The dura mater is approximated above by the cross-union of the four apical sutures, whilst the downward prolongation is also sutured except at the most dependent point, where a rubber drainage-tube is inserted beneath the dura mater and brought out through the scalp-flap (see [Fig. 56]). This tube should be anchored to the dura mater with a single fine catgut suture.
The tube should be allowed to remain in position for at least thirty-six hours. In this the surgeon must be guided by the amount of discharge and the general progress of the case.
Results.
The most complete results obtained by operative treatment are supplied by Bowen, who classifies a series of 72 cases as follows:—
Class A. Subdural hæmorrhage, apparently without other serious injury to bone or brain.
| 36 | cases. |
| 22 | recovered after operation. |
| 14 | died—11 without and 3 after operation. |
Class B. With serious brain-injury.
| 36 | cases. |
| 6 | recovered after operation. |
| 30 | died—10 without and 20 after operation. |
In other words, every case died in which no operative measures were adopted, whilst after operation 28 recovered and 23 died. My own experience is limited to 4 cases, 3 of which recovered.