Drainage Of Chronic Subdural Hematoma Research Articles

Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan.

Objective:To compare the efficacy of single versus double burr-hole for drainage of chronic subdural hematoma, keeping in consideration pertinent demographic, pre and postoperative associations.Methods:A prospective cohort study carried out in Combined Military Hospital, Multan, (December 2016-August 2018), on adults with diagnosed chronic subdural hematoma (CSDH); being segregated by randomized control trial, non-probability purposive sampling into Group-A and Group-B (who underwent single and double burr-holes for CSDH-drainage respectively). Utilizing SPSS-21, data expressed as frequencies/percentages and mean± standard deviation (SD) and cross-tabulated; p-value <0.05 was taken as significant.Results:Age and GCS scores were 62±13.694 (range 38-94) and 11.00±3.350 (range 3-15) respectively, males being 40(66.7). Post-operative fatality was Nil, while 8(13.3%) and 14(23.3%) had post-operative seizures and recurrence of hematoma respectively. There was no significant association between type of burr-hole and hospital stay (p 0-884), seizures (p 0.448) or recurrence (p 0.542). Hospital stay (p<0.000) and seizures (p-0.005) were inversely proportional to GCS scores on presentation. Recurrence rates were not affected by age (p-0 .175) or gender (p-0 .281).Conclusion:There was no significant difference between outcomes of single and double burr-hole surgeries; the former must be preferred because of lesser iatrogenic trauma. GCS-score on presentation was validated as a negative association to anticipate post-operative outcomes.

Sitting position awake craniostomy with drainage for chronic subdural hematoma: A viable alternative?

Background/Aim. Chronic subdural hematoma (CSDH) is one of the most frequent neurosurgical conditions with an overall incidence ranging from 1.72 to 20.6 per 100,000 persons per year. The surgical procedure for CSDH is relatively simple and usually performed in the supine position. Reported reoccurrence rates range from 11.7% to 28%. Postperative pneumocephalus was previously identified as a sole predictor of reoccurrence. The aim of this study was to assess the advantage of the procedure in the sitting position in patients with CSDH and a possible impact on the reoccurrence rate. Methods. The study included 31 patients who underwent awake craniostomy with closed system drainage for CSDH (16 in supine and 15 in sitting position) in our department from December 2016 to March 2018. Results. A total of 22 males and 9 females were included in the study. The overall reoccurrence rate was 19% (22% and 18% in females and males, respectively). The re-occurrence was noted in 5 patients who had undergone surgery in the supine position, and in one case in the sitting position. Our results revealed a lower reoccurrence rate in patients undergoing surgery in the sitting position, although not reaching statistical significance [odds ratio (OR): 0.18, 95% confidence interval: 0.01?1.42, p = 0.172]. Conclusion. Craniostomy in the sitting position under local anesthesia is a safe, simple, and reliable procedure for CSDH treatment. Besides being very comfortable for the patient, according to our initial results, it might also lead to a lower reoccurrence rate, probably due to the better management of the air inflow, and consequent pneumocephalus.

Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas.

ObjectiveChronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas.MethodsFrom January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images.Results60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group.ConclusionBurr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.

A Clinical Analysis to Detect Risk Factors of Chronic Subdural Hematoma Recurrence

Introduction: The etiology of recurrence of chronic subdural hematoma (CSDH) after surgical evacuation has not been completely understood until now, but several risk factors for recurrence have been reported. Meanwhile, the definitive risk factors have not been defined until now. Aim of Study: Analyze the potential risk factors, and emphasize preoperative, operative and post-operative ones for CSDH recurrence. Patients and Methods: This study is a prospective randomized clinical trial study including 82 patients with symptomatizing CSDH who underwent burr holes procedure and irrigation with closed system drainage for CSDH at Neurosurgical Department—Assuit University Hospital from July 2016 to July 2018. The possible factor studied for recurrence included age, hypertension, diabetes mellitus, liver diseases, Hemoglobin (Hb) level, prothrombin concentration and time (PC and PT), hematoma thickness and internal architecture, number of burr holes and position of drain, duration of drainage, amount of drainage and presence of postoperative residual hematoma on follow up CT brain. Multiple logistic regression analysis is used to assess the predictors of recurrence. Results: This study included 70 males and 12 females. The mean age was 58.9 years (range 34 - 93 years). 6 patients presented with recurrent CSDH. Age above 60 years, Hypertension, Diabetes mellitus (DM), prolong PT, separated and trabecular internal architecture of hematoma, and the thickness of hematoma more than 20 mm in pre-operative CT and postoperative residual hematoma were statistically significant factors for recurrence of CSDH. Conclusion: This information might be helpful in detecting patients with possible high incidence of recurrence and directing for close follow ups and acts that may reduce the incidence of recurrence.

