The Predicting Factors for Recurrence of Chronic Subdural Hematoma Treated with Burr Hole and Drainage

Song, Dae Hyo; Kim, Young Soo; Chun, Hyoung Joon; Yi, Hyeong Joong; Bak, Koang Hum; Ko, Yong; Oh, Sea Cheon

doi:10.13004/kjnt.2014.10.2.41

Cited by 43 publications

(40 citation statements)

References 30 publications

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“…Epidemiological profiles were similar to those expected, with the exception of the mean age being greater than usually observed (63 years old) 2,7 . Presenting symptoms were, respectively, motor deficit (39.4%), headache (9.1%) and impairment of consciousness/mental confusion (8.4%), all in agreement with those described in the literature 3,27 . Surgical treatment is the best therapeutic option for CSDH 10 .…”

Section: Discussionsupporting

confidence: 89%

“…Most patients have complete remission of symptoms when diagnosed and treated early 22,23,24 . Conditions such as the use of anticoagulants and antiplatelets, chronic alcohol use and the use of cerebrospinal fluid shunts (ventriculoperitoneal shunts) increase both the incidence and rates of complications and recurrences 25,26,27 , and may be important determinants of patient prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Since it is a procedure with few operative risks and with good efficacy, a burr hole has been the preferred choice for most neurosurgeons 25,26,27 , and is the most-used technique. A burr hole is associated with reoperation rates ranging from 9.25% to 26.5%…”

Section: Discussionmentioning

confidence: 99%

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The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

Heringer

Sousa

Oliveira

et al. 2017

Arq. Neuro-Psiquiatr.

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Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

Heringer

Sousa

Oliveira

et al. 2017

Arq. Neuro-Psiquiatr.

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“…BHD is the most widely used technique, and has a satisfactory outcome, but has a CSDH recurrence rate of 4-38% [6][7][8][9][10][11][12]. Several studies have revealed that predictors of CSDH recurrence following surgical evacuation include age, sex, antiplatelet or anticoagulation therapy, Glasgow Coma Scale (GCS), diabetes mellitus, hypertension, bilateral hematoma, preoperative hematoma size, midline shift, hematoma density, intraoperative irrigation, type of surgery and postoperative air collection, however, these results are inconsistent [7,[13][14][15][16][17][18][19]. The more controversial risk factors include surgery type and intraoperative irrigation [9,10,[20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Chen

Wang

et al. 2020

BMC Neurol

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Background: To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods: A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results: A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions: This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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“…Although we used endoscopic surgery in all types of CSDH, patients with a higher risk of recurrence could be good candidates for such procedures. Patients on antiplatelet therapy, 51,52 organized hematoma, 53 solid clot, [53][54][55] large size hematomas, 56 CSDH with thick membrane, 57,58 septate hematomas, 52,59,60 a lesser percentage of hematoma drainage, 52,55 more postoperative air in the hematoma cavity, 61,62 and recurrent CSDH 21 are at high risk of recurrences. Such patients could benefit more by endoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

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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The Predicting Factors for Recurrence of Chronic Subdural Hematoma Treated with Burr Hole and Drainage

Cited by 43 publications

References 30 publications

The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Endoscopic Management of Chronic Subdural Hematoma

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