Burr-hole Irrigation Research Articles

Extensive Roles and Technical Advances of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma.

Chronic subdural hematoma (CSDH) is a common pathology that typically affects the elderly in Japan, an aging society. Burr-hole irrigation is the standard treatment, but middle meningeal artery (MMA) embolization is a minimally invasive alternative. MMA embolization for CSDH has frequently been reported in recent years, and many technical innovations to improve clinical outcomes have been described. Embolic materials reaching more distally are found to avoid recurrences after MMA embolization. As a result, various studies have described the superiority of embolizing the anterior and posterior branches of the MMA, the advantages of embolic materials reaching beyond the midline, and a high degree of distal penetration using a "sugar rush technique" in which 5% soluble glucose is injected through an intermediate catheter during MMA embolization. Radiographically, reports have described the importance of a "bright falx" sign obtained by infiltrating embolic material beyond the midline and post-embolization enhancement of the dura, capsular membrane, septations, and subdural hematoma fluid as indicators of the spread of embolic materials. This review provides an overview of the current status and future challenges in MMA embolization for CSDH, focusing on technical aspects to improve clinical outcomes.

Recurrent Subdural Hematoma: An Institutional Experience.

Background Chronic subdural hematoma (CSDH) is a common neurosurgical problem, which offers a good outcome following surgery. In many cases, burr hole irrigation and drainage under local anesthesia can provide satisfactory results. However,recurrencecan be a cause for concern for both the surgeon and the patient. While recurrence is not a frequent phenomenon, studies have reported rates of up to 31.6%. Aims and objectives In this study, our objective is to examine a comprehensive range of potential risk factors and provide valuable insights into identifying patients at a higher risk of recurrence to aid in surgical decision-making. Methodology This study employed a prospective and retrospective design, conducted between 2017 and 2021, at Sri Ramachandra Institute of Higher Education and Research. The study received ethical approval from the Institutional Ethics Committee. The research aimed to assess patients who underwent surgery for CSDH, with a particular focus on those who experienced recurrence. Results The average age of patients with recurrence was 71.5 years compared to 65.2 years in the no-recurrence group, but this difference did not show a significant statistical correlation. A significant male predominance was observed, with 27 men and four women affected (out of a total of 147 men and 73 women in the study), resulting in a statistically significant p-value of 0.01.On multivariate analysis, heterogenous subtypes were a significant predictor of recurrence (OR: 8.88, 95% CI: 6.96-16.54, p = 0.01).The mean midline shift in those with recurrence was 11.4 mm compared to 7.09 mm in those without recurrence. This was a statistically significant correlation with a p-value of 0.02.Regarding those with recurrence, 24 patients underwent evacuation using two burr holes, with one placed in the frontal region and another in the parietal region. All of these patients had a subdural drain placed, which was removed on postoperative day 2. The remaining eight patients underwent a mini-craniotomy for evacuation.We had four cases of refractory CSDH, all of whom underwent the second evacuation using burr holes. Three of them underwent evacuation via craniotomy, while the family of the fourth patient did not give consent for the procedure. Conclusion Patient-related factors such as gender, bilateral presentation, and the presence of hypertension and radiological factors such as the presence of heterogenous subtype and a significant midline shift are clues towarda higher chance of recurrence.

Time and Influencing Factors to Chronic Subdural Hematoma Resolution After Middle Meningeal Artery Embolization

