scholarly journals Use of drains versus no drains after burr-hole evacuation of chronic subdural hematoma

2015 ◽  
Vol 42 (S1) ◽  
pp. S40-S41
Author(s):  
M Moores ◽  
L Fenerty ◽  
G Thibault-Halman ◽  
N Kureshi ◽  
S Walling ◽  
...  
Keyword(s):  
Chronic Subdural Hematoma ◽  
Retrospective Chart Review ◽  
Current Treatment ◽  
Burr Hole ◽  
Recurrence Rates ◽  
Chi Square ◽  
Exact Test ◽  
Risk Factors For Recurrence ◽  
Subdural Drain ◽  
Burr Hole Evacuation

Background: Chronic subdural hematomas (cSDH) are a common neurosurgical problem with significant morbidity and mortality. Current treatment methods are variable. Post-operative subdural drain used in conjunction with burr-hole craniostomy may reduce recurrence. This study compared recurrence rates for cSDH between two surgical practices with and without use of post-operative subdural drain at the QEII Health Sciences Center. Methods: A retrospective chart review was conducted to compare recurrence rates between surgical patients treated with or without a post-operative drain between 1997- 2012. The primary endpoint was recurrence, defined as occurrence of symptoms due to hematoma confirmed by CT within six months of the original operation. Categorical frequencies were compared with chi square or Fisher’s exact test. Logistic regression was performed to identify risk factors for recurrence. Results: There were 85 patients (mean age 73 years; SD 13.0) who had burr-hole craniostomy. Age, cSDH volume, site, GCS, anticoagulation, drain, conservative treatment with steroids and perioperative steroids were not found to be independent predictors of recurrence. Recurrence occurred in 2 of 34 (5.9%) patients with drain, and in 7 of 51 (13.7%) without (p=0.305). There were insufficient data to compare mortality and complications. Conclusions: Use of post-operative subdural drain did not significantly alter the cSDH recurrence rate.

scholarly journals A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma

2018 ◽  
Vol 5 (6) ◽  
pp. 2301
Author(s):  
Dhanapal Pattanam Velappan ◽  
Ponnaiyan Natesan Palaniappan ◽  
Anbarasi Pandian
Keyword(s):  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Randomized Study ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Prospective Randomized Study ◽  
Recurrence Rates ◽  
Eligibility Criteria ◽  
Subdural Drain ◽  
Burr Hole Evacuation

Background: The incidence of chronic subdural hematoma is 1-2 per 100000 per year in the general population.  Inserting subdural drain might reduce the recurrence rate but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains.Methods: A prospective randomized study to investigate the effect of subdural drains in the on-recurrence rates and clinical outcome following burr-hole drainage of chronic subdural hematoma was undertaken. During the study period, 100 patients with CSDH were assessed for eligibility. Among 100 patients fulfilling the eligibility criteria, 52 were assigned to drain inserted into the subdural space following burr hole drainage and 48 were assigned subdural drain was not inserted following burr hole drainage. The primary end point was recurrence needing re-drainage and to prevent post-operative pneumocephalus up to a period of 6 months from surgery.Results: Recurrence occurred in 1 of 100 patients with a drain, and 9 of 100 patients in without drain group the medical and surgical complications were comparable between the two study groups.Conclusions: Use of a subdural drain after burr-hole evacuation of a chronic subdural hematoma reduces the recurrence rate and is not associated with increased complications.

scholarly journals Does Drain Position and Duration Influence Outcomes in Patients Undergoing Burr-Hole Evacuation of Chronic Subdural Hematoma? Lessons from a UK Multicenter Prospective Cohort Study

Neurosurgery ◽  
2018 ◽  
Vol 85 (4) ◽  
pp. 486-493 ◽  
Author(s):  
Laurence Johann Glancz ◽  
Michael Tin Chung Poon ◽  
Ian Craig Coulter ◽  
Peter John Hutchinson ◽  
Angelos Georgiou Kolias ◽  
...  
Keyword(s):  
Cohort Study ◽  
Recurrence Rate ◽  
Prospective Cohort ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Recurrence Rates ◽  
Drain Group ◽  
Subdural Drain ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Abstract Background Drain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes. Objective To examine whether this is influenced by variation in drain location, positioning or duration of placement. Methods We performed a subgroup analysis of a previously reported multicenter, prospective cohort study of CSDH patients performed between May 2013 and January 2014. Data were analyzed relating drain location (subdural or subgaleal), position (through a frontal or parietal burr hole), and duration of insertion, to outcomes in patients aged >16 yr undergoing burr-hole drainage of primary CSDH. Primary outcomes comprised modified Rankin scale (mRS) at discharge and symptomatic recurrence requiring redrainage within 60 d. Results A total of 577 patients were analyzed. The recurrence rate of 6.7% (12/160) in the frontal subdural drain group was comparable to 8.8% (30/343) in the parietal subdural drain group. Only 44/577 (7.6%) patients underwent subgaleal drain insertion. Recurrence rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups (P = .95). We found no significant differences in discharge mRS between these groups. Recurrence rates were comparable between patients with postoperative drainage for 1 or 2 d, 6.4% and 8.4%, respectively (P = .44). There was no significant difference in mRS scores between these 2 groups (P = .56). CONCLUSION Drain insertion after CSDH drainage is important, but position (subgaleal or subdural) and duration did not appear to influence recurrence rate or clinical outcomes. Similarly, drain location did not influence recurrence rate nor outcomes where both parietal and frontal burr holes were made. Further prospective cohort studies or randomized controlled trials could provide further clarification.

