The Nelaton Catheter Guard for Safe and Effective Placement of Subdural Drain for Two-Burr-Hole Trephination in Chronic Subdural Hematoma: A Technical Note

2015 ◽  
Vol 76 (05) ◽  
pp. 415-417 ◽  
Author(s):  
Jens Fichtner ◽  
Jürgen Beck ◽  
A. Raabe ◽  
Lennart Stieglitz
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Technical Note ◽  
Burr Hole ◽  
Subdural Drain

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

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E797-E798 ◽  
Author(s):  
Jehuda Soleman ◽  
Katharina Lutz ◽  
Sabine Schaedelin ◽  
Maria Kamenova ◽  
Raphael Guzman ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Subdural Drain

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 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.

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