We sought to describe the resolution time of chronic subdural hematoma (CSDH) after middle meningeal artery embolization (MMAE) and potential variables that may affect hematoma resolution. A retrospective analysis was performed on CSDH patients between December 2018 and December 2021. Patient characteristics, radiologic manifestations, and data of hematoma resolution were recorded. Univariate and multivariate analyses were conducted to identify predictors of CSDH resolution time. A total of 53 patients were enrolled including 53 hematomas. Only 1 participant relapsed and did not require surgical evacuation. Hematoma resolution was observed in 27 (50.9%) at 4 months and 48 (90.6%) cases at the last radiologic follow-up. The median MMAE-to-resolution time was 19 weeks (interquartile range: 8-24). The burr-hole irrigation+ MMAE group showed faster hematoma resolution than MMAE alone during early follow-up periods, but no significant difference was found at 6 months. Increased thickness of residual hematoma, excessive postoperative midline shift, high-density hematoma, mixed-density hematoma, separated hematoma, and anticoagulant or antiplatelet agents used were predictive of nonresolution at 4 months as determined by univariate analysis, whereas anticoagulant or antiplatelet agents used and high-density hematoma were not significant on multivariate analysis. No significant association was noted between hematoma resolution and comorbidities or other hematoma radiologic features. MMAE is an effective and minimally invasive treatment for CSDH with a lower recurrence rate. The median resolution time of CSDH following MMAE was 19 weeks (interquartile range: 8-24). Burr-hole irrigation contributed to early hematoma resolution but had no significant effect at 6 months. In addition, residual hematoma thickness, postoperative midline shift, and specific type of hematoma were associated with delayed hematoma resolution at 4 months.

Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma.

ObjectiveAlthough liver diseases have already been identified as a risk factor for increased recurrence and mortality in patients with chronic subdural hematoma (CSDH), the association between subclinical liver disease, specifically liver fibrosis (LF), and CSDH remains unknown. In the present study, we aimed to investigate the association between the LF scores and CSDH recurrence.MethodsWe retrospectively analyzed consecutive patients with CSDH who underwent burr-hole irrigation in the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2018. The clinical data were collected, and the LF scores were calculated including aspartate aminotransferase–platelet ratio index (APRI), fibrosis-4 (FIB-4), and Forns index. Multivariable logistic regression analysis was applied to identify the association between the LF scores and CSDH recurrence, and Cox regression model and Fine–Gray competing risks model were performed to calculate hazard ratios (HRs) for CSDH recurrence based on time-to-event outcomes. The C-statistic, the integrated discrimination improvement (IDI), and the net reclassification improvement (NRI) evaluated the additive value of the LF scores to predict the recurrence of CSDH.ResultsA total of 419 patients with CSDH were included, hematoma recurrence was observed in 62 patients (14.80%) within 1 year after surgery. The LF scores were significantly higher in those who recurred, whereas the standard hepatic assays were mostly normal. The patients were assigned to groups of high and low LF scores based on the validated cut-offs; compared with the subjects with low scores, those with high score levels had significantly higher recurrence rates. After adjusting for potential confounders, the LF scores were independently associated with CSDH recurrence, multivariable-adjusted HRs (95% CI) for those with higher levels of APRI, FIB-4, and Forns score were 4.32 (1.37–13.60), 2.56 (1.20–5.43), and 2.02 (1.07–3.79) for the recurrence of CSDH, respectively. Moreover, adding the APRI to the conventional model improved the C-statistic from 0.731 to 0.763, with an NRI and IDI of 7.50 and 1.35%, respectively. Two further commonly-used LF score indices (FIB-4 score and Forns index) yielded comparable results.ConclusionsThe data from this study first indicated that the high LF scores were significantly associated with the recurrence of CSDH and that careful follow-up in these patients may be needed.

Postoperative recurrence of chronic subdural hematoma is more frequent in patients with blood type A.

Because of an aging society, the incidence of chronic subdural hematoma (CSDH) is increasing. This lesion is treated with simple burr hole irrigation, but one of the major issues is that CSDH frequently recurs. ABO blood type may be associated with a bleeding tendency and inflammation. However, its association with the recurrence of CSDH remains unknown. Therefore, the authors of the present study aimed to retrospectively investigate the association between ABO blood type and CSDH recurrence. The authors retrospectively analyzed symptomatic CSDHs in 425 cerebral hemispheres of 376 patients who had undergone surgical treatment with irrigation of the hematoma via burr holes at their institution from January 2011 to September 2019. Among these were 366 CSDHs in 320 patients whose ABO blood type had been determined and who were included in this study. In the study, 307 patients with CSDHs in 350 hemispheres were followed up postoperatively until the disappearance of the CDSH or for at least 3 months. Recurrence of CSDH was observed in 37 patients (10.6%) after surgical treatment. Blood type A was found to be significantly associated with CSDH recurrence compared to non-A blood types: 24 of 153 CDSHs (15.7%) versus 13 of 197 CDSHs (6.6%) (p = 0.008). In the multivariable regression analysis, blood type A, in addition to thrombocytopenia, was a significant independent predictor of the recurrence of CSDH. The study results showed that blood type A is an independent risk factor for the postoperative recurrence of CSDH and that careful follow-up in these patients may be needed.

