Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage

Matsumoto, Katsumi; Akagi, Katsuhito; Abekura, Makoto; Ryujin, Hideho; Ohkawa, Motohisa; Iwasa, Nobutaka; Akiyama, Chihiro

doi:10.1080/01616412.1999.11740931

Cited by 78 publications

(47 citation statements)

References 15 publications

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“…In the literature, re-intervention rates after burr-hole surgery with subdural drains vary between 8.3 and 26.5 % (5,6,14,19,20,24,35). Results from the present series, and 7.6 % obtained by the akin strategy reported by Gazzeri et al (7), thus represent comparatively low incidences of recurrence.…”

Section: Discussionmentioning

confidence: 44%

“…At present, burr-hole surgery with subdural closed-drainage system is the most commonly chosen strategy. This technique was repeatedly shown to be effective and safe (7,8,14,18,20,22,23,32,34,36,37). More recently, enlarged single-burr-hole trepanation in combination with a suction-assisted subgaleal draining system has also earned consideration as a safe and effective approach (7).…”

Section: Introductionmentioning

confidence: 99%

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Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

et al. 2009

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OBJECTIVE Most symptomatic chronic subdural hematomas are treated by subdural drainage. However, a subperiostal (i.e., extracranial) passive closed-drainage system in combination with double burr hole trepanation is used at our institution. Therefore, we wanted to analyze our results and compare them with the alternate treatment strategies reported in the current literature. METHODS In a retrospective single-center study, we analyzed the data of all patients undergoing double burr hole trepanation with a subperiostal passive closed-drainage system. Data analysis included general patient data, complications, postoperative seizure rate, and outcome. RESULTS One hundred forty-seven patients underwent surgery for 183 symptomatic chronic subdural hematomas. The perioperative mortality rate was 3.4%. Hematoma persistence or recurrence occurred in 13.1% of the cases. The postoperative seizure rate was 6.6%, and the infection rate was 1.6%, including 3 cases of superficial wound infection and 1 case with deep infection. The reintervention rate was 9.3%, including trepanation in 8.2% of the patients and craniotomy in 1.1%. The overall complication rate was 10.9%. CONCLUSION Double burr hole trepanation combined with a subperiostal passive closed-drainage system is a technically easy, highly effective, safe, and cost-efficient treatment strategy for symptomatic chronic subdural hematomas. The absence of a drain in direct contact with the hematoma capsule may moderate the risk of postoperative seizure and limit the secondary spread of infection to intracranial compartments.

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Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

et al. 2009

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“…Recurrence rates after burr hole surgery vary between 8.3% and 26.5%. [4][5][6][7][8][9][10] Numerous factors have been associated with recurrence of CSDH. Despite the common nature of CSDH, we were unable to locate a previous study that compared recurrence rates and outcome of single versus double burr holes in the treatment of CSDH.…”

Section: Introductionmentioning

confidence: 99%

Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases

Kansal¹,

Nadkarni²,

Goel³

2010

Journal of Clinical Neuroscience

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“…3,19,38,40) Multilobular hematoma was also reported as a causative factor of recurrent CSDH. 23) We found that the presence of thin subdural hematoma or effusion in the side contralateral to the first operation carried a high risk of recurrence.…”

Section: Surgical Treatment Of Csdhmentioning

confidence: 99%

Surgical Treatment of Chronic Subdural Hematoma in 500 Consecutive Cases: Clinical Characteristics, Surgical Outcome, Complications, and Recurrence Rate.

Mori

Maëda

2001

Neurol. Med. Chir.(Tokyo)

462

335

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Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice. The diagnosis and treatment are well established, but recurrence, complications, and factors related to these problems, especially in the elderly, are not completely understood. This study evaluated the clinical features, radiological findings, and surgical results in a large series of the patients treated at the same institution. 500 consecutive patients (359 men and 141 women) with CSDH were treated by burr hole craniostomy with closed system drainage from January 1987 through February 1999. Causes, clinical and computed tomographic findings, surgical results, re-expansion of brain after surgery, and hematoma recurrence were statistically analyzed to elucidate the potential risks of CSDH. Most patients (89.4%) had good recovery, 8.4% showed no change, and 2.2% worsened. Six patients (1.2%) died, three due to disseminated intravascular coagulation. Recurrence of hematoma was recognized in 49 patients (9.8%), at 1 to 8 weeks (3.5 ± 1.9 weeks) after the first operation. The brain reexpansion rate at one week after operation was 45.0 ± 21.4% in patients with hematoma recurrence and significantly lower than 55.3 ± 19.1% in patients without recurrence (p º 0.001). Old age, preexisting cerebral infarction, and persistence of subdural air after surgery were significantly correlated with poor brain re-expansion (p º 0.001). Twenty-seven patients (5.4%) suffered postoperative complications, of which 13 cases were acute subdural hematoma caused by incomplete hemostasis of the scalp wound and four cases were tension pneumocephalus. Careful hemostasis and complete replacement of subdural hematoma by normal saline to prevent influx of air into the subdural space will further improve the surgical outcome for patients with CSDH.

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Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage

Cited by 78 publications

References 15 publications

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

Chronic Subdural Hematomas Treated by Burr Hole Trepanation and a Subperiostal Drainage System

Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases

Surgical Treatment of Chronic Subdural Hematoma in 500 Consecutive Cases: Clinical Characteristics, Surgical Outcome, Complications, and Recurrence Rate.

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