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.

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

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

2014 ◽  
Vol 62 (2) ◽  
pp. 169 ◽  
Author(s):  
Bhaskar Suryanarayanan ◽  
Ajay Choudhary ◽  
LaxmiNarayan Gupta ◽  
Akhila Prasad ◽  
AmitKumar Singh ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Randomized Study ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Prospective Randomized Study ◽  
Burr Hole Evacuation

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.

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.

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.

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 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.

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.

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