Benefits of the Subdural Evacuating Port System (SEPS) Procedure Over Traditional Craniotomy for Subdural Hematoma Evacuation

Abstract

Background: There remains no consensus on the optimal primary intervention for subdural hematoma (SDH). Although historically favored, craniotomy carries substantial morbidity and incurs significant costs. Contrastingly, the subdural evacuating port system (SEPS) is a minimally invasive bedside procedure. We assessed the benefits of SEPS over traditional craniotomy for SDH evacuation. Methods: A single-center retrospective cohort study of SDH patients receiving craniotomy or SEPS between 2012 and 2017 was performed. Information regarding demographics, medical history, presentation, surgical outcomes, cost, and complications was collected. Pre- and postoperative hematoma volumes were calculated using 3D image segmentation using Vitrea software. Multivariate regression models were employed to assess the influence of intervention choice. Results: Of 107 patients, 68 underwent craniotomy and 39 underwent SEPS. There were no differences in age, sex, blood thinner use, platelet count, INR, hematoma lateralization, age, volume, or midline shift at presentation between intervention groups. Although there was no difference in percent residual hematoma volume 24-hour postintervention (44.1% vs 45.1%, P = .894), SEPS was associated with lower hospitalization costs ($108 391 vs $166 318, * P = .002), shorter length of stay (4.0 vs 5.8 days, * P = .0002), and fewer postoperative seizures (2.6% vs 17.7%, * P = .048). Reoperation rate was higher after SEPS overall (33.3% vs 13.2%, * P = .048) but comparable to craniotomy in chronic SDH (12.50% vs 7.69%, P = 1.000). Conclusion: In this retrospective cohort, SEPS was noninferior to craniotomy at reducing SDH hematoma volume. The SEPS procedure was also associated with decreased length of stay hospitalization costs, and postoperative seizures and demonstrated a comparable recurrence rate to craniotomy for chronic SDH in particular.

Effect of Twist-Drill Craniostomy With Hollow Screws for Evacuation of Chronic Subdural Hematoma: A Meta-Analysis

“…A total of 1,369 studies were obtained in the initial search, and 20 studies (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) were finally included based on the inclusion and exclusion criteria. These 20 studies included 17 English articles (13)(14)(15)(16)(17)(18)(19)(20)(24)(25)(26)(27)(28)(29)(30)(31)(32) and 3 Chinese articles (21)(22)(23), of which four of them were randomized controlled trials (15,17,20,21) while the remaining 16 were case-control trials. The workflow of literature retrieval and screening is shown in Figure 1.…”

Delayed Postoperative Tension Pneumocephalus Treated With a Subdural Evacuating Port System: A Case Report and Review of the Literature

“…Conventional operative treatments for tension pneumocephalus consist of open craniotomy in the operating room for the evacuation of intracranial air [ 6 ]. However, over the past decade, drainage systems such as SEPS drains have been becoming increasingly popular due to their potential in decreasing the utilization of systemic anesthesia and lower infection risk [ 17 ]. Additionally, SEPS drains have also been associated with a low postoperative infection rate and comorbidity rate, reduced seizure probability, and lowered hospitalization costs and length of stays when used for the evacuation of subdural hematomas.…”

“…Additionally, SEPS drains have also been associated with a low postoperative infection rate and comorbidity rate, reduced seizure probability, and lowered hospitalization costs and length of stays when used for the evacuation of subdural hematomas. These characteristics are especially beneficial for elderly patients, who are known to be suboptimal surgical candidates [ 17 , 18 ]. Given the favorable characteristic profile of SEPS compared to surgical decompressive modalities, further inquiry should be pursued to analyze the feasibility of establishing SEPS as a favorable treatment alternative to open surgical decompression for iatrogenic tension pneumocephalus.…”