The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

ABSTRACT

Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH).

Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications.

Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain.

Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months.

Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.

RESUMO

A trepanação é o procedimento mais utilizado para o tratamento de hematomas subdurais crçnicos (HSDC).

Objetivo: Avaliar o uso de dreno subdural e / ou o número de trepanações para tratamento de HSDC modifica as taxas de recidiva e complicações.

Métodos: Uma revisão retrospectiva de 142 pacientes operados por HSDC entre 2006 e 2015 analisando recidiva e complicações usando um ou dois orifícios com ou sem uso de dreno.

Resultados: Trinta e sete casos apresentaram HSDC bilaterais (26%) e 105 (73,9%) unilaterais. Em vinte e dois (59,4%) casos houve uso de dreno e em 15 (40,6%) não houve. O número total de recidivas foi de 22 casos (15,5%) e o número total de complicações foi de 6 casos (4,2%). O tempo médio de seguimento foi de 7,67 meses.

Conclusões: O número de trepanações e o uso do dreno não alteraram as taxas de recidiva e complicações no tratamento de HSDC.

Keywords:

hematoma, subdural - recurrence - trephining

Palavras-chave:

hematoma subdural - recidiva - trepanação

• References

• 1 Poulsen FR, Halle B, Pottegård A, Rodriguez LAG, Hallas J, Gaist D. Subdural hematoma cases identified through a Danish patient register: diagnosis validity, clinical characteristics, and preadmission antithrombotic drug use. Pharmacoepidemiol Drug Saf. 2016;25(11):1253-62. https://doi.org/10.1002/pds.4058
• 2 Soleman J, Taussky P Fandino J, Muroi C. Evidence-based treatment of chronic subdural hematoma. In: Sadaka F, Quinn T, editors. Traumatic brain injury. Rijeka: Intech; 2014 [cited 2016 Dec 10]. Available from: http://www.intechopen.com/books/traumatic-brain-injury/evidence-based-treatment-of-chronic-subdural-hematoma
• 3 Castro-Rodríguez C, Román-Pena P, Arán-Echabe E, Gelabert-González M. [Chronic subdural haematomas in very elderly patients]. Rev Esp Geriatr Gerontol. 2016;51(6):309-16. Spanish. https://doi.org/10.1016/j.regg.2016.05.003
• 4 Andersen-Ranberg NC, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. Bilateral chronic subdural hematoma: unilateral or bilateral drainage? J Neurosurg. 2017;126(6):1905-11. https://doi.org/10.3171/2016.4.JNS152642
• 5 Sharon LY, Wai Hoe NG. “Subarachnoid cyst” after evacuation of chronic subdural hematoma: case report of an unusual postoperative morbidity. Asian J Neurosurg. 2016;11(3):316. https://doi.org/10.4103/1793-5482.144210
• 6 Alves JL, Santiago JG, Costa G, Mota Pinto A. A standardized classification for subdural hematomas - I. Am J Forensic Med Pathol. 2016;37(3):174-8. https://doi.org/10.1097/PAF.20170136201701360255
• 7 Abe Y, Maruyama K, Yokoya S, Noguchi A, Sato E, Nagane M et al. Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness. J. Neurosurg. 2017;126(4):1042-6. https://doi.org/10.3171/2016.3JNS152957
• 8 Kolias AG, Chari A, Santarius T, Hutchinson PJ. Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol. 2014;10(10):570-8. https://doi.org/10.1038/nrneurol.2014.163
• 9 Muzii VF, Bistazzoni S, Zalaffi A, Carangelo B, Mariottini A, Palma L. Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study. J Neurosurg Sci. 2005;49(2):41-6.
• 10 Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Andersen KN et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155-69. https://doi.org/10.1007/s10143-011-0349-y
• 11 Cenic A, Bhandari M, Reddy K. Management of chronic subdural hematoma: a national survey and literature review. Can J Neurol Sci. 2005;32(4):501-6. https://doi.org/10.1017/S0317167100004510
• 12 Ramachandran R, Hegde T. Chronic subdural hematomas: causes of morbidity and mortality. Surg Neurol. 2007;67(4):367-72. https://doi.org/10.1016/j.surneu.2006.07.022
• 13 Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009;374(9695):1067-73. https://doi.org/10.1016/S0140-6736(09)61115-6
• 14 Erol FS, Topsakal C, Faik Ozveren M, Kaplan M, Tiftikci MT. Irrigation vs. closed drainage in the treatment of chronic subdural hematoma. J Clin Neurosci. 2005;12(3):261-3. https://doi.org/10.1016/j.jocn.2003.09.012
• 15 Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014;121(3):665-73. https://doi.org/10.3171/2014.5JNS132715
• 16 Han HJ, Park CW, Kim EY, Yoo CJ, Kim YB, Kim WK. One vs. two burr hole craniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc. 2009;46(2):87-92. https://doi.org/10.3340/ikns.2009.46.2.87
• 17 Smith MD, Kishikova L, Norris JM. Surgical management of chronic subdural haematoma: one hole or two? Int J Surg. 2012;10(9):450-2. https://doi.org/10.1016/iJjsu.2012.08.005
• 18 Rovlias A, Theodoropoulos S, Papoutsakis D. Chronic subdural hematoma: Surgical management and outcome in 986 cases: a classification and regression tree approach. Surg Neurol Int. 2015;6(1):127. https://doi.org/10.4103/2152-7806.161788
• 19 Taussky P, Fandino J, Landolt H. Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg. 2008;22(2):279-82. https://doi.org/10.1080/02688690701818885
• 20 Lee JK, Choi JH, Kim CH, Lee HK, Moon JG. Chronic subdural hematomas : a comparative study of three types of operative procedures. J Korean Neurosurg Soc. 2009;46(3):210-4. https://doi.org/10.3340/ikns.2009.46J.210
• 21 Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas: a study of 267 cases. J Clin Neurosci. 2010; 17(4):428-9. https://doi.org/10.1016/j.jocn.2009.07.109
• 22 Xu C, Chen S, Yuan L, Jing Y. Burr-hole Irrigation with Closed-system Drainage for the Treatment of Chronic Subdural Hematoma: A Meta-analysis. Neurol Med Chir (Tokyo). 2016;56(2):62-8. https://doi.org/10.2176/nmc.ra.2015-0013
• 23 Kutty SA, Johny M. Chronic subdural hematoma: a comparison of recurrence rates following burr-hole craniostomy with and without drains. Turk Neurosurg. 2014;24(4):494-7. https://doi.org/10.5137/1019-5149.JTN.8830-13.1
• 24 Zumofen D, Regli L, Levivier M, Krayenbühl N. Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system. Neurosurgery. 2009;64(6):1116-21. https://doi.org/10.1227/01.NEU.0000345633.45961.BB
• 25 Javadi SA, Naderi F, Javadi AM. The optimal surgical approach for treatment of chronic subdural hematoma: questionnaire assessment of practice in Iran and review of literature. Acta Med Iran. 2015;53(10):617-21.
• 26 Gelabert-Gonzalez M, Lopez-García E, Fernandez-Villa JM. Chronic subdural hematoma treated by burr holes and closed drainage system: a review of 630 cases. Med Princip Pract. 2001;10(2):41-7. https://doi.org/10.1159/000050338
• 27 Song DH, Kim YS, Chun HJ, Yi HJ, Bak KH, Ko Y et al. The predicting factors for recurrence of chronic subdural hematoma treated with burr hole and drainage. Korean J Neurotrauma. 2014;10(2):41-8. https://doi.org/10.13004/kjnt.2014.10.2.41