Subperiosteal versus Subdural Drain After Burr Hole Drainage for Chronic Subdural Hematomas: A Systematic Review and Meta-Analysis

Ding, Huaqiang; Liu, Shengjie; Quan, Xingyun; Liao, Shuai; Liu, Liang

doi:10.1016/j.wneu.2019.12.180

Cited by 25 publications

(24 citation statements)

References 24 publications

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“…A recent meta-analysis showed a significantly lower recurrence rate for SPD compared with SDD. [19][20][21][22] Based on our subgroup analysis, lower recurrence rates were also noted for patients treated with SPD who were ≥ 80 years old, without statistically significant differences. It seems, therefore, that SPD insertion in the geriatric population is comparable to SDD insertion, while the risk of drain misplacement can be avoided.…”

Section: Discussionmentioning

confidence: 56%

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Greuter¹,

Lutz

Fandiño

et al. 2020

Neurosurgical Focus

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OBJECTIVEChronic subdural hematoma (cSDH) occurs more frequently in elderly patients, while older patient age is associated with worse postoperative outcome following burr-hole drainage (BHD) of cSDH. The cSDH-Drain trial showed comparable recurrence rates after BHD and placement of either a subperiosteal drain (SPD) or subdural drain (SDD). Additionally, an SPD showed a significantly lower rate of infections as well as iatrogenic parenchymal injuries through drain misplacement. This post hoc analysis aims to compare recurrence rates and clinical outcomes following BHD of cSDH and the placement of SPDs or SDDs in elderly patients.METHODSThe study included 104 patients (47.3%) 80 years of age and older from the 220 patients recruited in the preceding cSDH-Drain trial. SPDs and SDDs were compared with regard to recurrence rate, morbidity, mortality, and clinical outcome. A post hoc analysis using logistic regression, comparing the outcome measurements for patients < 80 and ≥ 80 years old in a univariate analysis and stratified for drain type, was further completed.RESULTSPatients ≥ 80 years of age treated with an SDD showed higher recurrence rates (12.8%) compared with those treated with an SPD (8.2%), without a significant difference (p = 0.46). Significantly higher drain misplacement rates were observed for patients older than 80 years and treated with an SDD compared with an SPD (0% vs 20%, p = 0.01). Comparing patients older than 80 years to younger patients, significantly higher overall mortality (15.4% vs 5.2%, p = 0.012), 30-day mortality (3.8% vs 0%, p = 0.033), and surgical mortality (2.9% vs 1.7%, p = 0.034) rates were observed. Clinical outcome at the 12-month follow-up was significantly worse for patients ≥ 80 years old, and logistic regression showed a significant association of age with outcome, while drain type had no association with outcome.CONCLUSIONSThe initial findings of the cSDH-Drain trial and the findings of this subanalysis suggest that SPD may be warranted in elderly patients. As opposed to drain type, patient age (> 80 years) was significantly associated with worse outcome, as well as higher morbidity and mortality rates.

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Section: Discussionmentioning

confidence: 56%

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Greuter¹,

Lutz

Fandiño

et al. 2020

Neurosurgical Focus

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“…Similarly, the study by Häni and colleagues was not considered by us as an RCT, since it was not primarily designed to compare the recurrence rate after insertion of SPD or SDD, but rather a post-hoc analysis of their RCT initially designed to assess the need for follow up CT after evacuation of cSDH (8). In addition, as opposed to Pranata et al, Xie et al, and Ding et al (23)(24)(25), we combined the two different subdural drain types described by Sjavik et al into one SDD group (13) and we included the "as treated" rather than the "intention to treat" results from the study by Häni et al (8) in our analysis. Ding et al was the only study to report subgroup analysis in their analysis (25).…”

Section: Referencesmentioning

confidence: 99%

“…In addition, as opposed to Pranata et al, Xie et al, and Ding et al (23)(24)(25), we combined the two different subdural drain types described by Sjavik et al into one SDD group (13) and we included the "as treated" rather than the "intention to treat" results from the study by Häni et al (8) in our analysis. Ding et al was the only study to report subgroup analysis in their analysis (25). Due these reasons, some of our results differed from the previous reports published.…”