Application of modified brain protection double-lumen drainage tube in external drainage of chronic subdural hematoma

Objective: To compare the clinical effects of modified double-lumen drainage tube and traditional silicone tube in external drainage of chronic subdural hematoma. Methods: Selected 49 patients suffering from chronic subdural hematoma hospitalized in the Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College between July 2016 and June 2018 who underwent external drainage, and divided them randomly into experimental groups (using modified brain protection double lumen drainage tube in 23 cases) and control group (using traditional silicone drainage tube in 26 cases). Comparison of postoperative hematoma residual volume, the tube indwelling time, the numbers of drainage tube contact with brain tissue and arachnoid membrane, the numbers of infections, the numbers of postoperative epilepsy cases, and changes in Modified Rankin Scale scores between the two groups. Results: At the time of extubation, the residual amount of hematoma in the experimental group was (13±7) ml, and that in the control group was (17±8) ml. There was no significantly statistical difference in the residual amount of hematoma between the experimental group and the control group (P>0.05). The tube indwelling time of the experimental group was (2.0±0.9) days, and that of the control group was (2.7±0.8) days. The difference between the experimental group and the control group in the drainage tube indwelling time was statistically significant (P<0.05). No cases of drainage tube contact with brain tissue and/or arachnoid membrane appeared in the experimental group, and 7 cases of drainage tube contact with brain tissue or arachnoid membrane appeared in the control group. No infection occurred in both groups. No cases of epilepsy occurred in preoperative, and there were 0 cases of epilepsy in the experimental group and 1 case in the control group in postoperative. There were significantly statistical differences in each of the two groups in the modified Rankin scale before and after surgery (P<0.001), there was no significant difference in postoperative Modified Rankin Scale scores between the two groups. Conclusion: The modified brain protection double-lumen drainage tube has good drainage effect in the external drainage of chronic subdural hematoma, and the short tube retention time, causing fewer complications. It is a safe and effective tool for treating chronic subdural hematoma, and it is worthy of clinical promotion.

Risk of Recurrent Chronic Subdural Hematoma Associated with Early Warfarin Resumption: A Matched Cohort Study

Studies on resuming anticoagulation after burr-hole drainage for chronic subdural hematoma (CSDH) are limited. To evaluate the safety for early warfarin resumption after burr-hole drainage, we conducted a retrospective matched cohort study. Between January 2008 and April 2015, 36 patients with warfarin-related unilateral CSDH and 151 patients with ordinary unilateral CSDH were enrolled in this study. Patients taking warfarin were managed homogeneously according to the study protocol, and the usual dosage of warfarin was resumed within 2 or 3 days of burr-hole drainage to reach a target international normalized ratio (INR) of 2.1. The primary outcome, defined as recurrent CSDH requiring repeated burr-hole drainage within 3 months of the initial surgery, was compared between the two groups. The primary outcome was observed in 4 (11%) of the 36 patients taking warfarin and in 18 (12%) of the 151 ordinary patients. After propensity score matching, the primary outcome was observed in 3 of 33 patients (9%) in the matched warfarin cohort and 11 of 74 patients (15%) in the matched ordinary cohort. When the results were analyzed using the generalized estimating equation, no significant difference was observed in the rate of recurrent CSDH between the 2 groups (P= 0.411). In addition, we found that recurrent CSDH was not related to postoperative international normalized ratio levels (P= 0.332). There was no definitive association between postoperative early warfarin resumption and the recurrence rate of CSDH. Patients with warfarin-related CSDH and a strong indication for anticoagulation can be managed by resuming warfarin within 3 days of burr-hole drainage.

