scholarly journals One Versus Double Burr Holes for Treating Chronic Subdural Hematoma Meta-Analysis

2013 ◽  
Vol 40 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Sirajeddin Belkhair ◽  
Gwynedd Pickett
Keyword(s):  
Subdural Hematoma ◽  
Odds Ratio ◽  
Revision Rate ◽  
Meta Analysis ◽  
Random Effect ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Significant Difference ◽  
Retrospective Cohort Studies ◽  
Burr Holes

Abstract:Objective and Design:There is controversy among neurosurgeons regarding whether double burr hole craniostomy (DBHC) is better than single burr hole craniostomy (SBHC) in the treatment of chronic subdural hematoma (CSH), in terms of having a lower revision rate. In order to compare the revision rates after SBHC versus DBHC, we performed a meta-analysis of the available studies in the literature.Materials and Methods:Multiple electronic health databases were searched to identify all the studies published between 1966 and December 2010 that compared SBHC and DBHC. Data were processed in Review Manager 5.0.18. Effect sizes were expressed in pooled odds ratio (OR) estimates, and due to heterogeneity between studies we used random effect of the inverse variance weighted method to perform the meta-analysis.Results:Five observational retrospective cohort studies were identified: four published studies and one unpublished, describing the outcomes of 355 DBHC and 358 SBHC to evacuate 713 CSH in 631 patients. Meta-analysis showed that there was no significant difference in the revision rates between double burr hole craniostomy and single burr hole craniostomy when performed to evacuate CSH. Pooled odds ratio for all the studies was 0.62 (95% confidence interval 0.26 - 1.46).Conclusions:The results of this meta-analysis suggest that SBHC is as good as DBHC in evacuating chronic subdural hematoma and is not associated with a higher revision rate compared to DBHC.

scholarly journals Hematoma Recurrence in Burr Hole Drainage Compared to Burr Hole Irrigation as Treatment of Chronic Subdural Hematoma: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (F) ◽  
pp. 97-102
Author(s):  
Sri Maliawan ◽  
Made Bhuwana Putra ◽  
Tjokorda GB Mahadewa ◽  
I Putu Eka Widyadharma
Keyword(s):  
Systematic Review ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Chronic Subdural Hematoma ◽  
Open Access Journal ◽  
Burr Hole ◽  
Recurrence Rates ◽  
Saline Irrigation

BACKGROUND: Subdural hematoma is a common phenomenon following a traumatic brain injury where a hematoma is formed below the dura mater of brain meningeal layer, usually with a coup-contrecoup mechanism of injury. The chronic counterpart of subdural hematoma is frequently occurring in elderly patients. There are several techniques being used by many practitioners, including burr hole with or without irrigation, with little evidence of which technique is favorable, especially in terms of recurrence rates following the procedure. AIM: This study aimed to compare the recurrences of chronic subdural hematoma (CSDH) following burr hole with and without saline irrigation technique by systematic review and meta-analysis. METHODS: This study included all articles that describe the two specified burr hole techniques in treating patients with a CSDH. We extracted the eligibility criteria into keywords using Boolean Operator. In this study, we used keywords (CSDH) and (burr hole) and (irrigation) and ((drainage) or no irrigation)) in PubMed, directory of open access journal, and Google Scholar database. RESULTS: This study included seven retrospective cohort studies from 2002 to 2017 with a total of 635 samples. The incidence of hematoma recurrences between burr hole irrigation and burr hole drainage was 14.7% and 12.0%, respectively. Based on random effect model with high heterogeneity (I2 = 60%; X2 = 14.92; p = 0.02), pooled risk ratio between burr hole irrigation and burr hole drainage on hematoma recurrences was 1.05 (p = 0.92; 95% confidence interval, 0.43–2.54). CONCLUSION: There was no superiority between one procedure toward other in preventing recurrences of chronic subdural hematoma.

scholarly journals Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients

2020 ◽  
Vol 17 (02) ◽  
pp. 110-120
Author(s):  
Ramesh Chandra Vemula ◽  
B. C.M. Prasad ◽  
Venkat Koyalmantham ◽  
Kunal Kumar
Keyword(s):  
Ct Scan ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
P Value ◽  
First Choice ◽  
Significant Difference ◽  
Preoperative Ct

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.

