The Treatment of Chronic Subdural Hematoma by Burr-Hole Craniostomy with or without Irrigation and Closed-System Drainage

Abstract

We studied to ascertain the efficacy of irrigation of hematoma through burr holes and closed-system drainage for the treatment of chronic subdural hematoma(CSDH). Twenty-two patients were treated by burr-holes irrigation and drainage (Group A) and 24 patients by a burr hole and drainage(Group B). A closed-system drainage was placed within the hematoma cavity for 1 to 2 days. Computerized tomography scans were obtained before and after surgery to assess the maximum thickness of hematoma, residual cavity and accumulation of air. Twenty-one(95%) patients in Group A and 21(88%) in Group B had a functional recovery. Only one patient in each group suffered a recurrence. The reduction rate of the hematoma cavity was 45.4% in Group A and 52.1% in Group B. In contrast, accumulation of air in the subdural space after surgery was present in 13(59%) patients in Group A and in only 3(13%) in Group B(p<0.01). One patient in Group A developed symptomatic subdural tension pneumocephalus. These findings indicate that the irrigation of hematoma through burr holes results in an accumulation of air into the subdural space and produces a tension pneumocephalus. We conclude that the irrigation of hematoma is unnecessary for the treatment of CSDH.