331 Early Warfarin Resumption Following Burr-Hole Drainage for Chronic Subdural Hematoma

331 Early Warfarin Resumption Following Burr-Hole Drainage for Chronic Subdural Hematoma

Excellent Outcomes of Large-Volume Epidural Blood Patch Using an Intravenous Catheter in 15 Consecutive Cases with Cerebrospinal Fluid Leak

The effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period. Nineteen patients with idiopathic CSF leaks were enrolled in this study since November 2011 (12 women; mean age, 43.3 ± 14.0 years). Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively. Different types of headache were observed, including typical orthostatic headache alone (n= 10), orthostatic headache with chronic subdural hematoma (CSDH) (n= 3), and posture-unrelated headache accompanied with CSDH (n= 6). Regarding treatments, in 1 case, direct surgical closure was performed. In 15 cases, large-volume EBPs were performed, and the volume of injected blood was 44.8 ± 21.6 mL. The other 3 cases were treated by simple drip infusion regardless of the drainage for CSDH. Out of 9 cases with accompanied CSDH, recurrence of subdural hematoma was completely prevented by the application of an EBP after drainage in 5 cases and without drainage in 3 cases, and by simple intravenous drip-and-rest therapy after drainage in 1 case. Among 10 patients suffering from typical orthostatic headache alone, symptoms disappeared completely in 7 cases and were relieved in 3 cases. We demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter.

A Novel Application of the Integra Camino Bolt for the Drainage of Chronic Subdural Hematoma: A Technical Note.

Chronic subdural hematoma (cSDH) is a common neurosurgical pathology associated with older age and complicated by antiplatelet/anticoagulant therapies. With improving medical care in an aging population, the incidence of cSDH will likely increase over the next 25 years, placing a burden on health care costs. Consequently, a simple and inexpensive treatment option is desirable. As such, we report a basic, but novel, technique to drain cSDH with an Integra Camino bolt. This technique was employed in two patients, where the significant resolution of cSDH and associated clinical symptoms were observed without complications.

A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma

Background: The incidence of chronic subdural hematoma is 1-2 per 100000 per year in the general population. Inserting subdural drain might reduce the recurrence rate but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains.Methods: A prospective randomized study to investigate the effect of subdural drains in the on-recurrence rates and clinical outcome following burr-hole drainage of chronic subdural hematoma was undertaken. During the study period, 100 patients with CSDH were assessed for eligibility. Among 100 patients fulfilling the eligibility criteria, 52 were assigned to drain inserted into the subdural space following burr hole drainage and 48 were assigned subdural drain was not inserted following burr hole drainage. The primary end point was recurrence needing re-drainage and to prevent post-operative pneumocephalus up to a period of 6 months from surgery.Results: Recurrence occurred in 1 of 100 patients with a drain, and 9 of 100 patients in without drain group the medical and surgical complications were comparable between the two study groups.Conclusions: Use of a subdural drain after burr-hole evacuation of a chronic subdural hematoma reduces the recurrence rate and is not associated with increased complications.

Book Review

Among the various neurosurgical techniques currently being used in chronic subdural hematoma (CSDH) surgery, bur hole craniostomy is the most popular worldwide. Recent studies have strongly recommended that a drain be placed after surgical evacuation of a hematoma, and a broad spectrum of preformed surgical drains is widely available for this purpose. If preformed drains are unavailable, a surgeon-made drain can be used and various methods are available to develop a drain in the operating room.Using a case report, we demonstrate how to develop a surgeon-made drain. Next, we retrospectively screened for subdural drain usage in consecutive patients undergoing bur hole drainage for CSDH at Adiyaman University Hospital between January 2017 and April 2017, and data from only those patients in whom a surgeon-made drain was used were included for analyses.A 74-year-old male was operated with the diagnosis of CSDH. Assembly of a surgeon-made drain was explained step by step. Our review identified 6 unilateral and 2 bilateral cases in which 10 surgeon-made drains were used. Mean age of the patients was 72, and mean follow-up period was 7 months, 23 days. No instances of infection or drain-related complications had been recorded. The recurrence rate was 0%, and the average drainage period was 3.4 days.In case of unavailability of a preformed drain, a surgeon-made drain can be used during CSDH surgery. Different methods are available and can be further diversified using various combinations of simple medical materials.