scholarly journals Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

2020 ◽  
Vol 2 (1) ◽  
pp. 30-34
Author(s):  
Suresh Sapkota ◽  
Kiran Niraula ◽  
Subash Lohani ◽  
Shikher Shrestha ◽  
Bibhusan Shrestha ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Subdural Hematoma ◽  
Surgical Outcome ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Midline Shift ◽  
External Drainage ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Significant Difference

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 shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

scholarly journals International practice variation in postoperative imaging of chronic subdural hematoma patients

2019 ◽  
Vol 131 (6) ◽  
pp. 1912-1919 ◽  
Author(s):  
Alexander F. C. Hulsbergen ◽  
Sandra C. Yan ◽  
Brittany M. Stopa ◽  
Aislyn DiRisio ◽  
Joeky T. Senders ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Subdural Hematoma ◽  
Medical Center ◽  
Chronic Subdural Hematoma ◽  
Ct Scanning ◽  
Burr Hole ◽  
Ct Scans ◽  
Neurological Condition ◽  
Asymptomatic Patients ◽  
Significant Difference

OBJECTIVEThe value of CT scanning after burr hole surgery in chronic subdural hematoma (CSDH) patients is unclear, and practice differs between countries. At the Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, neurosurgeons frequently order routine postoperative CT scans, while the University Medical Center Utrecht (UMCU) in the Netherlands does not have this policy. The aim of this study was to compare the use of postoperative CT scans in CSDH patients between these hospitals and to evaluate whether there are differences in clinical outcomes.METHODSThe authors collected data from both centers for 391 age- and sex-matched CSDH patients treated with burr hole surgery between January 1, 2002, and July 1, 2016, and compared the number of postoperative scans up to 6 weeks after surgery, the need for re-intervention, and postoperative neurological condition.RESULTSBWH patients were postoperatively scanned a median of 4 times (interquartile range [IQR] 2–5), whereas UMCU patients underwent a median of 0 scans (IQR 0–1, p < 0.001). There was no significant difference in the number of re-operations (20 in the BWH vs 27 in the UMCU, p = 0.34). All re-interventions were preceded by clinical decline and no recurrences were detected on scans performed on asymptomatic patients. Patients’ neurological condition was not worse in the UMCU than in the BWH (p = 0.43).CONCLUSIONSWhile BWH patients underwent more scans than UMCU patients, there were no differences in clinical outcomes. The results of this study suggest that there is little benefit to routine scanning in asymptomatic patients who have undergone surgical treatment of uncomplicated CSDH and highlight opportunities to make practice more efficient.

scholarly journals Functional Outcome & Revision Rate Of Pfna Vs Dhs For Osteoporotic Intertrochanteric Femur Fracture: A Meta Analysis

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0003
Author(s):  
Sherly Desnita Savio ◽  
I Made Arya Susila ◽  
Cokorda Gde Oka Dharmayuda
Keyword(s):  
Functional Outcome ◽  
Femur Fracture ◽  
Revision Rate ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Harris Hip Score ◽  
Significant Difference ◽  
The Mean ◽  
Intertrochanteric Femur Fracture

Objectives: Intertrochanteric femur fracture in elderly presents a challenge as the source of morbidity and mortality if not well-treated. This study investigates the functional outcome and revision rate of two of the most common treatments of choice for this condition, Proximal Femoral Nail Antirotation (PFNA) and Dynamic Hip Screw (DHS), while furthermore investigate the secondary functional outcome of the two procedures if proceeded to Conversion to Total Hip Arthroplasty (CTHA). Methods: A systematic search was conducted to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 9 studies (2.251 patients) were included, divided into 3 meta-analysis. Random effect model was used for continuous outcomes using Review Manager. Results: For primary Harris Hip Score (HHS), the mean HHS at 12-months follow-up for PFNA (n = 184) was 77.77, as for DHS (n = 187) was 78.33, indicating no significant difference (P = 0.73). The mean revision rates for PFNA (n=784) was 2.68%, as for DHS (n=766) was 2.48%, indicating no significant difference (P = 0.61). For secondary HHS after CTHA, the mean HHS 12-months postoperatively for PFNA (n =142) was 83.97, as for DHS (n = 190) was 83.65, indicating no significant difference (P = 0.59). Discussion: PFNA and DHS can both be considered in osteoporotic intertrochanter femur fracture, as the two procedures offer similar 1-year functional outcome and revision rate. However, PFNA may benefit with less blood loss and operation time. Some potential revision causes, such as peri-implant femoral fracture, infection, and implant failure should always be monitored perioperatively. Furthermore, when CTHA is indicated for revision, the two procedures offer comparable secondary functional outcome. Conclusion: Current meta-analysis suggests that PFNA and DHS both have comparable primary functional outcome, revision rate, and post-CTHA secondary functional outcome.

