Burr-hole Drainage Of Chronic Subdural Hematoma Research Articles

Effect of drain placement on postoperative radiology following burrhole drainage of chronic subdural hematoma

Objective: The effect of drain placement on postoperative radiology following burrhole drainage of chronic subdural hematoma (ChSDH) is a topic that has been rarely addressed in literature. The present study was designed to study the effects of postoperative drain placement on different radiological parameters following ChSDH evacuation. Materials & Methods We studied the data of 117 patients operated with burrhole drainage of ChSDH and divided the patients into two groups. In the first group a postoperative subdural drain had been placed while the second was the no drainage group. The pre- and postoperative CT brain of the patients were analyzed and the change in the hematoma width and midline shift was noted. Results: In the drainage group 12 (18.2%) patients had recurrence. In the no drainage group also 12 (23.5%) patiens had recurrence. The difference in recurrence wasn’t significant (p=0.4775). The mean change in the width of the hematoma was 0.95 ± 0.37 mm in the drainage group, while in the no drainage group this was 0.51 ± 0.37 mm. This difference was very significant (p < 0.0000001). The mean change in the midline shift was 0.51 ± 0.21 mm in the drainage group, while in the no drainage group this was 0.26 ± 0.22 mm and this difference again was very significant (p < 0.0000001). Conclusion The placement of a subdural drain following burrhole evacuation of ChSDH leads to significantly decreased postoperative hematoma width and mass effect providing the radiological corroboration for drain placement.

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

BackgroundTo investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage.MethodsA multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019.ResultsA total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH.ConclusionsThis study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Effect of Antithrombotic Therapy on Development of Acute Subdural Hematoma After Burr Hole Drainage of Chronic Subdural Hematoma.

To evaluate the relationship between the time from cessation of anticoagulant/antiplatelet medication to surgery and risk of postoperative acute subdural hematoma (ASDH) after burr hole drainage of chronic subdural hematoma (CSDH). A retrospective study of patients who underwent burr hole drainage of CSDH between December 2014 and December 2019 was performed. Demographic and clinical data regarding age, gender, medication (antithrombotic therapy), smoking, daily alcohol consumption, history of head trauma, presenting symptoms, and neurological examination were collected from the medical records. Patients were divided into 3 groups based on time from referral to surgery: < 24 hours, 24?72 hours, and > 72 hours. One hundred seventeen patients underwent burr hole drainage of CSDH during the 5-year study period. Seventy-two patients were male (61.5%) and 45 were female (38.5%). Mean age was 70.5 ± 7.2 years. Postoperative ASDH occurred in 2 of the 32 patients (6.3%) who were not taking antithrombotic medication and 6 of the 85 patients (7.1%) who were taking antithrombotic medication. The difference was not significant (p=0.797). The risk of ASDH after burr hole drainage of CSDH was not affected by antithrombotic medication. Although the literature suggests that antiplatelet and anticoagulant drugs to be discontinued between 5 and 7 days before surgery, our results showed that acute hemorrhage was not detected in any patient who underwent surgery more than 72 hours after referral.

Prophylactic Use of Antiepileptic Drug (Phenytoin) in Preventing Early Postoperative Seizure in Patients with Chronic Subdural Hematoma: A Randomized Control Trial

Abstract Introduction Antiepileptic drug (AED) therapy has been used prophylactically in various centers in patients with chronic subdural hematoma (CSDH) after surgical evacuation, although the benefit is unclear. Materials and Methods In this randomized controlled trial, patients with CSDH undergoing burr hole drainage were enrolled into two groups—one which received prophylactic phenytoin and the other without the drug use. Their clinical presentation, imaging findings and postoperative complications were analyzed. Primary objective of the study was to assess the efficacy of phenytoin in the reduction of early postoperative seizure. Results A total of 54 patients were enrolled in the study and randomized into two groups. Twenty-seven patients were assigned into the phenytoin group while another 27 patients to the “no phenytoin” group. Analysis of all patients in the no phenytoin group and those in the phenytoin group with therapeutic serum phenytoin levels were done. The incidence of postoperative seizure was 5.7%; and all patients who had seizures were in the no phenytoin group. This, however, was not statistically significant (p = 0.262). Two out of 25 patients on phenytoin (8%) developed adverse drug reactions. Conclusion Incidence of postoperative seizure in patients undergoing burr hole drainage for CSDH was low. Routine prophylactic use of AED, did not reduce seizure in early postoperative period.

