Asim Ishfaq, Ishfaq Ahmed, Sabir Hussain Bhatti.
Effect of head positioning on outcome after burr hole craniostomy for chronic subdural haematoma.
J Coll Physicians Surg Pak Jan ;19(8):492-5.

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 30o. 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 30o head up position soon after operation in cases of chronic subdural haematoma does not significantly affect the outcome and recurrence.

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