The Influence of Postoperative Lesion-Down Head Position on the Recurrence Rate in Chronic Subdural Hematoma after Burr-Hole Surgery

2012 ◽  
Vol 8 (2) ◽  
pp. 134
Author(s):  
Gyu-Seong Bae ◽  
Seung-Won Choi ◽  
Hyon-Jo Kwon ◽  
Seon-Hwan Kim ◽  
Hyeon-Song Koh ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Head Position ◽  
Burr Hole

scholarly journals Chronic subdural hematoma: Influence of head position (head low/supine) postoperatively on recurrence rate after burr hole craniotomy

2014 ◽  
Vol 41 (3) ◽  
pp. 173
Author(s):  
TanayUpendra Sholapurkar ◽  
ShambhulingappaShrishal Mahantashetti ◽  
RajeshYashwant Shenoy ◽  
RavirajShambhajirao Ghorpade ◽  
PrafulSuresh Maste
Keyword(s):  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Head Position ◽  
Burr Hole

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.

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 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 Burr hole drainage without irrigation for chronic subdural hematoma

2020 ◽  
Vol 11 ◽  
pp. 89
Author(s):  
Hiroshi Uda ◽  
Alhusain Nagm ◽  
Tsutomu Ichinose ◽  
Yohei Onishi ◽  
Masaki Yoshimura ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Mri Findings ◽  
Risk Of Recurrence ◽  
Drainage Rate ◽  
Index Study ◽  
Magnetic Resonance Imaging Mri ◽  
Surgical Modality

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions, with different strategies for treatment. Most recent trials favor the use of drainage to reduce the recurrence rate. However, few reports have discussed the efficacy of burr hole drainage without irrigation for treating CSDH. This study aimed to examine the efficacy of burr hole drainage without irrigation in a series of 385 symptomatic CSDH lesions. Methods: This retrospective study included a series of 385 symptomatic CSDH lesions in 309 patients, who underwent burr hole drainage without irrigation, between September 2009 and August 2017 at the Department of Neurosurgery, Yao Tokushukai General Hospital, Japan. The risk of recurrence was evaluated based on the patients’ age, sex, preoperative magnetic resonance imaging (MRI) findings, preoperative anticoagulants, hematoma drainage rate, and bilaterality. Results: Of the 385 lesions, 41 cases (16 with inadequate follow-up periods and 25 with contraindications for MRI) were excluded from the analysis. The overall recurrence rate in the index study was 4.9% (17/344 lesions). The effects of the preoperative hematoma volume and nonhyperintensity on T1-weighted imaging on the recurrence rate were significant. Conclusion: Our findings indicated that burr hole drainage without irrigation is a good surgical modality in patients with CSDH, and preoperative MRI findings can evaluate the risk of recurrence.

THE ROLE OF POSTOPERATIVE PATIENT POSTURE IN THE RECURRENCE OF TRAUMATIC CHRONIC SUBDURAL HEMATOMA AFTER BURR-HOLE SURGERY

Neurosurgery ◽  
2007 ◽  
Vol 61 (4) ◽  
pp. 794-797 ◽  
Author(s):  
Mehdi Abouzari ◽  
Armin Rashidi ◽  
Jalal Rezaii ◽  
Khalil Esfandiari ◽  
Marjan Asadollahi ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Burr Hole ◽  
Upright Posture ◽  
Postoperative Patient ◽  
Repeat Surgery ◽  
Group A