Variation of Ventricular Size after Surgical Treatment of Chronic Subdural Hematoma.

Background:Surgical removal is the treatment of choice for chronic subdural hematoma (CSDH). Despite clinical improvement after surgery, computed tomography (CT) scan control often showed residual collection, which may discuss the possibility of failed surgery. The aim of this study is the assessment of ventricular size before and after surgery and to study its relation with residual hematoma.Methods:In this prospective study (2013-2016), 63 patients who had burr-hole drainage of CSDH were sequentially allocated to either two groups; Group 1 with CT scan control under the 3rd day of surgery and Group 2 with delayed CT scan control (from 4th to 7th day). Linear measure of ventricular size was assessed by Evans’ index. We reviewed and analyzed the data between both groups.Results:There were 33 patients in Group 1 and 30 patients in Group 2. Preoperatively, the average thickness of hematoma was 20.5 mm in Group 1 versus 19.9 mm in Group 2 (P = 0.67); the mean midline shift was 8.5 mm in each group; Evans’ index was 26.7% in Group 1 and 27% in Group 2 (P = 0.7). Postoperatively, the mean thickness of the residual hematoma was 7.7 mm in Group 1 and 8.4 mm in Group 2 (P = 0.57); the mean midline shift was 3.3 mm in Group 1 and 1.9 mm in Group 2 (P = 0.08); Evan's index was 28.5% in Group 1 and 32.1% in Group 2 (P = 0.002).Conclusion:The adoption of Evans’ index, for assessing the variation of ventricular size after surgery, by neurosurgeons appears to be a good and simple method for evaluation and following the success of surgical removal of CSDH, despite the observation of some residual collection in early CT scan control.

Value of routine early post-operative computed tomography in determining short-term functional outcome after drainage of chronic subdural hematoma: An evaluation of residual volume

Background:Computed tomography (CT) scans are widely used in managing chronic subdural hematoma (CSDH). Factors that determine early post-operative volume have not been examined. The value of routine early post-operative residual volume have not been evaluated. Our study aims to compare pre-operative and early post-operative CT findings to determine the factors affecting residual hematoma and evaluate if early post-operative CT scans are useful in the management of CSDH.Methods:Forty-three patients who underwent burr hole drainage of unilateral CSDH from August 2006 to January 2013 and had routine post-operative CT scans within 48 hours of surgery were selected. Data regarding age, sex, neurological deficit, Glasgow Coma Scale (GCS), pre-existing medical conditions, use of antiplatelets or anticoagulation, operative time, usage of drains, and number of burr holes were obtained. The pre-operative CSDH volume, CSDH density, and midline shift were measured. Residual volume was calculated from early post-operative CT scans. Clinical outcome was evaluated with Glasgow Outcome Scale (GOS) at the time of discharge. Statistical analysis was performed to look for correlation between the pre-operative factors and residual volume, and the residual volume and GOS.Results:Pre-operative volume was found to correlate significantly with post-operative residual volume. There was no significant correlation between all other pre-operative factors and residual volume. There was also no correlation between residual volume and GOS at discharge.Conclusion:Routine post-operative CT brain for burr hole drainage of CSDH may be unnecessary in view of the good predictive value of pre-operative volume, and also because it is not predictive of the clinical outcome.

Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

Burr hole drainage has been widely used to treat chronic subdural hematoma (CSDH). However, the incidence of recurrent CSDH varies from 3.7 to 30% after surgery. The authors attempted to elucidate the risk factors associated with the recurrence of CSDH in one burr hole drainage technique. A total of 255 consecutive cases who underwent one burr hole drainage for CSDH were included in this study. Twenty-four patients (9.4%) underwent a repeated operation because of the recurrence of CSDH. We analyzed retrospectively the demographic, clinical and radiologic factors associated with the recurrence of CSDH. In this study, two risk factors were found to be independently associated with the recurrence of CSDH. The incidence of CSDH recurrence in the high- and mixed-density groups was significantly higher than those in the low- and iso-density groups (p<0.001). Bleeding tendency such as in leukemia, liver disease and chronic renal failure was also significantly associated with recurrence of CSDH (p=0.037). These results suggest that high- and mixed- density shown on computed tomographic scan was closely relates with a high incidence of recurrence. Therefore, the operation could be delayed in those cases unless severe symptoms or signs are present. Reoperation using the previous burr hole site is a preferred modality to treat the recurrent CSDH.