Local Skull Thinning is One of Risks for the Ruptured Arachnoid Cysts With Chronic Subdural Hematoma in Adults: Thirty-two Clinical Reports.

Chronic subdural hematomas (CSDHs) in young people are uncommon, rupture of arachnoid cysts (ACs) is one of the reasons for young patients. The detailed features of CSDHs associated with ACs remain poorly understood. The objective of this study is to analyze the characteristics of risks for the rupture of ACs with CSDH in Adults. The CT scans of 1231 patients who were diagnosed as CSDH were reviewed between Jan 2009 and Jan 2019 in the Department of Neurotrauma in Beijing Tian Tan Hospital, Capital Medical University/China National Clinical Research Center for Neurological Diseases. The clinical features, treatments, and prognosis of 32 patients with ACs were analyzed. Ruptured ACs with CSDH were diagnosed in 32 patients in 1231 CSDH cases, which account for 2.60%. Headache was the commonest presenting symptom. According to the Takizawa' classification, there were 22 cases for Type A, 9 for Type B and 1 for Type C. Thinning or external convex of the calvarium was demonstrated in 17/32 cases (53.1%). Thirty-one patients were treated with burr hole irrigation. Favorable outcomes were achieved in all patients. The presence of ACs should be taken into consideration in young and middle-aged patients with CSDH. For those patients were found ACs in conventional medical examination, especially those whose imaging examinations demonstrated thinning or external convex of the calvarium, it was crucial to remind them to avoid the occurrence of traumatic brain injury (TBI). Burr hole irrigation is still the preferred treatment for ruptured ACs with CSDH.

Efficacy of the Direct Aspiration-Irrigation Maneuver for the Treatment of Chronic Subdural Hematoma: A Single Hospital's Experience.

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.

Chronic subdural hematoma in patients over 65 years old: Results of using a postoperative cognitive evaluation to determine whether to permit return to driving.

Background: Chronic subdural hematoma (CSDH) is usually associated with good recovery with burr hole irrigation and postoperative drainage under local anesthesia. In Japan, traffic accidents by the elderly drivers over 65 years old are severely increasing, and there is no consensus on whether or not to return to driving after CSDH treatment. We perform a postoperative cognitive assessment. We retrospectively investigated the return-to-driving rate and associated factors.Methods: Of the 45 patients over 65 y.o. and who had usually driven, 30 patients wished to drive again. We performed tests composed of Mini-Mental State Examination (MMSE), line cancellation and line bisection task, Kohs block design test, trail making test (TMT)-A and B, Kana-hiroi test, Rey-Osterrieth complex figure test, and behavioral assessment of the dysexecutive syndrome, in order. When all tests’ scores were better than the cutoff values, we let patients drive again. When some of the scores were worse than the cutoff values, we reevaluated the patients at the outpatient every month. If the patients’ scores could not improve at the outpatient, we recommended them to stop driving.Results: Nineteen of 30 patients could return to driving. Worse MMSE, Kohs block design test, TMT-A, TMT-B scores, higher age, dementia, or consciousness disturbance as chief complaints were associated with driving disability.Conclusion: CSDH is known as treatable dementia. However, we should perform an objective cognitive assessment before discharge because only 63% of the patients over 65 y.o. who wished to drive could return to driving.

A Global Neurosurgery Approach to Reducing the Burden of Traumatic Acute Subdural Hematoma: A Narrative Review