Hemorragia Intracraniana Pós-Drenagem de Hematoma Subdural Crônico

O hematoma subdural crônico (HSDC) é comum na prática neurocirúrgica. Ocorre mais no idoso, sexo masculino e associado a traumatismo cranioencefálico. Pode se manifestar de várias formas clinicas. A tomografia computadorizada tem sido útil no diagnóstico e conduta. Na maioria dos casos o tratamento é cirúrgico e com bons resultados. Várias complicações podem ocorrer após a drenagem do HSDC como: recidiva do hematoma, pneumoencéfalo, empiema subdural e hemorragia intracraniana. Os autores relatam uma série de casos de hemorragias intracranianas pós-drenagem do HSDC e discutem sua fisiopatologia, diagnóstico, tratamento e resultados.

Surgical Drains in Chronic Subdural Hematoma Surgery: From the Cheapest to the Most Expensive Drains.

Among the various neurosurgical techniques currently being used in chronic subdural hematoma (CSDH) surgery, bur hole craniostomy is the most popular worldwide. Recent studies have strongly recommended that a drain be placed after surgical evacuation of a hematoma, and a broad spectrum of preformed surgical drains is widely available for this purpose. If preformed drains are unavailable, a surgeon-made drain can be used and various methods are available to develop a drain in the operating room. Using a case report, we demonstrate how to develop a surgeon-made drain. Next, we retrospectively screened for subdural drain usage in consecutive patients undergoing bur hole drainage for CSDH at Adiyaman University Hospital between January 2017 and April 2017, and data from only those patients in whom a surgeon-made drain was used were included for analyses. A 74-year-old male was operated with the diagnosis of CSDH. Assembly of a surgeon-made drain was explained step by step. Our review identified 6 unilateral and 2 bilateral cases in which 10 surgeon-made drains were used. Mean age of the patients was 72, and mean follow-up period was 7 months, 23 days. No instances of infection or drain-related complications had been recorded. The recurrence rate was 0%, and the average drainage period was 3.4 days. In case of unavailability of a preformed drain, a surgeon-made drain can be used during CSDH surgery. Different methods are available and can be further diversified using various combinations of simple medical materials.

Influence of Postoperative Thrombosis Prophylaxis on the Recurrence of Chronic Subdural Hematoma After Burr-Hole Drainage.

Chronic subdural hematoma is a commonly encountered disease in neurosurgic practice, whereas its increasing prevalence is compatible with the ageing population. Recommendations concerning postoperative thrombosis prophylaxis after burr-hole drainage of chronic subdural hematoma are lacking. The aim of this study was to analyze the correlation between recurrence of chronic subdural hematoma and postoperative application of thrombosis prophylaxis. Retrospective, consecutive sample of patients undergoing burr-hole drainage for chronic subdural hematoma over 3 years. Single, academic medical center. All patients undergoing surgical evacuation of a chronic subdural hematoma with burr-hole drainage. Exclusion: patients under the age of 18 years, who presented with an acute subdural hematoma and those who underwent a craniotomy. We compared patients receiving thrombosis prophylaxis treatment after burr-hole drainage of chronic subdural hematoma with those who were not treated. Primary outcome measure was reoperation of chronic subdural hematoma due to recurrence. Secondary outcome measures were thromboembolic and cardiovascular events, hematologic findings, morbidity, and mortality. In addition, a subanalysis comparing recurrence rate dependent on the application time of thrombosis prophylaxis (< 48 vs > 48 hr) was undertaken. Overall recurrence rate of chronic subdural hematoma was 12.7%. Out of the 234 analyzed patients, 135 (57.3%) received postoperative thrombosis prophylaxis (low-molecular-weight heparin) applied subcutaneously. Recurrence of chronic subdural hematoma occurred in the thrombosis prophylaxis group and control group in 12 patients (8.9%) and 17 patients (17.2%), respectively, showing no significant difference (odds ratio, 0.47 [95% CI, 0.21 - 1.04]). A subanalysis comparing recurrence rate of chronic subdural hematoma dependent on the application time of thrombosis prophylaxis (< 48 vs > 48 hr) showed no significant difference either (odds ratio, 2.80 [95% CI, 0.83-9.36]). Higher dosage of thrombosis prophylaxis correlated with recurrence rates of chronic subdural hematoma, both in univariate and multivariate analyses. Our data suggest that the application of postoperative thrombosis prophylaxis after burr-hole drainage for chronic subdural hematoma does not result in higher recurrence rates of chronic subdural hematoma. In addition, it seems that early administration of thrombosis prophylaxis (< 48 hr) has no influence on recurrence rates; however, high dosage seems to increase recurrence rates.

