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

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.

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

Neurosurgery ◽

10.1093/neuros/nyz095 ◽

2019 ◽

Vol 85 (5) ◽

pp. E825-E834 ◽

Cited By ~ 19

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

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

International Surgery Journal ◽

10.18203/2349-2902.isj20182242 ◽

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.

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

Acta Neurochirurgica ◽

10.1007/s00701-021-04902-3 ◽

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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