This narrative review highlights the importance of timely neurosurgical interventional after a person suffers from a motor vehicle accident. Acute subdural hematomas account for 30-70% of traumatic brain injuries. The paper discusses the global burden of TBI as the forerunner of the public health problem, about 50% of the world population will acquire TBI once in their lifetime. There is a severe deficit in the global workforce to meet the neurotrauma, which becomes worse in low-income and middle-income countries especially in sub-Saharan and Southeast Asia. Indication for neurosurgical intervention depends upon several parameters such as clot thickness exceeding 10mm, midline shift greater than 5mm; which possibly increases intracranial pressure (ICP) more than 20 mmHg as a result of mass effect, and abnormal pupillary response such as asymmetrically unilateral or bilaterally dilated. Surgical procedures vary with different circumstances, which include mainly craniotomy, decompressive hemicraniectomy, and burr hole irrigation. Comparison of the outcomes of decompressive craniectomy and craniotomy are discussed under the DECRA and RESCUEicp trials. Robotic telepresence, task-shifting, and task-sharing are alternative interventional strategies and practices to carry various neurosurgical procedures by non-neurosurgeons in LMICs. Reintroduction of the survivors of MVA acquiring TBI into the society is a prime concern, therefore, various neurorehabilitation strategies are discussed. The barriers to becoming neurosurgeons by the young doctors as the core principle of infrastructure, governance by bodies such as World Health Organization and its universal health coverage initiative, and World Federation of Neurosurgical Societies efforts to balance the disparity in LMICs are discussed.

Elevated blood urea nitrogen is associated with recurrence of post-operative chronic subdural hematoma

BackgroundChronic subdural hematoma (CSDH) is fundamentally treatable with about a 2–31% recurrence rate. Recently, there has been renewed interest in the association between Blood Urea Nitrogen (BUN) and intracranial lesion. Therefore, this paper attempts to show the relationship between BUN and CSDH recurrence.MethodsA total of 653 CSDH cases with Burr-hole Irrigation (BHI) were enrolled from December 2014 to April 2019. The analyzed parameters included age, gender, comorbidities, laboratory investigations, medication use and hematoma location. The cases were divided into recurrence and non-recurrence groups while postoperative BUN concentration was further separated into quartiles (Q1 ≤ 4.0 mmol/L, 4.0 < Q2 ≤ 4.9 mmol/L, 4.9 < Q3 ≤ 6.4 mmol/L, Q4 > 6.4 mmol/L). Restricted cubic spline regressions and logistic regression models were performed to estimate the effect of BUN on CSDH recurrence.ResultsCSDH recurrence was observed in 96 (14.7%) cases. Significant distinctions were found between recurrence and non-recurrence groups in postoperative BUN quartiles of cases (P = 0.003). After adjusting for the potential confounders, the odds ratio of recurrence was 3.069 (95%CI =1.488–6.330, p = 0.002) for the highest quartile of BUN compared with the lowest quartile. In multiple-adjusted spline regression, a high BUN level visually showed a significantly high OR value of recurrence risk.ConclusionsElevated BUN at post-operation is significantly associated with the recurrence of CSDH, and it is indicated that high levels of serum BUN after evacuation may serve as a risk factor for CSDH recurrence.

Organized chronic subdural hematoma treated with middle meningeal artery embolization and small craniotomy: Two case reports

The most preferred treatment for organized chronic subdural hematoma (OSDH) remains controversial. Although a large craniotomy has been reported to be necessary and effective for the treatment of an OSDH, a craniotomy is associated with postoperative hemorrhagic complications and recurrence. Although middle meningeal artery (MMA) embolization has been reported to be effective for a refractory chronic subdural hematoma (CSDH), its efficacy for an OSDH remains unclear. We report two cases of OSDH treated with MMA embolization followed by hematoma removal via a small craniotomy under local anesthesia with good progress. Case 1: A 71-year-old man underwent a single burr hole irrigation for a CSDH, which failed due to a solid hematoma. He underwent a small craniotomy under local anesthesia after an MMA embolization. During the craniotomy, a small hemorrhage from the hematoma and its outer membrane was observed. Postoperatively, the symptoms disappeared immediately, and the hematoma did not recur. Case 2: A 77-year-old man underwent a burr hole irrigation, but the hematoma was not evacuated because of an OSDH, and he remained in motor aphasia. After an MMA embolization, a craniotomy was performed under local anesthesia. Intraoperative hemorrhage was minimal, and after the craniotomy, his neurological symptoms improved without any recurrence. MMA embolization and hematoma removal with a small craniotomy could be a treatment option for an OSDH.

