63 Award Paper Demonstration of Brain Expansion in Cases of Chronic SDH during Admission Leads to Decreased Rates of Recurrence Nishant S. Yagnick 1 Sandeep Moolchandani 1 Sumit Sinha 2 V. S. Mehta 3 1 Department of Neurosurgery, Paras Hospital, Gurugram, Haryana, India 2 Department of Neurosurgery and Minimal Access Spine Surgery, Paras Hospital, Gurugram, Haryana, India 3 Department of Neurosciences, Paras Hospital, Gurugram, Haryana, India received September 4, 2019 accepted September 5, 2019 Address for correspondence Nishant S. Yagnick, MCh, A-9, Puru Apartments, Sector 13, Rohini, Delhi 110085, India (e-mail: nishantsy@gmail.com). While being considered a simple procedure among the wide spectrum of neurosurgi- cal procedures, the surgical management of chronic subdural hematoma (SDH) still possesses a degree of variability. Present concepts of production versus absorption of chronic SDH fluid has led to practitioners differing in the use of drains, the treatment of inner membrane, the flushing of the subdural cavity, and the perioperative decision making for cases with comorbidities and a history of anticoagulant/antiplatelet usage. In this article, we present the management of chronic SDH over a period of 15 months using the principles followed at our center. In 60 patients of chronic SDH, with the use of drains, we waited for radiological demonstration of brain expansion before drain removal and discharge. In our experience, this has led to better prognostication and very low recurrence rates, particularly in patients with comorbidities and on anticoag- ulant/antiplatelet medication. Abstract Keywords ► burr hole ► chronic SDH ► drains ► imaging ► treatment DOI https://doi.org/ 10.1055/s-0039-1698715 ISSN 0973-0508. Copyright ©2019 Neurotrauma Society of India Introduction The treatment of chronic subdural hematoma (SDH) is con- sidered one of the first surgeries learnt by a trainee neuro- surgeon. But as we gain more experience, most surgeons would agree that this seemingly easy to treat disease can throw up harrowing surprises. Historically, the treatment of chronic SDH has many points of debate. This includes theories on the pathophysiology of the condition as well as treatment practices and steps. Added to this variability, is the increasing use of anticoagulants/antiplatelet drugs in the senior population in an era of increasing aware- ness and defensive practice in heart disease. The use of these drugs and the need to restart them after surgery for chronic SDH further increases the risk of recurrence. In this study, we elucidate the practice followed at our cen- ter, its basis in the pathophysiology of chronic SDH, and our results. Materials and Methods Patient Inclusion Criteria Sixty patients of chronic SDH operated at our center were stud- ied retrospectively. The study included patients from February 2018 to April 2019 with minimum 3-month follow-up. Patients were studied for characteristics of age, unilateral or bilateral collection, neurologic status, presenting complaints, and the presence of comorbidities. A special emphasis was placed on whether the patient was taking anticoagulants or antiplatelet medication. Patients were followed up for resolution of symp- toms, neurologic status, and recurrence/reoperation. Surgical Methodology At our center, chronic SDH is treated by burr hole and evacuation. Surgery was performed by four surgeons independently but using the same protocols. Surgeons pos- sessed 8 to 14 years of experience as individual practitioners. Indian J Neurotrauma 2019;16:63–66 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.