Section: Referencesmentioning

confidence: 99%

Type of Drain in Chronic Subdural Hematoma—A Systematic Review and Meta-Analysis

2020

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Background: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases, while burr-hole drainage is the most frequently used surgical treatment. Strong evidence exists that subdural drain (SDD) placement reduces recurrence rates. However, the insertion of a subperiosteal drain (SPD) was shown to lead to similar recurrence rates and less complications than SDD. The aim of this study is to provide a systematic review of the literature and conduct a meta-analysis of studies comparing SPD with SDD after burr-hole drainage of cSDH.Methods: Pubmed and Embase databases were searched using a systematic search strategy to identify studies on drain location up to December 2019. Two independent researchers assessed the studies for inclusion and quality. Primary outcome measure was recurrence, while secondary outcome measures were drain misplacement, morbidity, mortality, and clinical outcome. Besides randomized controlled trials (RCT), we included non-randomized prospective cohort studies, as well as retrospective cohort studies. A fixed effects model was used if low heterogeneity (I 2 < 50%) was present, otherwise a random effects model was used.Results: Following removal of duplicates, we screened 1109 articles of which 10 articles were included in our qualitative and quantitative analyses. One study was an RCT, three were non-randomized prospective cohort studies, and the remaining articles were retrospective cohort studies or subgroup analysis. In these 10 articles, 1,553 patients were treated with SPD and 1782 patients with SDD. Comparing the recurrence rate of cSDH a significant difference was found between SPD and SDD insertion (11.9 and 12.3%; RR 0.8, 95% CI 0.67-0.97, I 2 = 0%, z = −2.27, p = 0.02). SPD had significantly lower rates of drain misplacement and parenchymal injuries (1.2 and 7.8%; RR 0.17, 95% CI 0.07-0.42, I 2 = 0%, z = −3.4, p = 0.0001), as well as morbidity (6.4 and 8.2%; RR 0.65, 95% CI 0.5-0.84, I 2 = 44.5%, z = −3.32, p =0.0009). Mortality rates (5.0 and 4.6%; RR 0.83, 95% CI 0.6-1.14, I 2 = 0%, z = −1.2, p = 0.25) and favorable clinical outcome (89.6 and 88.9%; RR 1.1, 95% CI 0.89-1.24, I 2 = 54.2%, t = 0.98, p = 0.40) were comparable in both groups.Greuter et al. Meta-Analysis Drain Location CSDH Conclusion:The insertion of SPD after burr-hole drainage of cSDH showed lower rates of recurrence, drain misplacements and parenchymal injuries, as well as overall morbidity, while clinical outcome and mortality were comparable to SDD. Therefore, the insertion of SPD after surgical drainage of cSDH should be encouraged.

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“…[71,168] Por ese motivo, algunos estudios han propuesto la colocación de drenajes subperiósticos. [24,119,168] En cuanto a su efectividad y seguridad, no se ha encontrado diferencia significativa, pero sí una tendencia hacia la superioridad del drenaje subperióstico. [24] En cuanto al número de drenes subdurales, la evidencia es poca, contradictoria y no parece justificar el uso de más de un drenaje, sobre todo cuando hay una adecuada re expansión del cerebro.…”

Section: Controversias De La Cirugíaunclassified

“…[24,119,168] En cuanto a su efectividad y seguridad, no se ha encontrado diferencia significativa, pero sí una tendencia hacia la superioridad del drenaje subperióstico. [24] En cuanto al número de drenes subdurales, la evidencia es poca, contradictoria y no parece justificar el uso de más de un drenaje, sobre todo cuando hay una adecuada re expansión del cerebro. [36,150] Existen estudios con resultados discrepantes respecto al número de burr hole a realizar, pero al momento no hay evidencia contundente a favor del uso de 2 burr hole comparado a la realización de uno.…”

Section: Controversias De La Cirugíaunclassified

Hematoma subdural crónico: Una patología común de manejo complejo

Toledo

2021

Surgical Neurology International

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Antecedentes: El hematoma subdural crónico (HSDC) es una patología ampliamente estudiada, muy frecuente, sobre todo en adultos mayores; su cuadro clínico tiene una apariencia benigna y suele ir acompañado de múltiples comorbilidades asociadas a la edad, lo que resulta en un aumento de las complicaciones e incluso la muerte. Con el incremento de la expectativa de vida a nivel mundial, el uso de medicamentos antitrombóticos es cada vez más frecuente. El papel de estos fármacos en la evolución de la enfermedad como en la recurrencia, sigue siendo motivo de discusión. Métodos: Los autores revisaron la fisiopatología y características clínicas del HSDC. El presente artículo discute acerca de las terapéuticas actuales y las nuevas opciones de tratamiento que podrían mejorar los resultados. Este manuscrito es susceptible de cambios en el tiempo, con el desarrollo científico y tecnológico. Resultados: El HSDC puede ser abordado por vía quirúrgica y farmacológica; no obstante, un manejo individualizado requiere la consideracion cuidadosa de diversos factores. A pesar de los avances en el campo de la neurocirugía, la clásica trepanación craneal sigue siendo el Gold estándar en el HSDC y sobre todo en pacientes con síntomas graves. Se debe resaltar que aún hay aspectos de este procedimiento (como la localización del dren, número de drenajes, el efecto de la irrigación, la temperatura de la solución con que se irriga, etc.) que siguen siendo materia de estudio. Conclusiones: Entender el mecanismo de la enfermedad ha permitido explicar su historia natural y a su vez proponer nuevas alternativas de tratamiento. El manejo médico (atorvastatina, corticoides) ha generado gran interés por sus alentadores resultados preliminares. Recientemente, se ha reportado la terapia endovascular como una alternativa segura y existe gran expectativa por confirmar su efecto en estudios más grandes.

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Subperiosteal versus Subdural Drain After Burr Hole Drainage for Chronic Subdural Hematomas: A Systematic Review and Meta-Analysis

Cited by 25 publications

References 24 publications

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Type of Drain in Chronic Subdural Hematoma—A Systematic Review and Meta-Analysis

Hematoma subdural crónico: Una patología común de manejo complejo

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