Abstract
BackgroundChronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. In surgical management of CSDH, there is a lack of standardized guidelines concerning surgical techniques and a lack of consensus on which technique(s) are optimal. Neurosurgical centers have shown a wide variation in surgical techniques. The purpose of this study was to compare two different surgical techniques, one burr hole craniostomy with an active subgaleal drain (BHC) and minicraniotomy with a passive subdural drain (MC).MethodsWe conducted a multicenter retrospective cohort study at two neurosurgical centers in Sweden which included patients with unilateral CSDHs that received surgical treatment with either BHC or MC. The primary outcomes in comparison of the techniques were 30-day mortality, recurrence rate, and complications according to the Landriel Ibañez grading system for complications.ResultsA total of 1003 patients were included in this study. The BHC subgroup included 560 patients, and the MC subgroup included 443 patients. A 30-day mortality when comparing BHC (2.3%) and MC (2.7%) was similar (p = 0.701). Comparing recurrence rate for BHC (8.9%) and MC (10.8%) showed no significant difference (p = 0.336). We found that medical complications were significantly more common in the MC group (p = 0.001). Surgical complications (type IIb) was also associated with the MC group (n = 10, p = 0.003). Out of the 10 patients with type IIb complications in the MC group, 8 had postoperative acute subdural hematomas.ConclusionsBHC was comparable to MC concerning 30-day mortality rate and recurrence rates. We did, however, find that MC was significantly associated with medical complications and serious surgical postoperative complications.
Highlights
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases with a reported incidence of 8 to 14 per 100,000 person-years [14]
The increasing incidence already has a socio-economic impact on current healthcare systems, which together with recurrence rates estimated around 10–20% and a non-negligible surgical morbidity adds to the complexity of CSDH management [1, 4, 14]
The aim of this study was to assess burr hole craniostomy with active subgaleal drain in comparison to minicraniotomy with passive subdural drain with an emphasis on recurrence rate, mortality, and risk of complications
Summary
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases with a reported incidence of 8 to 14 per 100,000 person-years [14]. The most common surgical technique is considered to be the burr hole craniostomy (BHC) where 1–2 burr holes are drilled. Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. The purpose of this study was to compare two different surgical techniques, one burr hole craniostomy with an active subgaleal drain (BHC) and minicraniotomy with a passive subdural drain (MC). Methods We conducted a multicenter retrospective cohort study at two neurosurgical centers in Sweden which included patients with unilateral CSDHs that received surgical treatment with either BHC or MC. Out of the 10 patients with type IIb complications in the MC group, 8 had postoperative acute subdural hematomas. Find that MC was significantly associated with medical complications and serious surgical postoperative complications
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