Irrigation vs. closed drainage in the treatment of chronic subdural hematoma (original) (raw)
Related papers
Comparison of the Burr Hole Craniostomy Techniques for the Treatment of Chronic Subdural Hematoma
Medical Science and Discovery
Objective: To compare three different surgical techniques for chronic subdural hematoma (CSDH), one of the most common neurosurgical diseases increasingly affecting the elderly, and for which there is no standard treatment currently. Material and Methods: We included 28 patients diagnosed with CSDH and retrospectively analysed their data. The surgical techniques were compared to subgroups of the burr-hole craniostomy technique. Results: The mean age of included patients was 72.71 ± 10.81 years, and the male/female ratio was 2/5. Preoperative subdural hematoma volume was 113.63 ± 40.74 cc, and the Hounsfield unit value was 33.66 ± 8.67 HU. The mean operative time was 60.89 ± 20.04 min, and the mean hospital stay was 6.17 ± 2.56 days. Detectable radiologic complete recovery was 42.69 ± 17.46 days. Conclusion: All surgery subgroups experienced successful outcomes during long-term follow-up. The irrigation technique demonstrated no superiority to the other two techniques and the complic...
Objective: Comparison of evacuation of hematoma through burr hole irrigation (BHI) and closed system drainage (CSD) after burr hole irrigation in the treatment of chronic subdural hematoma (CSDH) in terms of relapse. Materials and Methods: 32 patients who were operated with CSDH diagnosis between 2001 and 2008 were retrospectively evaluated with respect to clinical features, etiologic factors, surgical technique and recurrence. Of the 5 recurrent cases in BHI group, 2 (20%) received tap and 3 received excision of hematoma via craniotomy. No pathology requiring additional surgery was detected in the follow-up of the patients who underwent BHI-CSD. Conclusion: Closed system drainage through burr hole irrigation in CSDH cases is a simple and reliable method which reduces the risk for recurrence and reoperation and enables evacuation of anticoagulants such as plasminogen and thrombomodulin, products of impaired coagulation-anticoagulation balance.
One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma
Journal of Korean Neurosurgical Society, 2009
Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH. From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical...
IOSR Journals , 2019
Objective: One or two burr-hole craniotomies with subgaleal or subdural drainage system and irrigation are the most common methods for surgical treatment of chronic subdural hematoma. The aim of this study is to compare the advantages or disadvantages of these techniques used for chronic subdural hematoma. Material and methods: 50 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, two burr-hole craniostomies with subgaleal drain and irrigation , Group II, one burr-hole craniostomy with subdural closed drainage system without irrigation. We compared both the groups for post-operative clinical and surgical outcome. Results: In our study there were significantly less number of revision surgery and pneumocepahlous in subdural under water drain as compare to subgaleal drain. Most common presenting symptom was headache and vomiting followed by altered sensorium. Conclusion: Both of the techniques have a higher cure rate. However, subdural under water drainage system is relatively safe, and technically easy. So it is applicable for aged and higher risk patients.
JSMC, 2020
Background Chronic subdural hematoma is a common neurosurgical condition. Its prevalence is increasing worldwide due to the increasingly aged population. Craniotomy, twist-drill craniostomy, and burr-hole drainage and drain with or without irrigation are among the very first lines of its management. Objectives We used burr-hole drainage with drain versus burr-hole drainage with drain and irrigation to find out which method is better regarding the outcome of chronic subdural hematoma treatment. Patients and Methods a case-control study design was used to inspect retrospectively both techniques in 47 patients. Twenty-one patients were treated with burr-hole drainage with drain only, and 26 were treated with burr-hole drainage with drain and irrigation. Results We found no statistically different association between the two types of operations and their outcomes (P value= 0.083 and Pearson's R Correlation= 0.029). Conclusion As long as there is no differences between the two techniques, irrigation is not necessary after burr-hole drainage of chronic subdural hematoma. It requires more time, more exposure of the patient to anesthetic agents, and increases the risk of both infection and pneumocephalus.
The Malaysian journal of medical sciences : MJMS, 2017
Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate. The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 Janua...
Arquivos de neuro-psiquiatria, 2017
Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.
Acta Neurochirurgica, 2005
Background. The study was conducted to determine the causative factors in the postoperative recurrence (PR) of chronic subdural haematomas (CSDHs) and to evaluate the efficacy of surgery in adults enrolled in this trial. Methods. 99 patients with 121 CSDHs, who were operated on between January 1999 and December 2001, were studied. We evaluated the PR rate related to anamnestic, clinical, surgical and neuroradiological imaging variables. In addition, we reviewed the number and the type of repeated operations, complications of surgery and the outcomes at one, three and 12 months. Findings. 82.6% of lesions were successfully treated following the initial evacuation, and 95.9% of lesions following a second procedure. The PR rate was 14.9%. A significantly high PR rate was found to be associated with separated type, frontal base type, a midline displacement >5 mm and the presence of acute subdural clots in cranial base type on CT scans obtained within four days postsurgery. The interval from head trauma to initial surgery <60 days, the maximum width of subdural space >10 mm and massive collection of air in the subdural space tended to give a high PR rate. The PR rate associated with the homogeneous type of CSDHs was significantly low. Age, sex, cause of CSDH, anticoagulant therapy, preoperative neurological presentation, concomitant disease, variables on preoperative CT scans, and surgical factors such as the extent of the surgical procedure, use of drainage, duration and volume of drainage were not significantly associated with PR rate. Conclusions. It is important to identify factors leading to a high or a low PR rate in the treatment of CSDHs because this may help to select appropriate surgical procedures and postoperative management to treat this condition efficiently.
Eastern Green Neurosurgery
Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline...
Outcome of Double burr-hole Craniotomy in patients with Chronic Subdural Haematoma
Sudan Journal of Medical Sciences, 2008
Background: Chronic subdural haematoma (CSDH) is a common condition in late stages of life. Most of the patients are subjected to minor trivial trauma which will end up with a collection of altered blood in the subdural space. This necessitates immediate surgical drainage, with the aim to reduce the mass effect on the brain to alleviate the symptoms and to reverse the condition. Objective: To report the experience and outcome of double burr-holes craniotomy in treatment of chronic subdudal haematoma. Patents and Methods: This study was conducted on 70 patients with CSDHs managed at Omdurman Teaching Hospital Sudan, during the period from November 2004 to November2006.. All patients after clinical assessment and CT scan of the brain proved to have CSDH. The haematoma was removed surgically by double burr-holes craniotomy, irrigation and close system drainage. Results: The study included 70 patients, 50 males and 20 females. The mean age was 69 years. Computed tomography scan, showed unilateral collection in 60% of patients and bilateral in 40%, only 1.8% showed conning of the brain. Unilateral double burr-hole craniotomy was performed in 60% of the patients, while bilateral was done in 35.7%. In the postoperative follow up 87.1% of the patients showed uneventful recovery. Seven patients developed complications in the form of pneumocephallus or postoperative recurrence. The mortality rate was 2.9%. Conclusion: burr holes craniotomy, irrigation and close system drainage, is effective and favor rapid regression of residual subdural collection and associated with fewer recurrences.