Burr hole drainage without irrigation for chronic subdural hematoma

Abstract

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions, with different strategies for treatment. Most recent trials favor the use of drainage to reduce the recurrence rate. However, few reports have discussed the efficacy of burr hole drainage without irrigation for treating CSDH. This study aimed to examine the efficacy of burr hole drainage without irrigation in a series of 385 symptomatic CSDH lesions. Methods: This retrospective study included a series of 385 symptomatic CSDH lesions in 309 patients, who underwent burr hole drainage without irrigation, between September 2009 and August 2017 at the Department of Neurosurgery, Yao Tokushukai General Hospital, Japan. The risk of recurrence was evaluated based on the patients’ age, sex, preoperative magnetic resonance imaging (MRI) findings, preoperative anticoagulants, hematoma drainage rate, and bilaterality. Results: Of the 385 lesions, 41 cases (16 with inadequate follow-up periods and 25 with contraindications for MRI) were excluded from the analysis. The overall recurrence rate in the index study was 4.9% (17/344 lesions). The effects of the preoperative hematoma volume and nonhyperintensity on T1-weighted imaging on the recurrence rate were significant. Conclusion: Our findings indicated that burr hole drainage without irrigation is a good surgical modality in patients with CSDH, and preoperative MRI findings can evaluate the risk of recurrence.

Bilateral evacuation of bilateral non-acute subdural hematomas – evaluation of postoperative outcomes and complications

“…As in the study by Huang et al, there was no correlation in our cohort between PV and neurological outcome of patients (11). Uda et al confi rmed the effect of PHV on the recurrence rate of NASH, which is in line with our study (16). Molina et al reported that PHV > 80 ml is signifi cantly more frequent in the hematoma recurrence group of patients after evacuation (17).…”

“…It should be noted that in our study group of bilateral hematomas, no homogeneous hyperdense morphological type of hematoma occurred. Other various factors are referred to as conditions carrying the risk of hematoma recurrence and worse neurological outcome, namely arterial hypertension, absence of postoperative drainage, early removal of drainage tube, hematoma evacuation via burr holes, antithrombotic agents, midline shift, admixture of acute blood in post-evacuation hematoma cavity, phatic disorder, preoperative seizures, disorder of consciousness, thrombocytopenia, diabetes mellitus, brain atrophy, non-hyperintensity on T1-weighted magnetic resonance, general anesthesia and heterogeneous density of hematoma (6,7,10,12,(16)(17)(18)(20)(21)(22)(23). Further studies focusing on the results of surgical treatment of bilateral NASH are needed.…”

Risk factors of recurrence in chronic subdural hematoma and a proposed extended classification of internal architecture as a predictor of recurrence

“…Additionally, bone flap craniotomy was more commonly performed in the subacute type of the extended classification and this treatment might have contributed to the low observed recurrence rate observed. Finally, other treatment algorithms, such as burr hole drainage without irrigation [ 28 ] or placement of subperiostal drains [ 29 ], were not assessed in this study.…”

Hematoma subdural crónico: Una patología común de manejo complejo

“…[50,145,164] Si bien la irrigación permite una rápida y efectiva evacuación del HSDC, no hay evidencia que demuestre que la irrigación es superior a no realizarla y podría agregar otros riesgos. [50,66,97,137,145,151,164] El tipo de solución para irrigar también ha sido estudiado. Un trabajo encontró que el uso de LCR artificial (solución de composición similar al LCR) tuvo un efecto benéfico comparado con la irrigación con solución salina normal.…”