Efficacy of closed-system drainage in treating chronic subdural hematoma

Wakai, Susumu; Hashimoto, Kazuyoshi; Watanabe, Naofumi; Inoh, Satoshi; Ochiai, Chikayuki; Nagai, Masakatsu

doi:10.1097/00006123-199005000-00006

Cited by 65 publications

(18 citation statements)

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“…[7] However, the majority of the published literature agrees that optimal surgical treatment is achieved with the burr-hole trepanation surgery with a closed drainage system. [101720233236] The outcome results based on those series are favorable in around 80% of the patients, similar to the results from the twist-drill craniostomy series.…”

Section: Discussionsupporting

confidence: 66%

“…conducted a prospective comparative study with 38 patients on the recurrence rate of CSDH after surgery with (group A) and without (group B) closed system drainage. [32] There were no significant differences between the two groups for sex, age, preoperative hematoma volume and density on CT scan. Recurrence rate in group A was 5% (one case) as opposed to 33% in group B (six cases) (P < 0.05).…”

Section: Discussionmentioning

confidence: 92%

“…[20] They are commonly associated with old alcohol-addicted male patients, with a history of head trauma and concomitant coagulopathy. [14101228323335] The mortality rate varies between 8% and 15.6%. [4728] However, specific groups of patients, such as those with coagulation abnormalities and older people, demonstrate a more elevated mortality rate.…”

Section: Introductionmentioning

confidence: 99%

“…[435] In the past, several authors have analyzed the outcome of surgically treated patients with CSDH regarding factors such as bilateral localization, recurrence, placement or not of drainage systems, drainage blood volume, gender, admission Glasgow Coma Scale (GCS) and surgical technique, but the results were not always consistent. [471011181923242830323536]…”

Section: Introductionmentioning

confidence: 99%

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Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!

Silva¹,

Gk²,

Lf³

et al. 2012

Surg Neurol Int

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Background:To present the accumulated experience from treating chronic subdural hematomas (CSDH) in a local hospital of a third world country.Methods:One hundred and twenty-five consecutive patients with CSDH who were surgically treated in the Neurosurgical Department of the Hospital da Restauração, Recife-PE, Brazil, between January 2006 and May 2008, were retrospectively studied. Glasgow Outcome Scale (GOS) was employed to define outcome at 6 months as good (GOS 4 and 5) or poor (GOS ≤ 3). Age, admission Glasgow Coma Scale (GCS), location of hematomas (unilateral/bilateral), drainage system placement and recurrence were all analyzed for potential impact on final outcome.Results:The median age was 69 years, with a male/female ratio of 102/23. History of trauma was present in 60.8% of the patients. The median GCS on admission was 14. In 64 patients, the hematoma was on the left side, while in 42 patients it was on the right side. Bilateral hematomas were present in 19 cases (15.2%). Drainage systems were used in 93.6% of the cases. Recurrence occurred in 8.8% of the patients. One hundred and three patients obtained a good outcome at 6 months. The mortality rate was 11.2%. Patients with GCS ≥9 on admission presented better outcome (P < 0.05). Recurrent cases presented a poor outcome (P < 0.05).Conclusions:This study suggests that the main factors associated with outcome in patients harboring CSDH are the admission GCS score and the recurrence status. Advanced age is not a contraindication for surgical treatment. This study, solely focused on the Brazilian population, is the first of its kind in the English literature, and it could serve as a useful introduction to a more complex, multivariate, debate.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!

Silva¹,

Gk²,

Lf³

et al. 2012

Surg Neurol Int

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“…Also, some researchers have reported lower recurrence rates with the use of postoperative drains [16]. In addition, clinical data support the beneficial effects of intraoperative irrigation in order to resolve hematoma and reduce recurrences.…”

Section: Discussionmentioning

confidence: 94%

Comparison of Subgaleal and Subdural Closed Drainage System in Surgical Treatment of Chronic Subdural Hematoma

Oral

Borklu

Küçük

et al. 2015

North Clin Istanbul

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OBJECTIVE:One or two burr-hole craniostomies with subgaleal or subdural drainage system and irrigation are the most common methods for surgical treatment of CSDH. The aim of this study is to compare the advantages or disadvantages of these techniques used for CSDH.METHODS:Seventy patients were treated by burr-hole subdural drainage or subgaleal drainage system with irrigation. Our patients were classified into two groups according to the operative procedure as follows: Group I, one or two burr-hole craniostomy with subgaleal closed system drainage and irrigation (n=36), Group II, one or two burr-hole craniostomies with subdural closed drainage system and irrigation (n=38). We compared male and female ratios, complication rates, and age distribution between groups.RESULTS:There was no remarkable difference between recurrence rates of the two groups. Recurrence rate was 6.25% in Group I and 7.8% in Group II. Subdural empyema occurred in one of the patients in Group II. Symptomatic pneumocephalus did not develop in patients. Four patients were reoperated for recurrence at an average of 12–20 days after the operation with the same methods.CONCLUSION:Both of the techniques have a higher cure rate and a lower risk of recurrence. However, subgaleal drainage system is relatively less invasive, safe, and technically easy. So it is applicable for aged and higher risk patients.

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Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage

et al. 1995

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The radiological aspect, pathology, treatment and results of 132 subdural haematomas observed in 100 patients, are discussed. The majority of these cases were characterized by a nonhomogenous CT scan picture, resulting from repeated bleeding in a previous subdural haematoma evolving to chronicity, or in a pre-existent subdural hygroma. Taking aspirin may have constituted a predisposing factor in 16% of our patients, whilst coagulation disturbances, including anticoagulant treatment, were observed in another 6%; ethylism was present in 11%. A traumatic origin was ascertained in 80% of the patients. The treatment consisted of burr hole evacuation and drainage in 91.5% of the haematomas, corresponding to 92% of the patients; it was eventually repeated once or twice in some cases. In 6% of the patients, a subduro-peritoneal drainage had to be placed ultimately and in 2%, a membranectomy had to be performed because the haematoma had become nearly completely fibrous. The necessity for repeated evacuation and eventual subduro-peritoneal drainage seems to depend mainly on a slow brain re-expansion in some elderly people, who are actually more frequently referred. Two patients died; one was deeply comatose and another in poor general condition. Morbidity in the 96 remaining patients, 2 being lost to follow-up, was 11%: 5% related to the haematoma or to the causal trauma, and 6% from other concomitant neurological disease. The functional result was satisfactory in 85%.

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Efficacy of closed-system drainage in treating chronic subdural hematoma

Cited by 65 publications

References 0 publications

Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!

Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!

Comparison of Subgaleal and Subdural Closed Drainage System in Surgical Treatment of Chronic Subdural Hematoma

Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage

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