A Randomized Controlled Trial Comparing the Outcome of Burr-Hole Irrigation with and without Drainage in the Treatment of Chronic Subdural Hematoma: A Preliminary Report

Javadi, Seyed Amirhossein; Amirjamshidi, Abbas; Aran, Shima; Hamzeh, Hosseini Seyed

doi:10.1016/j.wneu.2010.11.042

Cited by 76 publications

(48 citation statements)

References 46 publications

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“…Application of drainage systems is also a controversial topic. Despite the adverse studies (46), placement of drainage systems has been usually associated with lower recurrence and mortality rates (6,21,(47)(48)(49)(50).…”

Section: Discussionmentioning

confidence: 99%

Treatment of chronic subdural hematoma: 5-year clinical experience

Oktay¹,

Olguner²,

Saraç³

et al. 2017

Eur J Ther

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Section: Discussionmentioning

confidence: 99%

Treatment of chronic subdural hematoma: 5-year clinical experience

Oktay¹,

Olguner²,

Saraç³

et al. 2017

Eur J Ther

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“…28,34,35 The other 4 trials did not identify significant differences in outcome. 2,5,15,23 In all 7 trials, reoperation rates were considered recurrence rates. However, indications for reoperation were different.…”

Section: Postoperative Drainagementioning

confidence: 99%

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

Liu

Bakker

Groen

2014

JNS

244

151

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Object In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T2 (tau-squared), I2, and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Results Of the 297 studies identified, 19 RCTs were included. Of them, 7 studies evaluated the use of postoperative drainage, of which the meta-analysis showed a pooled OR of 0.36 (95% CI 0.21–0.60; p < 0.001) in favor of drainage. Four studies compared twist drill and bur hole procedures. No significant differences between the 2 methods were present, but heterogeneity was considered to be significant. Three studies directly compared the use of irrigation before drainage. A fixed-effects meta-analysis showed a pooled OR of 0.49 (95% CI 0.21–1.14; p = 0.10) in favor of irrigation. Two studies evaluated postoperative posture. The available data did not reveal a significant advantage in favor of the postoperative supine posture. Regarding positioning of the catheter used for drainage, it was shown that a frontal catheter led to a better outcome. One study compared duration of drainage, showing that 48 hours of drainage was as effective as 96 hours of drainage. Conclusions Postoperative drainage has the advantage of reducing recurrence without increasing complications. The use of a bur hole or twist drill does not seem to make any significant difference in recurrence rates or other outcome measures. It seems that irrigation may lead to a better outcome. These results may lead to more standardized procedures.

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“…(17) Headache has moreover been identified in 60% of patients undergoing surgery for acute-on-chronic subdural hematomas in a previous study. (22) In our study, 28% of patients who underwent emergency surgery experienced headache, but it is worth mentioning that although the median rate in the Ramsay sedation scale was similar in the two groups, emergency surgery patients remained in deep sedation longer in the postoperative period, thus reducing the reports and signs of pain during this period.…”

Section: Discussionmentioning

confidence: 50%

“…In studies with patients who underwent emergency skull surgery for TBI and SDH drainage, AKI was diagnosed in only 1.3 to 2.5% of patients. (9,22) Patients from the emergency surgery group moreover had a greater incidence of hypotension with the need for vasoactive drugs, which may be related to the AKI. (23) Patients in the emergency surgery group also had a higher incidence of hypoglycemia and use of intensive insulin protocols than patients in the elective surgery group.…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rates observed in previous studies with emergency surgery patients vary from 1.4% to 35.0%. (10,19,22,25) Some studies with emergency surgery patients analyzed factors associated with the risk of death: low scores in the GCS and anisocoria were identified as important factors associated with a worse prognosis. (6,9,20) Accordingly, in this study, patients who underwent emergency surgery had lower scores in the GCS compared to the elective surgery patients.…”

Section: Discussionmentioning

confidence: 99%

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Complicações pós-operatórias em neurocirurgia eletiva e não eletiva

Siqueira

Diccini

2017

Acta paul. enferm.

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Objective: To evaluate the incidence of postoperative complications and mortality among patients submitted to elective or non-elective neurosurgery. Methods: Prospective cohort study in adult patients, followed from preoperative period until hospital discharge or death. Results: One hundred and twenty seven patients were included in elective surgery group and 75 patients in non-elective surgery group. The elective group had more vomiting (p=0.010) and pain (p<0.001) and the non-elective group presented more intracranial hypertension (p=0.001), anisocoria (p=0.002), cerebral vasospasm (p=0.043), light-unresponsive pupil (p=0.006) and reoperation (p=0.046). The mortality rate was 5.5% in the elective surgery group and 26.7% in the non-elective surgery group (p<0.001). Conclusion: Elective procedures in neurosurgery are related to higher frequencies of systemic complications while non-elective surgeries had significantly higher rates of neurological complications and mortality. ResumoObjetivo: Avaliar a incidência de complicações pós-operatorias e mortalidade entre pacientes submetidos a neurocirurcia eletiva e não eletiva. Metodos: Estudo de coorte prospectivo com pacientes adultos, acompanhados desde o período pré-operatório até a alta hospitalar ou óbito. Resultados: Foram incluídos 127 pacientes no grupo cirúrgico eletivo e 75 pacientes no grupo cirúrgico não eletivo. O grupo eletivo teve mais vômitos (p=0,010) e dor (p<0,001) e o grupo não eletivo apresentou mais hipertensão intracraniana (p=0,001), anisocoria (p=0,002), vasoespasmo cerebral (p=0,043), pupilas não fotorreagentes (p=0,006) e reoperação (p=0,046). A taxa de mortalidade foi de 5,5% no grupo de cirurgia eletiva e 26,7% no grupo de cirurgia não eletiva (p<0,001). Conclusão: Os procedimentos eletivos em neurocirurgia estão relacionados a maior frequência de complicações sistêmicas, enquanto as cirurgias não eletivas tiveram taxas significativamente mais altas de complicações neurológicas e mortalidade.

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A Randomized Controlled Trial Comparing the Outcome of Burr-Hole Irrigation with and without Drainage in the Treatment of Chronic Subdural Hematoma: A Preliminary Report

Cited by 76 publications

References 46 publications

Treatment of chronic subdural hematoma: 5-year clinical experience

Treatment of chronic subdural hematoma: 5-year clinical experience

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

Complicações pós-operatórias em neurocirurgia eletiva e não eletiva

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