Abstract OBJECTIVE Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, especially in the elderly, with a significant recurrence rate ranging from 9.2 to 26.5%. The role of postoperative patient posture in the recurrence of CSDH has not been studied sufficiently. METHODS A total of 84 consecutive patients with unilateral traumatic CSDH without known risk factors of CSDH recurrence were prospectively enrolled in this study. All patients underwent burr-hole surgery with closed system drainage and were then allocated randomly to either of two groups: Group A (n = 42) patients were kept in a supine position for 3 days after the operation, whereas Group B (n = 42) patients assumed a sitting position in bed, with the head of the bed elevated to 30 to 40 degrees, for the same duration as Group A. After 3 days, there was no restriction in patients' activities in both groups. All patients were followed-up for at least 3 months after surgery. RESULTS The groups were not significantly different in age, sex, presence of brain atrophy or hydrocephalus, preoperative hematoma width, and postsurgery subdural space width. The recurrence rate in Groups A and B were 2.3 and 19.0% (necessitating repeat surgery in one patient), respectively (P = 0.02). Other complications in Groups A and B, respectively, were atelectasis (10 versus seven; P = 0.41), pneumonia (five versus four; P = 0.72), decubitus ulcer (three versus two; P = 0.64), and deep vein thrombosis (zero versus one; P = 0.31). CONCLUSION Assuming an upright posture soon after burr-hole surgery was associated with a significantly increased incidence of CSDH recurrence but not with a significant change in other position-related postsurgical complications. According to this result, it is not recommended that elderly patients assume an upright posture soon after burr-hole surgery to prevent postoperative atelectasis and dementia, as these might significantly increase the risk of CSDH recurrence.

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.

Efficacy of Closed-System Drainage in Treating Chronic Subdural Hematoma: A Prospective Comparative Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 771-773 ◽  
Author(s):  
Susumu Wakai ◽  
Kazuyoshi Hashimoto ◽  
Naofumi Watanabe ◽  
Satoshi Inoh ◽  
Chikayuki Ochiai ◽  
...  
Keyword(s):  
Comparative Study ◽  
Recurrence Rate ◽  
Closed System ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Treatment Modalities ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B

Abstract The authors conducted a prospective comparative study on the recurrence rate of chronic subdural hematoma after the use of two different treatment modalities: burr-hole irrigation of the hematoma cavity with (Group A) and without closed-system drainage (Group B). Thirty-eight patients were studied. Patients were assigned to groups sequentially upon admission. There were no significant differences between the two groups for age, sex, preoperative hematoma volume, and density on computed tomographic scan. One patient in Group A (5%) suffered a recurrence as opposed to 6 in Group B (33%). The difference in recurrence rate between the two groups was statistically significant (p &lt; 0.05). The authors conclude that closed-system drainage after burr-hole irrigation reduces the recurrence rate of chronic subdural hematoma.

scholarly journals Burr-Hole Evacuation of Chronic Subdural Hematoma: Biophysically and Evidence-Based Technique Improvement

2019 ◽  
Vol 10 (01) ◽  
pp. 113-118 ◽  
Author(s):  
Martin Májovský ◽  
David Netuka ◽  
Vladimír Beneš ◽  
Pavel Kučera
Keyword(s):  
Recurrence Rate ◽  
Local Anesthesia ◽  
Subdural Hematoma ◽  
Scientific Evidence ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Evidence Based ◽  
Rural And Remote Areas ◽  
Burr Hole Evacuation ◽  
Reoperation Rates

ABSTRACTChronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Despite ongoing efforts, recurrence and reoperation rates after surgical treatment remain high. We synthesize scientific evidence on the treatment of CSDH with biophysical principles and then propose a simple and effective surgical technique aiming to reduce the recurrence rate. Under local anesthesia, one burr hole is placed in the area above the maximum hematoma thickness. One drain is inserted into the dorsal direction to the deepest point of the hematoma cavity, and a second drain is inserted frontally into the highest point. Next, saline is gently instilled to the dorsal drain to eliminate air from the hematoma cavity through the frontal drain. Once saline has filled the frontal drain, the frontal drain is removed. The dorsal drain is left in situ for 48 h, and the pressure within the cavity may be adapted hydrostatically. We implemented evidence-based conclusions of previous studies and modified the classical burr-hole technique to reduce the recurrence rate. As a result, we developed a straightforward surgical procedure that is possible to perform under local anesthesia, suitable for everyday practice in rural and remote areas while working with limited resources. The novelty of this technique is in the purposeful reduction of postoperative pneumocephalus, a known independent factor of recurrence. Subdural air is eliminated during surgery using a two-drain system. Safety and efficacy of the technique need to be evaluated in future clinical trials.

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