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BACKGROUND: Traditionally, cranial perforate-rinse-dram operation and tube drainage were often used in the treatment of chronic subdural hematoma in the elderly, recently,instead of which oxygen-exchange therapy through dural puncture via cranium is more and more used.OBJECTIVE: To investigate the reliability and safety of the new operation-method using oxygen-exchange in treating the older people with chronic subdural hematoma in comparison with traditional cranial perforate-rinse-dram operation.DESIGN: Retrospective case analysis.SETTING: The Department of Neurosurgery, the Second Clinical College of China Medical University.PARTICIPANTS: Eleven male patients (meanly 62 years of age)who had undertaken oxygen-exchange therapy via skull without drain tube in the Department of Neurosurgery, Second Clinical College of China Medical College from January 1997 to December 2004 were enrolled in the study, with an average disease history of 1.5 months. Among them, 10 subjects suffered from head injury to different extent within 7 weeks on average. Main chief complaint was headache, and Unilateral limb asthenia above Ⅳ was found in 5 cases asking for medical service. As shown by CT and MRI, all the subjects were diagnosed as having chronic subdural hematoma located at supratentorium, 5 cases in the right side and 6 in the left side. Volume of hematom was calculated as the following formula: volume of hematom=length×width×number of layers (1 cm thick for one layer). And the range of volume was from 70 mL to 140 mL, and the average value was 105 mL. The hematom in all the cases was found to move to the midline to different extents.METHODS: Patients in lateral recumbent position were undertaken boring at the CT-located thickest area with bone awl of 0.4-0.5 cm under local anesthesia. After boring, 14-size lumbar puncture needle with trochar was used to acupuncture dura mater then moving the needle core so that blood was discharged. Then 10 mL medical oxygen was perfused into the needle guard to cause the blood discharged from hematom again. Oxygen was perfused repetitively, once for 10 mL, till there was no blood flow. Finally, 10 mL oxygen was perfused following moving of trochar and bandaging.Oxygen volume used in each case was recorded. After operation,the volume of normal saline infusion could be increased as large as possible. The duration of infusion was 2 weeks.MAIN OUTCOME MEASURES: Improvement in limb function.RESULTS: All the patients were involved in the result analysis.①Within 24 hours, volume of hematomwas decreased obviously detected with CT, and hematom completely disappeared in 3 cases,which was replaced by oxygen. Three weeks later, all the oxygen was absorbed, the structure of midline was symmetrical and the form of brain ventricles was normal. No pain was found and 5 casesof limb asthenia were also recovered. ②Advantage and disadvantage of foramen-vertebrate oxygen-exchange operation: Advantages were listed as follows: It was simple and spent shorter time,there were few complications, and patients had no limitation in movement after operation. The operation avoided the occurrence of thrombosis of lower limbs. Cranial pressure could not lower quickly. As the pressure resident in envelope, cerebraospinal fluid could not move into the envelope. Along with the absorption of oxygen,hematom was decreased gradually till completely disappeared. Occurrence of clinical symptoms resulting from cerebral blood perfusion was decreased so as to draw rein. The disadvantage of this operation was that it was not suitable for heart disease patients to undertake this operation at bedside, and headache or limb asthenia could not be alleviated immediately.CONCLUSION: The new operation-method of cranial foramen-vertebrate oxygen-exchange to treat chronic subdural hemtoma in the elderly is safe, reliable and feasible through preoperative CT localization.