A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation

Abstract

Object The traditional methods for managing symptomatic chronic subdural hematoma (SDH) include evacuation via a bur hole or craniotomy, both with or without drain placement. Because chronic SDH frequently occurs in elderly patients with multiple comorbidities, the bedside approach afforded by the subdural evacuating port system (SEPS) is an attractive alternative method that is performed under local anesthesia and conscious sedation. The goal of this study was to evaluate the radiographic and clinical outcomes of SEPS as compared with traditional methods. Methods A prospectively maintained database of 23 chronic SDHs treated by bur hole or craniotomy and of 23 chronic SDHs treated by SEPS drainage at Tufts Medical Center was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcome was collected. The volume of SDH before and after treatment was semiautomatically measured using imaging software. Results There was no significant difference in initial SDH volume (94.5 cm(3) vs 112.6 cm(3), respectively; p = 0.25) or final SDH volume (31.9 cm(3) vs 28.2 cm(3), respectively; p = 0.65) between SEPS drainage and traditional methods. In addition, there was no difference in mortality (4.3% vs 9.1%, respectively; p = 0.61), length of stay (11 days vs 9.1 days, respectively; p = 0.48), or stability of subdural evacuation (94.1% vs 83.3%, respectively; p = 0.60) for the SEPS and traditional groups at an average follow-up of 12 and 15 weeks, respectively. Only 2 of 23 SDHs treated by SEPS required further treatment by bur hole or craniotomy due to inadequate evacuation of subdural blood. Conclusions The SEPS is a safe and effective alternative to traditional methods of evacuation of chronic SDHs and should be considered in patients presenting with a symptomatic chronic SDH.

Chronic Subdural Hematoma with Hypodense on CT-Scan in the Elderly: Surgical Drainage or Conservative Treatment

“…However, surgical treatment can result in improvement of cognitive ability in a short-term (1-month follow-up), and improvement of neurological status in a longterm (1-year follow-up), despite some patients will remain dependent with limited mRS scores. This is in contrast to past research [25,26], but more recent studies have shown the similar results to our findings [15,16].…”

“…The term "chronic" subdural hematoma has been loosely defined, with various authors applying it to those in the different stage of CSDH. According to CT scan, hematoma density is known to decrease with time, passing from a high-stage to an iso-and finally a low density stage [15,16]. Therefore, lower hematoma densities are expected to be seen in the late stage of hematoma course.…”

Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma

“…Safain et al found a mean volume reduction of 68.2% for SEPS and 76.2% for traditional techniques (p = 0.25), 14 and Rughani et al found a mean reduction in maximal CSDH thickness of 45.4% in the BHC group and 40.5% in the SEPS group (p = 0.31);…”

“…8,13,14,17 Two considered outcomes based on the maximum CSDH width, while the other 2 studies considered volume estimates. Overall, radiological improvement was seen in 150 of 197 collections (76.1%), and these and other studies commented on the lack of correlation between radiological and clinical outcomes with many patients experiencing symptomatic improvement despite lack of radiological improvement.…”

Keyhole revision after failed subdural craniostomy for chronic subdural hematoma

“…Twist drill craniostomy appears to have morbidity similar to that of BHD, with complications reported in 0-18% of patients with twist drill procedures [9,10,11] vs. 0-25% for BHD [12,13]. Yet the rates of recurrence are empirically higher with bedside procedures: 25.9% with SEPS vs. 14.8% with BHD in the study of Rughani et al [14]; 18% (twist drill) vs. 8% (BHD) requiring reoperation/drainage in the study of Horn et al [9]; and, similarly, 17% (twist drill) vs. 0% (BHD and craniotomy) rates of inadequate SDH drainage in the study of Safain et al [15]. Many of these differences are not reported as statistically significant, but this is possibly due to the low power of the studies.…”