Independent predictors for functional outcome after drainage of chronic subdural hematoma identified using a logistic regression model.

Chronic subdural hematoma (CSDH) is a common indication for undergoing neurosurgery, but the outcome may remain limited despite timely surgical treatment. The factors potentially associated with the functional outcome have not been sufficiently investigated. We set out to identify independent predictors associated with the functional outcome after surgical treatment of CSDH, avoiding arbitrary classifications and thresholds or subjective imaging assessment. We retrospectively reviewed 197 consecutive surgical cases of CSDH. Univariate and multivariate analyses were performed to identify the relationship between clinical plus radiographic factors and outcome. Imaging analysis was performed using computer-assisted 3D-volumetric analysis. One-hundred and sixty-four (83.2%) patients had a favorable (GOS grade 5 and 4) and 33 (16.8%) an unfavorable clinical outcome (GOS grade 1-3). The multivariate logistic regression analysis determined 4 independent prognostic factors: age over or under 77 years, preoperative clinical condition (Markwalder Score), recurrence and surgical technique applied. Patients treated with mini-craniotomy procedures had worse outcomes than those treated with single or two burr-hole craniostomies. The percentage of the hematoma drained correlated strongly with recurrence and was by itself not an independent predictor for outcome. In our study age, preoperative neurological status, surgical technique and recurrence were found to be independent prognostic factors for the functional outcome in patients with CSDH.

Association between antithrombotic drug use before chronic subdural haematoma and outcome after drainage: a systematic review and meta-analysis.

In view of their age and vascular co-morbidities, people are often taking an antithrombotic drug when diagnosed with chronic subdural haematoma (CSDH). It is unclear whether antithrombotic use at CSDH diagnosis, or resumption afterwards, is associated with recurrent CSDH or vaso-occlusive events. We systematically reviewed the literature for studies reporting CSDH recurrence or vaso-occlusive events after drainage of CSDH associated with antithrombotic drug use. We searched Medline 1946-2016 and Embase 1974-2016 inclusive for cohort studies reporting the risk of CSDH recurrence or vaso-occlusive events after CSDH associated with antithrombotic (anticoagulant or antiplatelet) drug use. We meta-analysed outcome data using a random effect model and assessed inconsistency between studies using the I-squared (I 2) statistic. We found 20 studies reporting outcome after drainage of CSDH associated with antithrombotic drug use. Before CSDH drainage, 337 (11.5%) of 2941 patients in 12 studies used an anticoagulant drug and 600 (19%) of 3150 patients in 11 studies used an antiplatelet drug. The association between antithrombotic drug use and CSDH recurrence was significant for antiplatelet drug use (relative risk [RR] 1.36, 95% CI 1.05 to 1.75; I 2=36.3%), but marginally significant for anticoagulant drug use (RR 1.38 95% CI 1.00-1.91; I 2=37.5%). Two studies including 30 patients reported one vaso-occlusive outcome event after CSDH. Antithrombotic drug use at CSDH diagnosis may be associated with post-operative CSDH recurrence. It is unclear whether this is attributable to confounding factors, antithrombotic reversal strategies or antithrombotic drug resumption. Further observational studies and randomised controlled trials of antithrombotic drug resumption are needed.

