To Drain or Two Drains: Recurrences in Chronic Subdural Hematomas

Reply

“…We also recognize the great value and contribution of the randomized controlled trial (RCT) performed in 2009 by Santarius et al 4 , in which the use of a drain was effectively associated with a lower rate of recurrence of CSDH and lower rate of patient mortality 4 . The same author has a commendable list of publications in this regard, reinforcing the advantages of using a drain 5 .However, it is almost a decade since the publication of the RCT by Santarius et al, which was the sole RCT discussing this theme at the time, and more recently, some newer, respectable publications have brought to our attention the fact that the same results might not be achieved worldwide.In this regard, Gernsback et al 7 and Sivaraju et al 8 have recently reported, in two different respectable neurosurgical journals, that their results did not match with those found by Santarius et al 4 . In both cases, the use of a drain did not affect recurrence rates 7,8 .…”

“…In this regard, Gernsback et al 7 and Sivaraju et al 8 have recently reported, in two different respectable neurosurgical journals, that their results did not match with those found by Santarius et al 4 . In both cases, the use of a drain did not affect recurrence rates 7,8 . We must highlight that neither of these recent studies were RCTs 7,8 .…”

“…Teles and Kraemer 1 on our article "The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas (CSDH)". We really appreciated their attention to our study and contribution to current statements on CSDH treatment.We agree that standard management of this condition still remains controversial in its pre-operative, intraoperative and postoperative details 1,2,3,4,5,6,7,8 . This may be due to complex pathophysiological characteristics of this disorder and distinct patient profiles in different health institutions.…”

Coleções subdurais crônicas não infecciosas: Aspectos epidemiológicos e resultados em 581 pacientes consecutivos submetidos a tratamento cirúrgico

“…Importante destacar que do total de 530 procedimentos realizados, 28 foram em pacientes que necessitaram de reoperação para tratamento de recidiva, porém até neste grupo a trepanação foi o procedimento mais realizado, representado por pouco mais de 86% dos casos. Gernsback et al, 2016 (10) em artigo publicado na revista World Neurosurgery, encontraram taxa de recidiva em 6,1% dos casos. Aspecto interessante observado pelos referidos autores foi o fato dos pacientes com doença hepática apresentarem maior probabilidade de recorrência.…”

“…Entretanto, outras comorbidades não tiveram aumento significativo. A taxa de recorrência é semelhante a encontrada em nosso trabalho, onde ocorreram 5,2% de recidivas (10) . O HSD é uma coleção semelhante ao líquor: apresentando conteúdo líquido claro, xantocrômico ou levemente hemorrágico.…”