Burr hole drainage and burr hole drainage with irrigation to treat chronic subdural hematoma

Abstract

ObjectiveNumerous studies have investigated different operative procedures for treating chronic subdural hematoma (CSDH); however, the results are controversial. This meta-analysis was performed to evaluate the efficacy of burr hole drainage without irrigation (BHD) and burr hole drainage with irrigation (BHDI) for CSDH.MethodsWe searched the following electronic databases to identify all studies from their inception to September 2017: Cochrane Library, Science Direct, MEDLINE, EMBASE, Scopus, Google Scholar, the China Biomedical Database (CBM), and the Chinese National Knowledge Infrastructure (CNKI). Randomized clinical trials (RCTs), prospective cohort studies, retrospective observational cohort studies, and case-control studies investigating BHD and BHDI for the treatment of CSDH were included. The Cochrane Collaboration's RevMan 5.3 software was used for meta-analysis.Results:In total, 7 retrospective cohort studies and 2 RCTs involving 993 participants were included. Comprehensive analysis results of 9 studies indicated that the recurrence of the BHDI was similar to that in BHD (odds ratio [OR] = 1.27, 95% confidence interval [CI] = .61–2.63, P = .53). Moreover, analysis for comparing recurrence in the 2 RCTs was not significantly different (OR = 1.14, 95% CI = .16–8.24, P = .95).In addition, meta-analysis of pneumocephalus (OR = 5.91, 95% CI = .61–56.86, P = .12) and mortality (OR = 0.94, 95% CI 0.14–6.16, P = .95) was not significantly different.Conclusions:The results of this meta-analysis demonstrated that procedures with or without irrigation in the treatment of CSDH might have similar effect regarding recurrence and complications; therefore, irrigation might not be necessary. However, well-conducted RCTs and high-quality observational studies are still required to corroborate this issue.

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

“…Several studies have revealed that predictors of CSDH recurrence following surgical evacuation include age, sex, antiplatelet or anticoagulation therapy, Glasgow Coma Scale (GCS), diabetes mellitus, hypertension, bilateral hematoma, preoperative hematoma size, midline shift, hematoma density, intraoperative irrigation, type of surgery and postoperative air collection, however, these results are inconsistent [7,[13][14][15][16][17][18][19]. The more controversial risk factors include surgery type and intraoperative irrigation [9,10,[20][21][22]. Previous reports have shown a CSDH mortality rate of 1.8-32% [6,23].…”

Transition of a Clinical Practice to Use of Subdural Drains after Burr Hole Evacuation of Chronic Subdural Hematoma: The Helsinki Experience

“…Some studies indicate that irrigation results in a better outcome, 9 while others show that there is no disadvantage to placing a drain without irrigation. 5,38,39 We keep the drain in place for 48 h, although elsewhere, the use of 12-to 18-h drainage has been reported. 7 We allow patient mobilisation during drain treatment, while some opt for bed rest.…”

“…1,2 Most physicians would agree that nonsurgical treatment is recommendable with asymptomatic patients who have small CSDHs. 3 For symptomatic CSDHs, burr-hole evacuation has become the most preferred treatment method, 4,5 as it results in rapid resolution of the symptoms and a short period of hospitalisation. Other surgical options, such as using two burr-holes, twist drill craniostomy or even craniotomy in selected patient population have been used to treat CSDHs.…”

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

“…[7,[13][14][15][16][17][18][19] The more controversial risk factors include surgery type and intraoperative irrigation. [9,10,[20][21][22] Previous reports have shown a CSDH mortality rate of 1.8-32%. [6,23] Surgical complications, such as irritability, wound infection and acute intracranial hemorrhage (AIH), occur at a rate of 0-38%.…”