A comparative study of treatment of chronic subdural hematoma — burr hole drainage versus continuous closed drainage

Abstract

The incidence of chronic subdural hematoma (CSDH) is about 5 per 100000 per year in the general population & is higher for those aged 70 years and older. The recurrence rates after the initial drainage procedure range from 5% to 30%, and the treatment strategies for reducing the recurrence rates are the focus of the current research. The aim of this study was to evaluate the results of treatment, especially in terms of recurrence, following surgery for the CSDH obtained with “one time burr-hole drainage” (OTD) vs “continuous closed drainage”, using subdural drain (CD). Patients with diagnosis of CSDH, operated at our center during the period from September 2008 through March 2010 were prospectively studied. The patients randomized to two arms, group 1 underwent OTD and group 2 underwent CD. Patients were analyzed by evaluating their hospital clinical, laboratory and radiological data. Recurrence of CSDH was defined as reappearance of clinical symptoms after a minimum period of one month post surgery, with evidence of CSDH in the same site on plain CT head. Clinical outcome was measured using Glasgow outcome score (GOS). Fifty one patients with chronic subdural hematoma were randomized. OTD was done in 26 patients and 25 patients underwent CD. Males outnumbered the females (45 vs. 6). Age ranged from 17 to 85 years (mean 53 ± 15 years). While 47 patients had GCS of 9–15, remaining 4 (7%) had GCS of 8 or less. Deranged coagulation profile was recorded in 9 patients. Imaging showed 9% patients with bilateral CSDH and in 14% patients had isodense CSDH. Hospital stay ranged from 2 to 24 days (mean 3 ± 4 days). Patients with deficit at admission usually had neurological deficit at discharge. GOS at 6 months was better in continuous drainage group (48% vs 44%) but had more complications. Symptomatic recurrence was noticed in 10 (19%) patients; recurrence was lower in the patients in CD group (n= 4, 16%) than in the OTD group (n= 6, 23%) but this was not statistically significant (p value - 0.60). Our study shows that continuous drainage of chronic subdural hematoma does not offer any advantage over simple burr hole drainage.