Clinical effect of a new closed irrigation and drainage technique for surgical evacuation of chronic subdural haematomas

doi:10.3877/cma.j.issn.2095-9141.2020.04.009

Abstract

Abstract:

Objective

To observe the clinical effect of single burr-hole irrigation and continuous closed sub-periosteal drainage in patients with chronic subdural hematoma (CSDH).

Methods

A total of 106 patients with CSDH admitted to Department of Neurosurgery, Jiangyin People’s Hospital from January 2017 to June 2019 were divided into the conventional single bone hole drilling and drainage group (conventional group) and the single burr-hole irrigation and continuous closed sub-periosteal drainage group (closed group). The surgical efficacy and complications of the two groups were statistically analyzed.

Results

There was no statistically significant difference in surgical efficacy between the two groups (Z=0.262, P>0.05) . The intracranial pneumatocele in closed group was significantly less than that in conventional group (Z=3.963, P<0.05). There was no significant difference in the incidence of postoperative symptomatic pneumocephalus, brain injury, cerebrospinal fluid leakage, epilepsy and hematoma recurrence between the two groups (P>0.05).

Conclusion

The treatment of CSDH by single burr-hole irrigation and continuous closed sub-periosteal drainage can significantly reduce the intracranial pneumatocele after operation, which is a simple, effective and safe treatment method.

Key words: Chronic subdural hematoma, Closed burr hole drainage, Subperiosteal drainage, Intracranial pneumatosis

Xin Huang, Kai Gong, Weidong Xu, Yu Xu, Jianfeng Jiang, Xincheng Xue, Xiaofeng Wu, Xinmin Zhou. Clinical effect of a new closed irrigation and drainage technique for surgical evacuation of chronic subdural haematomas[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(04): 233-236.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2020.04.009