Hematoma Recurrence in Burr Hole Drainage Compared to Burr Hole Irrigation as Treatment of Chronic Subdural Hematoma: A Systematic Review and Meta-analysis

BACKGROUND: Subdural hematoma is a common phenomenon following a traumatic brain injury where a hematoma is formed below the dura mater of brain meningeal layer, usually with a coup-contrecoup mechanism of injury. The chronic counterpart of subdural hematoma is frequently occurring in elderly patients. There are several techniques being used by many practitioners, including burr hole with or without irrigation, with little evidence of which technique is favorable, especially in terms of recurrence rates following the procedure.&#x0D; AIM: This study aimed to compare the recurrences of chronic subdural hematoma (CSDH) following burr hole with and without saline irrigation technique by systematic review and meta-analysis.&#x0D; METHODS: This study included all articles that describe the two specified burr hole techniques in treating patients with a CSDH. We extracted the eligibility criteria into keywords using Boolean Operator. In this study, we used keywords (CSDH) and (burr hole) and (irrigation) and ((drainage) or no irrigation)) in PubMed, directory of open access journal, and Google Scholar database.&#x0D; RESULTS: This study included seven retrospective cohort studies from 2002 to 2017 with a total of 635 samples. The incidence of hematoma recurrences between burr hole irrigation and burr hole drainage was 14.7% and 12.0%, respectively. Based on random effect model with high heterogeneity (I2 = 60%; X2 = 14.92; p = 0.02), pooled risk ratio between burr hole irrigation and burr hole drainage on hematoma recurrences was 1.05 (p = 0.92; 95% confidence interval, 0.43–2.54).&#x0D; CONCLUSION: There was no superiority between one procedure toward other in preventing recurrences of chronic subdural hematoma.

Surgery for a Refractory Chronic Subdural Hematoma Using an Exoscope:A Technical Case Report

Burr hole irrigation and drainage is effective in most cases of chronic subdural hematoma(CSDH). However, we sometimes encounter refractory cases that need further procedures or other interventions. Here we report a case with a disturbance of consciousness and left hemiparesis. CT of the head showed a right CSDH, which recurred three times in spite of repeated burr-hole irrigation surgeries. We performed a mini-craniotomy and evacuation of the hematoma under the exoscope to remove the hematoma effectively. The post-operative course was uneventful and no recurrence was found at the last follow up. A mini-craniotomy with an exoscope might be a useful option for treating cases of refractory CSDH.

Enhanced Hematoma Membrane on DynaCT Images During Middle Meningeal Artery Embolization for Persistently Recurrent Chronic Subdural Hematoma

Chronic subdural hematoma (CSDH) is generally treated by burr-hole irrigation, but it can recur despite repeating these procedures. Embolization of the middle meningeal artery (MMA) has recently been proposed as a curative treatment for CSDH, but evidence for the indication and timing of MMA embolization is not definitive. The present study retrospectively analyzed the effects and safety of MMA embolization among patients with persistent CSDH recurrence. We retrospectively assessed data from 381 consecutive patients who underwent burr-hole irrigation for CSDH between 2009 and 2017. Recurrent symptomatic ipsilateral CSDH in 71 (18%) patients was treated by a second burr-hole irrigation, and 20 of them had a further symptomatic CSDH recurrence thereafter. Those with persistent ipsilateral CSDH recurrence were treated by MMA embolization. Before the MMA embolization procedures, the amount of hematoma membrane enhancement determined using superselective MMA angiography-DynaCT imaging was classified into 3 stages. Embolization of the MMA proceeded without perioperative complications or further CSDH recurrence. The interval between recurrence and the amount of hematoma membrane enhancement significantly correlated (first to second and second to third treatments: P= 0.012 and P= 0.017, respectively). The frequency of bilateral CSDH was significantly higher and the recurrence interval between the first and second treatments was significantly shorter in the repeated recurrences group compared with the recurrence group (P= 0.023 and P= 0.006, respectively). Repeatedly recurrent CSDH can be safely treated and cured by MMA embolization. Hematoma membrane enhancement pattern using DynaCT images can predict repeated recurrences CSDH.

