Abstract
BackgroundChronic subdural hematoma (cSDH) is predicted to become the most common intracranial neurosurgical condition by 2030. Recurrence is estimated between 5-15%, and the use of a surgical drain is associated with lower recurrence rates. The authors present their experience with six patients undergoing cSDH evacuation with an irrigating drainage system, comprising the largest single-institution group in the United States (US).MethodsIRB-approved, retrospective chart review was performed for six patients who underwent irrigating surgical drain placement during cSDH evacuation. Outcome measures included device settings and duration of the irrigating drain, postoperative length of stay, neurological status at follow-up, and hematoma recurrence.ResultsThere were no recurrences noted within this group at last follow-up, with an average follow-up length over three months. The average postoperative length of stay was 2.67 ± 0.51 days. Patients were drained on average for 1.41 ± 0.49 days at 0cm water, irrigating at 55.25 ± 46.44cc/hr. On postoperative day one, average hematoma size and midline shift (MLS) reduction were respectively 13.43 ± 3.31mm and 5.71 ± 1.33mm. No device-related complications were noted.ConclusionThe authors' early experience with this irrigating drainage device demonstrates that it is safe and effective for this population. Although this is a preliminary study on a small sample size, the excellent results warrant further investigation and establishment of a standard protocol to compare against current treatment regimens.
Highlights
Subdural hematoma is common in the elderly population partly due to increased use of anticoagulants, decreased brain volume, and increased fall risk [1,2]
A cohort study by Sjavik et al compared continuous irrigation and drainage with passive subdural drainage (SDD) and active subgaleal drainage [24]
It is hypothesized that irrigating drainage systems may reduce hematoma recurrence by improving cerebral re-expansion, a known risk factor for recurrence
Summary
Subdural hematoma is common in the elderly population partly due to increased use of anticoagulants, decreased brain volume, and increased fall risk [1,2]. An increasing body of evidence supports the use of surgical drains after hematoma evacuation as a means to lower recurrence rates [7,1517]. Chronic subdural hematoma (cSDH) is predicted to become the most common intracranial neurosurgical condition by 2030. Recurrence is estimated between 5-15%, and the use of a surgical drain is associated with lower recurrence rates. The authors present their experience with six patients undergoing cSDH evacuation with an irrigating drainage system, comprising the largest single-institution group in the United States (US)
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