Irrigation vs. closed drainage in the treatment of chronic subdural hematoma

Erol, Fatih Serhat; Topsakal, Cahide; Özveren, Mehmet Faik; Kaplan, Metin; Tiftikci, Murat T.

doi:10.1016/j.jocn.2003.09.012

Cited by 68 publications

(45 citation statements)

References 19 publications

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“…Application of drainage systems is also a controversial topic. Despite the adverse studies (46), placement of drainage systems has been usually associated with lower recurrence and mortality rates (6,21,(47)(48)(49)(50).…”

Section: Discussionmentioning

confidence: 99%

“…However, craniotomy is best performed under general anesthesia and is the most invasive option for the treatment of CSDH, encompassing the greatest operative time as well as the greatest volume of the blood loss. Despite the increased risks, craniotomy remains the best option for evacuation of organized, calcified, solid CSDH with numerous thick membranes or the cases with multiple recurrences (5,15,16,(28)(29)(30)39,41,47,52,53).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of chronic subdural hematoma: 5-year clinical experience

Oktay¹,

Olguner²,

Saraç³

et al. 2017

Eur J Ther

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of chronic subdural hematoma: 5-year clinical experience

Oktay¹,

Olguner²,

Saraç³

et al. 2017

Eur J Ther

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“…However, whether drainage alone or drainage with irrigation is better for patients with CSDH remains unclear [1,2,4,5,[10][11][12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Treatments for Chronic Subdural Hematoma: Burr Hole Drainage versus Burr Hole Drainage with Irrigation

2011

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“…28,34,35 The other 4 trials did not identify significant differences in outcome. 2,5,15,23 In all 7 trials, reoperation rates were considered recurrence rates. However, indications for reoperation were different.…”

Section: Postoperative Drainagementioning

confidence: 99%

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

Liu

Bakker

Groen

2014

JNS

244

151

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Object In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T2 (tau-squared), I2, and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Results Of the 297 studies identified, 19 RCTs were included. Of them, 7 studies evaluated the use of postoperative drainage, of which the meta-analysis showed a pooled OR of 0.36 (95% CI 0.21–0.60; p < 0.001) in favor of drainage. Four studies compared twist drill and bur hole procedures. No significant differences between the 2 methods were present, but heterogeneity was considered to be significant. Three studies directly compared the use of irrigation before drainage. A fixed-effects meta-analysis showed a pooled OR of 0.49 (95% CI 0.21–1.14; p = 0.10) in favor of irrigation. Two studies evaluated postoperative posture. The available data did not reveal a significant advantage in favor of the postoperative supine posture. Regarding positioning of the catheter used for drainage, it was shown that a frontal catheter led to a better outcome. One study compared duration of drainage, showing that 48 hours of drainage was as effective as 96 hours of drainage. Conclusions Postoperative drainage has the advantage of reducing recurrence without increasing complications. The use of a bur hole or twist drill does not seem to make any significant difference in recurrence rates or other outcome measures. It seems that irrigation may lead to a better outcome. These results may lead to more standardized procedures.

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Irrigation vs. closed drainage in the treatment of chronic subdural hematoma

Cited by 68 publications

References 19 publications

Treatment of chronic subdural hematoma: 5-year clinical experience

Treatment of chronic subdural hematoma: 5-year clinical experience

A Comparative Study of Treatments for Chronic Subdural Hematoma: Burr Hole Drainage versus Burr Hole Drainage with Irrigation

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

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