Recurrence in 787 Patients with Chronic Subdural Hematoma: Retrospective Cohort Investigation of Associated Factors Including Direct Oral Anticoagulant Use

Chronic subdural hematoma (CSDH) is a highly recurrent disorder. Although some predictors including the use of antithrombotic agents such as aspirin and warfarin have been proposed, the pathogenic mechanism involved remains unclear. Moreover, the link between direct oral anticoagulant (DOAC) agent use and CSDH recurrence has not been reported. The aim of this study was to investigate factors including DOAC use that could potentially be associated with CSDH recurrence. The authors analyzed 787 patients with CSDH who underwent surgery for CSDH with 1 burr-hole irrigation at Baba Memorial Hospital from January 2012 to November 2017. The patients were divided into recurrence and nonrecurrence groups and anticoagulant, antiplatelet, and control groups. Recurrence was defined as ipsilateral hemorrhage within 90 days from the original operation. Variables with P < 0.1 in the univariate analysis were included in a multivariate logistic regression model. CSDH recurrence was observed in 12.2% of patients, and significantly more men (80.2%) than women experienced recurrence. Age, sex, and warfarin use were entered in the multivariate analysis, and it was revealed that age and male sex were independently associated with CSDH recurrence. Antithrombotic agent use including use of DOACs was not associated with increased CSDH recurrence. The present study found that age and male sex were independently associated with CSDH recurrence, while the use of antithrombotic agents wasnot.

Effectiveness of goreisan in preventing recurrence of chronic subdural hematoma

Background:Burr-hole irrigation surgery is now recognized as a widespread simple technique for the treatment of chronic subdural hematoma (CSDH). However, recurrence of CSDH is sometimes experienced after initial surgery. Recently, it has been reported that goreisan is effective in preventing CSDH recurrence.Materials and Methods:Methods: We studied patients with CSDH who received burr-hole irrigation at our hospital between January 2011 and December 2014. We divided these patients into three groups. The first group was given goreisan during the early phase after burr-hole irrigation. The second group was given goreisan when there was a visual tendency of recurrence, as observed in the course of computed tomography imaging for outpatients. The third group was not given any drug.Results:The recurrence rate was compared between each group. The recurrence rate was significantly lower in the early goreisan administration group (5% vs. 12%, P = 0.046). There was a decreased tendency of recurrence in the goreisan-administered group compared with the group that was not administered any drug, but this was not statistically different (6.1% vs. 12%, P = 0.082). The recurrence period in the goreisan-administered group was longer than that in the group that was not administered any drug (39.9 ± 12.1 vs. 27.45 ± 8.5, P = 0.017).Conclusions:Goreisan is effective in preventing recurrence of CSDH after burr-hole irrigation.

A closed system irrigation & drainage technique for surgical evacuation of chronic subdural haematomas.

Background: Chronic subdural haematoma (CSDH), is a common neurosurgical disorder that is associated with morbidity and mortality affecting the ageing population. The aim is to present the treatment experience of CSDH patients treated with a technique that combines the classical single burr-hole irrigation and the continuous closed system drainage: The closed system irrigation & drainage (CSID) technique. Methods: The cases undergoing CSDH evacuation with the CSID method were captured over a 4-year period at a tertiary neurosurgical centre. The authors describe the performance of this methods with respect to post-operative clinical and radiological features, including recurrence rates, complications, and length of stay. Results: A total of 36 cases undergoing 42 CSID procedures (30 unilateral and 6 bilateral CSDHs) were performed, in cases ranging between 55-95 years old (median age 79 years). The rate of recurrence or significant ruminant blood in the subdural space on post-operative imaging was 11% (n=4). No cases of pneumocephalus were observed in this series (n=0). The mean (SD) skin-to-skin time for this procedure was 13.4 (4.4) minutes, with a mean (SD) length of stay of 4 (1.9) days. Conclusion: We conclude that the one burr-hole closed system irrigation and drainage technique with a sub-periosteal drain seems to be a simple, effective and safe procedure for treatment of CSDH. It's well tolerated under local anaesthesia for patients with high co-morbidities and these preliminary results indicated it may potentially be a better option for treatment of CSDH with a lower rate of post-operative complications.

