The Effect of Irrigation Solutions on Recurrence of Chronic Subdural Hematoma: A Consecutive Cohort Study of 234 Patients

Abstract

Chronic subdural hematomas (CSDHs) occur often in elderly persons and can occur with mild head trauma. With burr-hole irrigation as standard treatment, symptoms usually improve and can be cured, and outcomes are good, but postoperative recurrences are a common problem. This study investigated the effectiveness and recurrence rates when using artificial cerebrospinal fluid (ACF) instead of normal saline (NS) as an irrigation solution for burr-hole irrigation in patients with CSDH. This prospective study included 234 consecutive patients who underwent initial surgical treatment by burr-hole irrigation for a CSDH between April 2008 and June 2015. The irrigation solution used was changed from NS to ACF in June 2011. Factors examined with regard to recurrence included age, sex, unilateral or bilateral surgery, computed tomography (CT) findings, antiplatelet or anticoagulant drug use, past history, and irrigation solution (NS or ACF). These were analyzed by univariate and multivariate analyses. Univariate analyses (chi-square test) with a significance level <5% showed that recurrence rates were significantly lower in the ACF group than in the NS group (P = 0.003). Multivariate analysis (multiple logistic regression analysis) showed that the risk of recurrence was reduced 3.14-fold in the ACF group compared to the NS group (odds ratio, 3.143; 95% confidence interval, 0.1504–0.6733; P = 0.0028). None of the other factors were significantly different. In burr-hole irrigation for CSDH, the use of ACF instead of NS as an irrigation solution significantly reduces recurrence rates.

Randomized controlled study on the curative effects of twist‑drill craniotomy and burr‑hole craniotomy in the treatment of chronic subdural hematoma

“…At present, it remains to be clarified whether the residual hematoma is the unabsorbed hematoma after the first onset and treatment, compensatory product formed due to the difficult re-expansion and failed filling of residual cavity in patients with brain atrophy or new subdural hematoma. Since the recurrence of CSDH was determined based on residual hematoma in the past (11,(24)(25)(26)(27)(28)(29) and monitoring of the changes in residual hematoma varies, the definition of 'recurrence' is not consistent among studies.…”

“…The appearance of a dark red bloody fluid overflow was considered to indicate a successful puncture, and the rapid improvement in symptoms were used for verification. The highest point of drainage tube was maintained 10-15 cm higher than the head puncture point, and the symptoms were improved; the drainage tube was temporarily clipped and then opened after 2 h, and the total drainage time was 48 h. The minimally invasive puncture drainage was successful in 19 patients, and the drainage tube was removed after 48 h without the traditional irrigation according to previous studies (24)(25)(26)(27)(28)(29). Through the routine post-operative review of the head CT, severe complications were excluded and the drainage tube was removed after 48 h.…”

Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma

“…In the present study, we included only those patients aged ≥65 years, so that the presence of frailty could be appropriately evaluated. From July 2011, the surgical procedure for CSDH was uniform: under local anesthesia, a single burr hole was placed at the thickest point of the hematoma, which was aspirated as much as possible; subsequently, the hematoma cavity was irrigated with artificial cerebrospinal fluid; and finally, the burr hole was closed without inserting a drain . Consequently, a postoperative image assessment through computed tomography (CT) scan was carried out 1 day and 1 week after surgery.…”

“…From July 2011, the surgical procedure for CSDH was uniform: under local anesthesia, a single burr hole was placed at the thickest point of the hematoma, which was aspirated as much as possible; subsequently, the hematoma cavity was irrigated with artificial cerebrospinal fluid; and finally, the burr hole was closed without inserting a drain. 7 Consequently, a postoperative image assessment through computed tomography (CT) scan was carried out 1 day and 1 week after surgery. After confirming the absence of apparent recurrence at 1 week after surgery, the patients were discharged and evaluated again 1 month later in the outpatient clinic.…”

Hematoma subdural crónico: Una patología común de manejo complejo

“…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. [69] La temperatura de la solución usada es materia de investigación, bajo la hipótesis de que una solución a temperatura corporal (37°C) ofrecería ventajas sobre la coagulación y solubilidad del hematoma, por lo tanto, menor recurrencia. [7,8,27] La colocación de un drenaje durante la cirugía del HSDC ha demostrado disminuir significativamente la recurrencia en varios estudios prospectivos.…”