Randomized Controlled Trial of the Use of Drains Versus No Drains after Burr Hole Evacuation of Chronic Subdural Hematoma

Santarius, Thomas; Kirkpatrick, Peter J.; Ganesan, Dharmendra; Chia, Hui Ling; Jalloh, Ibrahim; Marcus, Hani J.; Smielewski, Peter; Price, Stephen J.; Kirollos, Ramez; Hutchinson, Peter J.

doi:10.1227/01.neu.0000358671.05488.a2

Cited by 8 publications

(13 citation statements)

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“…6) The postoperative rate of recurrence was almost equal to those reported. 6,14,15,18,23) The Monro-Kellie doctrine holds that the skull is a rigid compartment housing three components, the brain, blood, and CSF, and if the volume of one component becomes decreased, the volumes of the other components must enlarge accordingly. 9) In the closed condition of surgery for CSDH, the intracranial components are the brain, circulating blood, CSF, and old hematoma (modified elements of the Monro-Kellie doctrine).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, two burrhole craniostomy is more efficient to flush out subdural fluid collections. 14,15,21) The two burr-hole method maintains the open condition by design, because the other route is secured by the second burr hole (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

“…The two burr holes are generally 7 cm apart. 15) A large part of the hematoma is discharged spontaneously.…”

Section: Discussionmentioning

confidence: 99%

“…Craniostomy is the main method of surgical treatment, 23) and is performed by twist drill craniostomy (diameter less than 5 mm), 6,7,13,19,23) one burr-hole craniostomy (8-15 mm), 5,7,18,20) and two burr-hole craniostomy. 15,21) Twist drill craniostomy was introduced as a less invasive method for the treatment of CSDH, and is used worldwide. 13,19) The two burr-hole method is also widely used, 15,21) and was introduced to achieve sufficient irrigation, which could reduce the rate of recurrence of CSDH.…”

Section: Introductionmentioning

confidence: 99%

“…15,21) Twist drill craniostomy was introduced as a less invasive method for the treatment of CSDH, and is used worldwide. 13,19) The two burr-hole method is also widely used, 15,21) and was introduced to achieve sufficient irrigation, which could reduce the rate of recurrence of CSDH. 3,12) One burr-hole craniostomy with or without irrigation may be the most important surgical method and the most widely used in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Tosaka

Sakamoto²,

Watanabe³

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The``closed condition'' represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The``open condition'' includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the``open condition,'' shortens the operation time, and achieves good irrigation of the hematoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The two burr holes are generally 7 cm apart. 15) A large part of the hematoma is discharged spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Tosaka

Sakamoto²,

Watanabe³

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma

Kim

Song

Kim

et al. 2017

Korean J Neurotrauma

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Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

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Unilateral drainage of bilateral chronic subdural hematoma

Drapkin¹,

P²

2021

JNSK

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Bilateral chronic subdural hematoma (bCSDH) is a condition frequently encountered in neurosurgical practice, and it is usually the result of head trauma. Despite its frequency, no consensus currently exists regarding its optimal treatment. While the use of corticosteroids in the treatment of chronic subdural hematoma is not currently accepted by the neurosurgical community, there is enough evidence in the literature that supports its use. In bCSDH the unilateral burr hole evacuation of the larger of the subdural collections followed by a course of corticosteroids seems to be an effective and safer course of action in the management of bilateral chronic subdural hematoma.

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Randomized Controlled Trial of the Use of Drains Versus No Drains after Burr Hole Evacuation of Chronic Subdural Hematoma

Cited by 8 publications

References 0 publications

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Critical Classification of Craniostomy for Chronic Subdural Hematoma; Safer Technique for Hematoma Aspiration

Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma

Unilateral drainage of bilateral chronic subdural hematoma

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