BURR-HOLE DRAINAGE WITH DRAIN VERSUS BURR-HOLE DRAINAGE WITH DRAIN AND IRRIGATION IN TREATING CHRONIC SUBDURAL HEMATOMA: A CASE-CONTROL STUDY
DOI:
https://doi.org/10.17656/jsmc.10255Keywords:
Chronic subdural hematoma (CSDH), Burr-hole drainage, Irrigation, OutcomeAbstract
Background
Chronic subdural hematoma is a common neurosurgical condition. Its prevalence is increasing worldwide due to the increasingly aged population. Craniotomy, twist-drill craniostomy, and burr-hole drainage and drain with or without irrigation are among the very first lines of its management.
Objectives
We used burr-hole drainage with drain versus burr-hole drainage with drain and irrigation to find out which method is better regarding the outcome of chronic subdural hematoma treatment.
Patients and Methods
a case-control study design was used to inspect retrospectively both techniques in 47 patients. Twenty-one patients were treated with burr-hole drainage with drain only, and 26 were treated with burr-hole drainage with drain and irrigation.
Results
We found no statistically different association between the two types of operations and their outcomes (P value= 0.083 and Pearson’s R Correlation= 0.029).
Conclusion
As long as there is no differences between the two techniques, irrigation is not necessary after burr-hole drainage of chronic subdural hematoma. It requires more time, more exposure of the patient to anesthetic agents, and increases the risk of both infection and pneumocephalus.
References
-Yuan Y, Wang QP, Cao YL . Burr-hole drainage and burr-hole drainage with irrigation to treat chronic subdural hematoma: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97(33):e11827.
- Abouzari M, Rashidi A, Rezaii J. The role of postoperative patient posture in the recurrence of a traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery. 2007;61(4):794-7.
- Xu C, Chen S, Yuan L, and Jing Y. Burr-hole irrigation with closed-system drainage for the treatment of chronic subdural hematoma: a meta-analysis. Neurol Med Chir (Tokyo). 2016;56(2):62-8.
- Santarius T, Kirkpatrick PJ, Ganesan D. Use of drains versus no drains after the burr-hole evacuation of chronic subdural hematoma: a randomized controlled trial. Lancet. 2009;374(9695):1067-73.
- Sousa EB, Brandão LFS, Tavares CB. Epidemiological Characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasília, Brazil. BMC Surg. 2013; 13:5.
- Weigel R, Schmiedek P, Krauss JK. The outcome of contemporary surgery for chronic subdural hematoma: an evidence-based review. J Neurol Neurosurg Psychiatry. 2003;74(7):937–43.
- Wang QP, Yuan Y, Guan JW, Jiang XB. A comparative study of irrigation versus no irrigation during burr-hole craniotomy to treat a chronic subdural hematoma. BMC Surg. 2017;17: 99.
- Kim DH, Kim HS, Choi HJ. Recurrence of the chronic subdural hematoma after burr-hole drainage with or without intraoperative saline irrigation. Korean J Neurotrauma. 2014;10(2):101–5.
- Suzuki K, Takano S, Nose T, Doi M, and Ohashi N. Increased concentration of vascular endothelial growth factor (VEGF) in a chronic subdural hematoma. J Trauma. 1999;46(3):532-3.
- Iftikhar M, Siddiqui UT, Rauf MY, Malik AO, and Javed G. Comparison of Irrigation versus No Irrigation during Burr Hole Evacuation of Chronic Subdural Hematoma. J Neurosurg A Cent Eur Neurosurg. 2016;77(5):416-21.
- Ducruet AF, Grobelny BT, Zacharia BE . The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155-69.
- Regan JM, Worley E, Shelburne C, Pullarkat R, and Watson JC., Burr-hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis. PLoS One. 2015;10(1):e0115085.
- Kareem H, and Adams H. A closed system irrigation & drainage technique for surgical evacuation of chronic subdural haematomas. Version 1. F1000Res. 2018;7: 619.
- Lee KS. How to treat chronic subdural hematoma? Past and now. J Korean Neurosurg Soc. 2019;62(2):144–52.
- Ishibashi A, Yokokura Y, and Adachi H. A comparative study of treatments for chronic subdural hematoma: burr-hole drainage versus burr-hole drainage with irrigation. Kurume Med J. 2011;58(1):35-9.
- Gurelik M, Aslan A, Gurelik B. A safe and effective method for treatment of chronic subdural haematoma. Can J Neurol Sci. 2007;34(1):84-7.
- Kuwabara M, Sadatomo T, Yuki K . The effect of irrigation solutions on the recurrence of chronic subdural hematoma: a consecutive cohort study of 234 patients. Neurol Med Chir (Tokyo). 2017;57(5):210–6.
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