Abstract
ObjectiveThe traditional methods for managing symptomatic chronic subdural hematoma (CSDH) at our hospital include evacuation via single burr-hole irrigation with continuous closed subdural drainage (SBID). The single burr-hole aspiration and irrigation technique with continuous closed subdural drainage (SBAID) is an attractive alternative method. The goal of this study was to evaluate the radiographic and clinical outcomes of SBAID compared with traditional SBID methods.MethodsA database of 51 CSDH patients treated with the SBAID method and 35 CSDH patients treated with the SBID method was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcomes were collected. Predictors of recurrence requiring reoperation and other outcomes were analyzed.ResultsCompared to the patients in the SBID group, the patients in the SBAID group had a shorter mean duration of surgery (56.6±5.6 minutes vs 59.5±4.8 minutes, respectively, P=0.02); a shorter mean interval from procedure to discharge (6.2±1.2 days vs 6.8±1.3 days, respectively, P=0.046); no significant difference in preoperative hematoma volume (106.4±21.7 cm3 vs 101.3±16.3 cm3, respectively, P=0.25); and a smaller subdural space volume 48 hours after the operation (43.6±7.4 cm3 vs 47.4±9.1 cm3, respectively, P=0.03).In addition, symptomatic hematoma recurrence developed in one patient in the SBAID group and five patients in the SBID group (P=0.03). The in-hospital mortality rates of the SBAID and SBID groups were 2% (1 of 51) and 6% (2 of 35), respectively; this difference was not statistically significant (P=0.35).ConclusionsThe SBAID method results in a remarkably low recurrence rate and good outcomes. This method should be considered for patients presenting with symptomatic CSDHs.
Highlights
Chronic subdural hematoma (CSDH) is one of the most commonly encountered diseases in clinical neurosurgical practice
A database of 51 CSDH patients treated with the SBAID method and 35 CSDH patients treated with the SBID method was compiled, and a retrospective chart review was performed
Symptomatic hematoma recurrence developed in one patient in the SBAID group and five patients in the SBID group (P=0.03)
Summary
Chronic subdural hematoma (CSDH) is one of the most commonly encountered diseases in clinical neurosurgical practice. Multiple surgical techniques have been frequently described in the literature, including closed-system drainage after a one- or two-burr hole craniostomy [8,9], twist-drill craniostomy with or without drainage, craniotomy, and evacuation of the CSDH and its surrounding membranes [10], and many additional but less commonly practiced methods [11,12,13]. There is no universal consensus regarding the optimal surgical procedure for treating CSDH [14]. CSDH is usually not a life-threatening condition, its
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