Single Versus Double Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma: A Meta-Analysis

2019 ◽  
Vol 131 ◽  
pp. e149-e154 ◽  
Author(s):  
Yingfeng Wan ◽  
Dajiang Xie ◽  
Zhaoliang Xue ◽  
Jixi Xie ◽  
Zhengfei Song ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Single Versus

scholarly journals Single versus Double Burr Holes for Treating Chronic Subdural Hematoma

2020 ◽  
Vol 9 (2) ◽  
pp. 99-104
Author(s):  
Uzzal Kumer Sadhu Khan ◽  
Asit Chandra Sarker ◽  
Md Mahamudul Haq Morshed ◽  
Md Motasimul Hasan ◽  
Saiful Hoque ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Cerebral Atrophy ◽  
The Elderly ◽  
Burr Hole ◽  
Group A ◽  
Group B ◽  
Burr Holes ◽  
Better Than

A subdural hematoma is a collection of blood below the inner layer of the dura but external to the bran and arachnoid membrane.Chronic subdural hematoma is commonly associated with cerebral atrophy, occur in the elderly after apparently insignificant head trauma. The incidence of Chronic subdural hematoma increases with age and after 70 years of age. Surgical evacuation of hematoma is indicated in patients who are clinically deteriorate or do not improve. Surgery can bring a rapid clinical improvement with a favorable outcome in over 80% of patient. Methods: This study was a prospective intervention study. Results: It was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B in GOS scoring on the 7th POD. The alive patients were again divided into 4 sub groups, as shown in the table. Among total 60 patients, in Group A 1(3.4%) died and 3 (10.0%) died in Group B. After 3 months follow up, it was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B. The alive patients were again divided into 4 sub groups, as shown in the table. Persistent vegetative and severe disability was not improved in Group B. Conclusion: In my study it was observed that the surgical outcome in single burr hole craniotomy is better than double burr hole craniotomy for treating of chronic subdural hematoma. Bang. J Neurosurgery 2020; 9(2): 99-104

scholarly journals Burr hole craniostomy versus minicraniotomy in chronic subdural hematoma: a comparative cohort study

2021 ◽  
Author(s):  
Shaian Zolfaghari ◽  
Jiri Bartek ◽  
Isabelle Strom ◽  
Felix Djärf ◽  
San-San Wong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Surgical Techniques ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Medical Complications ◽  
Recurrence Rates ◽  
Significant Difference ◽  
Comparative Cohort Study

Abstract Background Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. In surgical management of CSDH, there is a lack of standardized guidelines concerning surgical techniques and a lack of consensus on which technique(s) are optimal. Neurosurgical centers have shown a wide variation in surgical techniques. The purpose of this study was to compare two different surgical techniques, one burr hole craniostomy with an active subgaleal drain (BHC) and minicraniotomy with a passive subdural drain (MC). Methods We conducted a multicenter retrospective cohort study at two neurosurgical centers in Sweden which included patients with unilateral CSDHs that received surgical treatment with either BHC or MC. The primary outcomes in comparison of the techniques were 30-day mortality, recurrence rate, and complications according to the Landriel Ibañez grading system for complications. Results A total of 1003 patients were included in this study. The BHC subgroup included 560 patients, and the MC subgroup included 443 patients. A 30-day mortality when comparing BHC (2.3%) and MC (2.7%) was similar (p = 0.701). Comparing recurrence rate for BHC (8.9%) and MC (10.8%) showed no significant difference (p = 0.336). We found that medical complications were significantly more common in the MC group (p = 0.001). Surgical complications (type IIb) was also associated with the MC group (n = 10, p = 0.003). Out of the 10 patients with type IIb complications in the MC group, 8 had postoperative acute subdural hematomas. Conclusions BHC was comparable to MC concerning 30-day mortality rate and recurrence rates. We did, however, find that MC was significantly associated with medical complications and serious surgical postoperative complications.

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