Comparison of Outcomes and Recurrence in Chronic Subdural Hematoma Patients Treated by Burr-Hole Drainage with or without Irrigation

Abstract

Purpose: Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or without irrigation in patients with CSDH. methods: Eighty-two CSDH patients treated with burr-hole drainage at Wonju Severance Christian Hospital from March 2015 to June 2016 were enrolled in this study. The subjects were divided into three groups based on the surgical technique performed as follows: single burr-hole drainage without irrigation (group A, n=47), single burr-hole drainage with irrigation (group B, n=14), or double burr-hole drainage with irrigation (group C, n=21). These three groups were compared with respect to clinical and radiological factors and the recurrence rate, and independent factors predicting recurrence were sought. results: After burr-hole drainage, CSDH recurred in 15 (18.3%) of the 82 patients, and six patients (7.3%) required reoperation. More specifically, recurrence was observed in 12 patients (25.5%) in group A, one (7.1%) in group B, and two (9.5%) in group C. The number of burr-holes did not significantly affect recurrence (odds ratio [OR]=0.38; 95% confidence interval [CI]: 0.60-2.38), but irrigation had a significant effect (OR=0.20; 95% CI: 0.04-0.97). Conclusions: This study shows that irrigation during burr-hole surgery in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burrholes used. We therefore recommend the use of active irrigation during burr-hole drainage surgery in CSDH patients.

Factors Associated with Recurrence in Chronic Subdural Hematoma following Surgery

“…Intraoperative saline irrigation has been reported to significantly reduce CSDH recurrence compared with no irrigation in prior studies. [28][29][30] Moreover, the amount of saline irrigation has noteworthy importance for reducing recurrent rates when at least 3,200 mL of saline was used by the HR plot. Initially, we analyzed this variable as a continuous variable and found that the amount of saline irrigation significantly affected a reduction of risk of recurrence (HR: 0.99, 95% CI: 0.992-0.998 in multivariable analysis).…”

Factors Associated With Short-Term Outcomes of Burr-Hole Craniostomy Associated With Brain Re-Expansion and Subdural Hematoma Shrinkage for Chronic Subdural Hematoma

“…CSDH is generally a condition affecting the elderly after mild trauma. 2 7 13 17 29) and while it can be completely cured with surgery, there is a high rate of postoperative relapse. 2 15) The postoperative prognosis for CSDH is diverse and there have been various studies on the factors affecting prognosis during treatment after the initial diagnosis of CSDH.…”

“…CSDH has low morbidity and mortality after surgical intervention. 2 15) Nevertheless, the relapse rate is an important factor in the prognosis of patients with CSDH. There have been several previous studies on CSDH relapse.…”