Clinical audit effectively bridges the evidence-practice gap in chronic subdural haematoma management

BackgroundPlacement of a subdural drain after drainage of chronic subdural haematoma (CSDH) has been shown to reduce the rate of recurrence in several randomised controlled trials (RCT). The most recently published RCT was from Cambridge, UK, in 2009. Despite class I evidence for the use of subdural drains, it is unclear whether these results have been translated into clinical practice. In this clinical audit we review the use of subdural drains in our institution before and after the publication of the 2009 RCT results.MethodsA longitudinal retrospective study was performed on all adults having burr holes for CSDH between January 2009 and January 2014. Case notes were analysed to determine subdural drain use, re-operation for CSDH recurrence and post-operative complications. The audit loop was closed with data collected from August 2015 to January 2016.ResultsThirty-one per cent of patients had subdural drains placed at operation. Drain placement was associated with lower reoperation rates (8% vs. 17%, p = 0.021) without increasing complication rates. Drain usage doubled after publication of the Santarius et al. (2009) trial but we observed persisting and significant variability in drain utilisation by supervising consultants. The use of drains in the department increased from 35% to 75% of all cases after presentation of these results.ConclusionsThe use of subdural drains in our unit reduced recurrence rates following drainage of CSDH and reproduced the results of a 2009 clinical trial. Although the use of subdural drains doubled in the post-trial epoch, significant variability remains in practice. Clinical audit provided an effective tool necessary to drive the implementation of subdural drain placement in our unit.

Evaluation of Cortical Brain Parenchyma by Diffusion and Perfusion MRI Before and After Chronic Subdural Hematoma Surgery.

To evaluate microcirculatory changes in neighboring parenchyma as a result of pressure due to chronic subdural hematoma (CSDH) in early and late periods after hematoma drainage. The subject group consisted of 25 patients who underwent CSDH drainage. Brain diffusion and perfusion magnetic resonance images (MRIs) were obtained preoperatively, and at 48 hours (early period) and 2 months (late period) postoperatively. Measurements were performed on 1 cm2 regions of interest (ROI) in the neighboring parenchymal tissue. The early postoperative diffusion values showed improvement compared to the preoperative values. The late postoperative values showed improvement compared to the preoperative and early postoperative values. The early postoperative perfusion values showed slight decline compared to the preoperative values. However, the late postoperative values showed improvement compared to the preoperative and early postoperative values. The fact that there was an increase in diffusion values from early to late postoperative periods, compared with the preoperative period, indicates that the beneficial effects of surgery increase over time. Brain perfusion was found to be slightly decreased in early postoperative period. Following CSDH drainage, neurological deteriorations are observed in some patients in the early postoperative periods; a slight impairment in perfusion may account for this. However, during the late postoperative period, perfusion was seen to recover prominently.

The efficacy and safety of burr-hole craniotomy without continuous drainage for chronic subdural hematoma and subdural hygroma in children under 2years of age.

Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2years old. We also aimed to determine the predictors of CSDH/SDHy recurrence. We conducted a retrospective chart review of 25 children under 2years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period. We analyzed the relationship between CSDH/SDHy recurrence and factors such as abusive head trauma, laterality of CSDH/SDHy, and subdural fluid collection type (hematoma or hygroma). CSDH/SDHy recurred in 5 of the 25 patients (20%), requiring a second operation at an average of 0.92 ± 1.12months after the initial procedure. The mean follow-up period was 25.1 ± 28.6months. There were no complications related to either operation. None of the assessed factors were statistically associated with recurrence. Burr-hole craniotomy without continuous drainage for CSDH/SDHy appears safe in children aged under 2years and results in a relatively low recurrence rate. No predictors of CSDH/SDHy recurrence were identified. Advantages of this method include avoiding external subdural drainage-related complications. However, burr-hole drainage may be more effective for CSDH, which our data suggests is more likely to recur than SDHy, providing the procedure is performed with specific efforts to reduce complications.

Using Mount Fuji for diagnosis of tension pneumocephalus

Not available.