Subperiosteal vs Subdural Drain After Burr-Hole Drainage of Chronic Subdural Hematoma: A Randomized Clinical Trial (cSDH-Drain-Trial)

Neurosurgery ◽  
2019 ◽  
Vol 85 (5) ◽  
pp. E825-E834 ◽  
Author(s):  
Jehuda Soleman ◽  
Katharina Lutz ◽  
Sabine Schaedelin ◽  
Maria Kamenova ◽  
Raphael Guzman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Final Analysis ◽  
Mortality Rates ◽  
Burr Hole ◽  
Recurrence Rates ◽  
Surgical Infections ◽  
Subdural Drain

Abstract BACKGROUND The use of a subdural drain (SDD) after burr-hole drainage of chronic subdural hematoma (cSDH) reduces recurrence at 6 mo. Subperiosteal drains (SPDs) are considered safer, since they are not positioned in direct contact to cortical structures, bridging veins, or hematoma membranes. OBJECTIVE To investigate whether the recurrence rate after insertion of a SPD is noninferior to the insertion of a more commonly used SDD. METHODS Multicenter, prospective, randomized, controlled, noninferiority trial analyzing patients undergoing burr-hole drainage for cSDH aged 18 yr and older. After hematoma evacuation, patients were randomly assigned to receive either a SDD (SDD-group) or a SPD (SPD-group). The primary endpoint was recurrence indicating a reoperation within 12 mo, with a noninferiority margin of 3.5%. Secondary outcomes included clinical and radiological outcome, morbidity and mortality rates, and length of stay. RESULTS Of 220 randomized patients, all were included in the final analysis (120 SPD and 100 SDD). Recurrence rate was lower in the SPD group (8.33%, 95% confidence interval [CI] 4.28-14.72) than in the SDD group (12.00%, 95% CI 6.66-19.73), with the treatment difference (3.67%, 95% CI -12.6-5.3) not meeting predefined noninferiority criteria. The SPD group showed significantly lower rates of surgical infections (P = .0406) and iatrogenic morbidity through drain placement (P = .0184). Length of stay and mortality rates were comparable in both groups. CONCLUSION Although the noninferiority criteria were not met, SPD insertion led to lower recurrence rates, fewer surgical infections, and lower drain misplacement rates. These findings suggest that SPD may be warranted in routine clinical practice

scholarly journals Comparison of Frequency of Recurrence after Burr Hole Evacuation of Chronic Subdural Hematoma with or without Subdural Drain.

2020 ◽  
Vol 24 (1) ◽  
pp. 33-38
Author(s):  
TALHA ABBAS ◽  
MUHAMMAD ABD-UR-REHMAN ◽  
NABEEL CHOUDHARY ◽  
TAIMOOR ANWAR ◽  
ANJUM WAHAB ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
P Value ◽  
First Line ◽  
Significant Difference ◽  
Group A ◽  
Subdural Drain ◽  
Burr Hole Evacuation ◽  
Group B

Chronic subdural hematoma (CSDH) is known to have a significant recurrence rate. The rate of recurrence of chronic subdural hematoma after surgery ranges from roughly 5% to 30%.  Burr hole evacuation without drainage is performed as a first line of treatment for CSDH. As there is controversy in literature regarding the use of drainage after burr hole evacuation, the results of my study may be helpful for selecting a proper treatment modality as a first line of treatment for CSDH in terms of recurrence. The objective of this study was to compare the frequency of recurrence after burr hole evacuation of CSDH with and without subdural drain. It was a randomized controlled trial conducted in Department of Neurosurgery, Allied hospital, Faisalabad form Aug 2016 to Aug 2018 RESULTS:In our study, out of 130 cases(65 in each group). 84.62%(n=55) in Group-A and 76.92%(n=50) in Group-B were between above 40 years of age whereas 15.38%(n=10) in Group-A and 23.08%(n=15) were between 18-40 years of age, mean+sd was calculated as  64.03+7.61 years in Group-A and 62.28+7.83 years in Group-B, 78.46%(n=51) in Group-A and 72.31%(n=47) in Group-B were male while 21.54%(n=14) in Group-A and 27.69%(n=18) in Group-B were females, comparison of frequency of recurrence after burr hole evacuation of CSDH with and without subdural drain shows 10.77%(n=7) in Group-A and 27.69%(n=18) in Group-B, p value was 0.01 showing a significant difference. CONCLUSION: We concluded that the frequency of recurrence after burrhole evacuation of CSDH is significantly lower with drain when compared without subdural drain.

Chronic Subdural Hematomas: To Drain or Not to Drain?

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 185-188 ◽  
Author(s):  
Thomas Marc Markwalder ◽  
Rolf W. Seiler
Keyword(s):  
Clinical Improvement ◽  
Closed System ◽  
Subdural Hematoma ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Postoperative Phase ◽  
Consecutive Series ◽  
Neurological Improvement ◽  
Burr Hole Evacuation

Abstract A consecutive series of 21 adult patients with chronic subdural hematoma was studied in respect to postoperative resolution of subdural collections and clinical improvement after burr hole evacuation without subdural drainage. This series was compared to a previously studied series of patients with chronic subdural hematoma in whom postoperative closed system drainage had been installed. Using the identical protocol for treatment and postoperative follow-up, we obtained identical results with respect to time-related neurological improvement and persistence of subdural collections in the undrained and drained series, except that the steadily progressive clinical improvement during the early postoperative phase (24 hours) in all cases of the drained series was not universal in the undrained cases. Our study suggests that, to avoid the possibility of early postoperative clinical deterioration, burr hole craniostomy and closed system drainage is advisable. We think that subdural drainage is not necessary when the installation of the drainage system seems to be technically difficult, as it may be in cases with considerable perioperative cortical expansion.

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