Efficacy and Safety of Subdural Drains After Burr-Hole Evacuation of Chronic Subdural Hematomas: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alcalá-Cerra, Gabriel; Young, Adam M. H.; Moscote-Salazar, Luís Rafael; Paternina-Caicedo, Ángel

doi:10.1016/j.wneu.2014.08.012

Cited by 61 publications

(34 citation statements)

References 45 publications

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“…43 The meta-analysis also demonstrated that the insertion of a drain was associated with a statistically significant reduction in the risk of symptomatic recurrence and statistically significant improvements in both short-term and long-term functional outcome. 44 There was no additional risk of infection in our series. Kale et al also observed that increasing the duration of the drainage provided better results without increasing the risk of complication.…”

Section: Discussionmentioning

confidence: 53%

“…Other authors made similar observations of no differences in recurrences, reoperations, or medical complications in a flat position versus head elevation. 38 Duration of surgical procedure in endoscopic technique was comparable with burr hole evacuation. Although Yan et al also observed fewer recurrences in the endoscopy group compared with the burr hole group, 21 they reported that the burr hole surgery required less operative time and less medical consumption as compared with the endoscopic approach.…”

Section: Discussionmentioning

confidence: 87%

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Endoscopic Management of Chronic Subdural Hematoma

Yadav

Ratre

Parihar

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Twist drill evacuation, burr hole aspiration, mini-craniotomy, and craniotomy are some of the surgical methods to remove chronic subdural hematoma (CSDH). Endoscopic treatment was also recently found to be useful. Methods We conducted a prospective study of 72 hematomas in 68 patients. Computed tomography was performed in all cases. Endoscopic surgery was performed in all CSDH patients. Surgical procedure A 4-cm skin incision was performed at the most curved part of skull with the CSDH. A mini-craniotomy or enlarged burr hole was made. The inner and outer table of the burr hole margin was drilled to provide a straight trajectory to the hematoma cavity. An endoscope supported by a telescope holder was used. A modified silicone brain retractor was used in five patients. A subgaleal drain was left in all patients for 3 to 5 days. Results There were 42 male and 26 female patients. The age ranged from 45 to 79 years (average: 69 years). All patients had a history of head trauma. Preoperative average Glasgow Coma Scale Score was 14. The procedure was effective in hematoma evacuation and a good visualization of the whole cavity in all patients. The endoscopic technique helped in complete hematoma removal in organized/solid clot, septations, and bridging vessels in 17, 2, and 2 cases, respectively. Duration of surgery ranged from 35 to 80 minutes. One death occurred. There was no recurrence, infection, fresh bleed, or injury to the brain or membrane. Conclusion The endoscopic technique is an effective alternative technique for treating CSDH. Although the study has limitations because of the small number of patients with a short follow-up, the study indicated that thick and vascular membranes, septations, and organized and solid clots can be removed effectively using this technique.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 87%

Endoscopic Management of Chronic Subdural Hematoma

Yadav

Ratre

Parihar

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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“…Kiymaz et al 23 also found continuous drainage for CSDH is superior to one-time drainage having with shorter hospital stay and reduced rate of recurrence 23 . The meta-analysis by Alcalá-Cerra et al demonstrates that the insertion of a subdural drain was associated with a statistically significant reduction in the risk of symptomatic recurrence and the requirement for the further surgical intervention of CSDH after surgical evacuation 24 .…”

Section: Discussionmentioning

confidence: 99%

Chronic Subdural Hematoma - A Dilemma to Put Drain

Ali¹,

Islam

Chowdhury³

et al. 2019

Bangla J. Neurosurgery

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Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain. Objectives: our study is to compare the clinical outcome of CSDH with or without drain. Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS. Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %). Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone. Bang. J Neurosurgery 2019; 9(1): 26-32

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“…Site of drain placement was also explored such as subperiosteal drain versus subdural drain, which showed comparable outcome [12,13]. Our recent comment on the latest meta-analysis of the use of subdural drain in chronic subdural hematoma expressed concern with the result predominant by one single randomized controlled trial findings [14,15,16]. At the same time, the role of steroid is continued to be explored.…”

Section: Discussionmentioning

confidence: 99%

Steroid for chronic subdural hematoma? A prospective phase IIB pilot randomized controlled trial on the use of dexamethasone with surgical drainage for the reduction of recurrence with reoperation

2015

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Background: Chronic subdural hematoma is a common neurosurgical condition especially in the aging population. Burr hole for drainage is an effective treatment, yet recurrence is reported at 8 to 22 % worldwide, and 1-year mortality rates could be as high as 32 %. Our previous study on the use of dexamethasone as a primary nonsurgical treatment showed good response in selected group of patients. This study aims to assess the efficacy of dexamethasone with surgical drainage in the reduction of recurrence requiring reoperation. Methods: From October 2000 to September 2006, patients with chronic subdural hematoma admitted to the Prince of Wales Hospital, The Chinese University of Hong Kong, were randomized to surgical drainage with steroid versus surgical drainage only. The primary endpoint was symptomatic recurrence requiring reoperation. Results: Two hundred forty-eight patients were recruited and consented for the randomization during the study period. One hundred twenty-two received both surgery and steroid (the intervention arm) while 126 received surgery only (the control arm). The recurrence rate requiring reoperation was 6.6 % (8/122) and 13.5 % (17/126), respectively (p = 0.109). There was no significant difference in complications such as chest infection (p = 0.201) or wound infection (p = 0.987). Favorable outcome (Glasgow Outcome Score 4-5) was 104/122 (85.2 %) in the intervention group versus 105/126 (83.3 %) in the control group, respectively (p = 0.811). Based on the recurrence rate in our study, we generate a potential sample size of at least 594 patients (type I error = 5 %, power = 80 %, two-sided test) to detect a significant difference. Conclusions, brief summary, and potential implications: In this prospective pilot phase IIB randomized controlled study, steroid with surgical drainage had a lower recurrence with reoperation though statistically insignificant. It was safe with no significant difference in complication rates. This pilot study generates a potential sample size for a definitive larger double-blinded randomized controlled trial in the future.

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Efficacy and Safety of Subdural Drains After Burr-Hole Evacuation of Chronic Subdural Hematomas: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 61 publications

References 45 publications

Endoscopic Management of Chronic Subdural Hematoma

Endoscopic Management of Chronic Subdural Hematoma

Chronic Subdural Hematoma - A Dilemma to Put Drain

Steroid for chronic subdural hematoma? A prospective phase IIB pilot randomized controlled trial on the use of dexamethasone with surgical drainage for the reduction of recurrence with reoperation

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