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2020/V06/I04/233

Figures/Tables 3

References 22

[1]	You CG, Zheng XS. Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma[J]. Clin Neurol Neurosurg, 2018, 166: 56-60.
[2]	Santarius T, Kirkpatrick PJ, Ganesan D, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial[J]. Lancet, 2009, 374(9695): 1067-1073.
[3]	Zumofen D, Regli L, Levivier M, et al. Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system[J]. Neurosurgery, 2009, 64(6): 1116-1121; discussion 1121-1122.
[4]	Bellut D, Woernle CM, Burkhardt JK, et al. Subdural drainage versus subperiosteal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas[J]. World Neurosurg, 2012, 77(1): 111-118.
[5]	Chih AN, Hieng AW, Rahman NA, et al. Subperiosteal drainage versus subdural drainage in the management of chronic subdural hematoma (a comparative study)[J]. Malays J Med Sci, 2017, 24(1): 21-30.
[6]	Gazzeri R, Galarza M, Neroni M, et al. Continuous subgaleal suction drainage for the treatment of chronic subdural haematoma[J]. Acta Neurochir (Wien), 2007, 149(5): 487-493; discussion 493.
[7]	Sharma BS, Tewari MK, Khosla VK, et al. Tension pneumocephalus following evacuation of chronic subdural haematoma[J]. Br J Neurosurg, 1989, 3(3): 381-387.
[8]	Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate[J]. Neurol Med Chir (Tokyo), 2001, 41(8): 371-381.
[9]	Kravtchouk AD, Likhterman LB, Potapov AA, et al. Postoperative complications of chronic subdural hematomas: prevention and treatment[J]. Neurosurg Clin N Am, 2000, 11(3): 547-552.
[10]	Miele VJ, Sadrolhefazi A, Bailes JE. Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma[J]. Surg Neurol, 2005, 63(5): 420-423; discussion 423.
[11]	Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review[J]. Neurocrit Care, 2010, 13(1): 152-158.
[12]	Xu C, Chen S, Yuan L, et al. Burr-hole irrigation with closed-system drainage for the treatment of chronic subdural hematoma: a meta-analysis[J]. Neurol Med Chir (Tokyo), 2016, 56(2): 62-68.
[13]	Lind CR, Lind CJ, Mee EW. Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains[J]. J Neurosurg, 2003, 99(1): 44-46.
[14]	Panourias IG, Skandalakis PN. Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication[J]. Clin Neurol Neurosurg, 2006, 108(4): 396-399.
[15]	Sun HL, Chang CJ, Hsieh CT. Contralateral acute subdural hematoma occurring after evacuation of subdural hematoma with coexistent contralateral subdural hygroma[J]. Neurosciences (Riyadh), 2014, 19(3): 229-232.
[16]	Eom KS, Kim TY, Park JT. Contralateral acute interdural haematoma occurring after burr hole drainage of chronic subdural haematoma[J]. Br J Neurosurg, 2009, 23(2): 213-215.
[17]	Cohen-Gadol AA. Remote contralateral intraparenchymal hemorrhage after overdrainage of a chronic subdural hematoma[J]. Int J Surg Case Rep, 2013, 4(10): 834-836.
[18]	Kim CH, Song GS, Kim YH, et al. Remote hemorrhage after burr hole drainage of chronic subdural hematoma[J]. Korean J Neurotrauma, 2017, 13(2): 144-148.
[19]	Gürbüz MS, Karaarslan N, Gök S, et al. Remote cerebellar haemorrhage after burr hole drainage of chronic subdural haematoma: a case report[J]. J Clin Diagn Res, 2016, 10(5): PD01-PD02.
[20]	Kobayashi S, Mutoh T, Ishikawa T, et al. Remote cerebellar hemorrhage after single burr hole drainage of chronic subdural hematoma of the elderly[J]. No Shinkei Geka, 2011, 39(8): 755-761.
[21]	Wang G, Yu J. Remote acute subarachnoid hemorrhage after drainage of chronic subdural hematoma: a case report and review of the literature[J]. Int J Surg Case Rep, 2018, 44: 202-206.
[22]	杨炳石,江志静,王晓晨,等.慢性硬膜下血肿封闭式钻孔引流术的临床效果观察[J].中华神经创伤外科电子杂志, 2017, 3(4): 210-213.

组别	例数	治愈	好转	未愈
常规组	82	70（85.3）	8（9.8）	4（4.9）
封闭组	24	21（87.5）	2（8.3）	1（4.2）
Z值	?	?	0.262	?
P值	?	?	0.793	?

组别	例数	治愈	好转	未愈
常规组	82	70（85.3）	8（9.8）	4（4.9）
封闭组	24	21（87.5）	2（8.3）	1（4.2）
Z值	?	?	0.262	?
P值	?	?	0.793	?

组别	例数	症状性气颅	脑损伤	脑脊液漏	癫痫	复发	并发症总计
常规组	82	4（4.88）	1（1.22）	2（2.44）	6（7.32）	8（9.76）	21（25.61）
封闭组	24	0	0	0	1（4.17）	1（4.17）	2（8.33）
χ²值	?	1.217	0.295	0.597	0.299	0.747	3.262
P值	?	0.270	0.587	0.440	0.585	0.388	0.071

组别	例数	症状性气颅	脑损伤	脑脊液漏	癫痫	复发	并发症总计
常规组	82	4（4.88）	1（1.22）	2（2.44）	6（7.32）	8（9.76）	21（25.61）
封闭组	24	0	0	0	1（4.17）	1（4.17）	2（8.33）
χ²值	?	1.217	0.295	0.597	0.299	0.747	3.262
P值	?	0.270	0.587	0.440	0.585	0.388	0.071

组别	例数	<5 mL	5~14 mL	15~29 mL	≥30 mL
常规组	95	18（18.9）	40（42.1）	32（33.7）	5（5.3）
封闭组	28	12（42.9）	16（57.1）	0	0
Z值	?	?	3.963		?
P值	?	?	0.000		?

Please choose a citation manager

Content to export