Effect of Intra-operative Saline Irrigation during Burr Hole Surgery on the Recurrence for Chronic Subdural Hematomas

Abstract

Objective:The aim of this study is to compare the postoperative recurrence rates and alteration in follow-up brain CT radiographic results between patients with chronic subdural hematoma (CSDH) treated by burr hole trephination with or without irrigation during the surgery. Methods: A total of 100 patients diagnosed with CSDH underwent burr hole trephination from January 2013 to May 2015. The patients were divided into two groups: those who underwent intra-operative saline irrigation and those who did not. Difference in the rate of symptomatic recurrence requiring second surgery between the two groups was evaluated. Radiographic results were analyzed based on the patients' follow-up brain CTs taken 1 month after the surgery. Results: Sixty eight patients underwent intra-operative irrigation while 32 patients did not. The median ages of the two groups were 69.6 years (range, 39-91 years) and 69.1 years (range, 38-86 years), respectively. Among the "irrigated" group, six patients required second surgery due to recurrent hematoma (8.8%) while nine patients in the "not irrigated" group underwent second surgery (28.1%). Difference in the Glasgow coma scale (GCS) between the two groups had no statistical significance. Conclusion: Upon conducting burr hole trephination surgery for CSDH, saline irrigation is a simple procedure that can reduce the recurrence rate.

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

“…Regarding the use of irrigation, Kim et al [1] reported a higher recurrence rate in a 114-case saline irrigation group with closed drainage than in a 38-case non-irrigation group with closed drainage. Conversely, Ishibashi et al [14], Jang et al [8], and Lee et al [5] reported better prognoses after irrigation. The present study also showed that the recurrence rate was significantly lower after intraoperative irrigation.…”

“…It is usually treated surgically and has low postoperative morbidity and mortality rates. However, its postoperative recurrence rate is high; therefore, the question of how best to treat CSDH remains a meaningful topic in the neurosurgical field [5,19]. Many studies have investigated CSDH recurrence.…”

“…Chronic subdural hematoma (CSDH) is a relatively common neurosurgical disease, especially in elderly patients [1][2][3][4][5]. In 2016, its global incidence was reported to be 1-13.5 per 100,000 per year [2], and its incidence continues to increase concomitantly with population aging [4,6].…”

“…Although small CS-DHs can be resolved without surgery, surgical treatment is required in most cases [2]. The prognosis of CSDH is relatively favorable, but the postoperative recurrence rate has been reported to range widely, from as little as 2% to as high as 37% [1,2,5,[7][8][9][10].…”

“…Single burr-hole craniostomy and drainage is the most commonly used treatment modality [1,5,8,11], but various surgical techniques, such as multi burr-hole craniostomy, massive irrigation, irrigation with thrombin, small or large craniotomy, and membranectomy, have been reported to reduce recurrence [1,2,[11][12][13][14][15][16][17], and as a result, controversy exists regarding the optimal surgical method for CSDH.…”