Which surgical procedure is effective for refractory chronic subdural hematoma? Analysis of our surgical procedures and literature review

Refractory chronic subdural hematoma (CSDH) is rare but remains a difficulty for neurosurgeons, and no consensus on treatment procedures has been established. To discuss effective surgical procedures for refractory CSDH, we analyzed our surgical procedures and outcomes for refractory CSDH. We defined patients with refractory CSDH as those who presented with two or more recurrences. Fourteen patients with refractory CSDH were analyzed. Eight patients underwent burr-hole irrigation and closed-system drainage alone, four patients received embolization of the middle meningeal artery (MMA), and two patients with organized CSDH underwent large craniotomy with outer membranectomy as the third surgery. Two of the eight patients (25%) treated with burr-hole irrigation and drainage alone showed a third recurrence. No further recurrences were identified in patients treated with embolization of the MMA or craniotomy. However, statistical analysis showed no significant difference in cure rate between patients treated with burr-hole irrigation and drainage alone and patients treated with burr-hole irrigation and drainage with embolization of the MMA (P = .42). Similarly, no significant differences in cure rate were seen between patients treated with burr-hole irrigation and drainage alone and patients treated with craniotomy (P = .62). When selecting a surgical procedure, assessing whether the CSDH is organized is crucial. Embolization of the MMA may be considered as one of the optional treatments for refractory CSDH without organized hematoma. On the other hand, for refractory cases of organized CSDH, hematoma evacuation and outer membranectomy with large craniotomy or mini-craniotomy assisted by an endoscope may be suitable, as previous reports have recommended.

The efficacy of Atorvastatin in reducing recurrence of chronic subdural hematoma after single burr hole drainage and irrigation

Objective To investigate the efficacy of Atorvastatin in reducing the recurrence rate of chronic subdural hematoma (CSDH) after single burr hole drainage and irrigation. Methods Between January 2000 and May 2005 and between January 2013 and December 2015, 122 patients with CSDH admitted to the Neurosurgery Department, Lanzhou General Hospital were treated with single burr hole drainage and irrigation under local anesthesia.All patients were classified into two groups.Patients in the treatment group (n=67) took Atorvastatin after operation and those in the control group (n=55) did not take Atorvastatin.Patient demographics, clinical characteristics, imaging data, Markwalder's Grading Scale (MGS) and recurrence rates were assessed. Results Preoperative clinical characteristics and MGS levels at discharge were similar between the two groups (all P>0.05). The recovery rate of CSDH was 98.5% in the treatment group, without recurrence or death.The recovery rate of CSDH was 96.4% in the control group, with four cases of relapse, making up a recurrence rate of 7.3% (4/55). As a result, the recurrence rates were statistically significantly different between the two groups (χ2=5.038, P=0.039). Conclusions Atorvastatin can significantly reduce the recurrence rate of CSDH after single burr hole drainage and irrigation. Key words: Atorvastatin; Hematoma, subdural; Recurrence; Drainage

Burr hole craniostomy irrigation with and without drainage during surgical treatment of chronic subdural hematoma: A retrospective study of 87 cases.

To evaluate the surgical treatment of a chronic subdural haematoma (CSDH). We compared two surgical treatments of CSDH: burr-hole craniostomy irrigation with and without drainage. We retrospectively studied patients with chronic subdural haematomas admitted to our hospital. A total of 87 patients underwent surgery: 57 were treated via burr-hole irrigation with postoperative drainage (Group BD) and 30 were treated via irrigation without drainage (Group BI). Two instances of rebleeding developed in Group BD. The cerebral cortex did not expand in one case. One instance of rebleeding developed in Group BI but the cerebral cortex expanded in all cases. The average length of hospitalisation, number of postoperative complications, incidence of rebleeding, and extent of expansion of the cerebral cortex did not differ between the two groups (all P-values 0.05). At the 6-month follow-up, most patients had recovered well. The Glasgow Outcome Scale (GOS) revealed no significant differences between the groups. No significant difference was found between the two surgical treatments in terms of the length of hospitalisation, rebleeding, or expansion of the cerebral cortex (which was complete in all but one patient). We believe that the key feature of CSDH surgery is thorough irrigation during the operation; whether to use postoperative drainage is not of great importance. We currently use burr-hole irrigation without postoperative drainage.