%. Most common type of lesion encountered in our study was chronic followed by acute on chronic. Most lesions were observed on the right side. Most common site of lesion was fronto-parietal followed by fronto-temporoparietal in location. Associated lesions were seen in 57.86% of cases. Generally outcome based on (GCS) preoperative and postoperative scores were good in about 78.90%. Generally outcome based on (GCS) preoperative and postoperative scores were good in about 78.90%. Conclusion: This study underlines that craniotomy and subtotal membranectomy is still an acceptable, safe, efficient and even a better procedure for patients presenting with subdural membranes.