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Acta neurochirurgica
04, 2023;165 (4): 841-848.

Butterfly needle tap and suction (BTS) technique: a treatment for recurrent chronic subdural hematoma after burr hole craniostomy.

Shun Yamamoto, Yoshitaka Nagashima, Hideki Maki, Yusuke Nishimura, Yoshio Araki, Masahiro Nishihori, Tomoyuki Noda, Tasuku Imai, Teppei Kawabata, Masahiro Ueno, Yasumasa Nishida, Ryuta Saito
Author Information
  1. Shun Yamamoto: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan. ORCID
  2. Yoshitaka Nagashima: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan. y-nagashima@med.nagoya-u.ac.jp. ORCID
  3. Hideki Maki: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan.
  4. Yusuke Nishimura: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan.
  5. Yoshio Araki: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan.
  6. Masahiro Nishihori: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan.
  7. Tomoyuki Noda: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan.
  8. Tasuku Imai: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan.
  9. Teppei Kawabata: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan.
  10. Masahiro Ueno: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan.
  11. Yasumasa Nishida: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan.
  12. Ryuta Saito: Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan.
PMID: 36918432 DOI: 10.1007/s00701-023-05543-4

Abstract

BACKGROUND: In this study, we propose a butterfly needle tap and suction (BTS) technique for recurrent chronic subdural hematoma (CSDH) as an alternative to reoperation with burr hole craniostomy (BHC) and investigate its efficacy and safety. The procedure involves percutaneous puncture through the burr hole created during the previous surgery and subsequent hematoma evacuation using a butterfly needle.
METHODS: This retrospective study included patients who underwent BTS for CSDH at Ogaki Municipal Hospital between January 2017 and December 2020. The follow-up CT scans were reviewed after several weeks. We evaluated the number of percutaneous punctures required to resolve CSDH during the BTS technique, the volume of the evacuated hematoma, and procedure-related complications.
RESULTS: Twenty-six patients were enrolled in the study, 21 of whom achieved resolution of the hematoma using punctures with the BTS technique alone (mean, 2.2 ± 1.5). Five patients had a recurrence of hematoma after one or more punctures during the BTS technique, and they underwent reoperation with BHC according to the surgeon's decision or patient requests. Among the 55 punctures, 43.0 ± 16.0 ml of hematoma was evacuated per puncture. The evacuated hematoma volume was 41.9 ± 16.4 ml in the BTS-alone group and 49.4 ± 12.9 ml in the reoperation group, with no significant difference (p = 0.25). Three patients complained of a headache during the puncture procedure, and no other complications, including intracranial hemorrhage or infection, were reported therein.
CONCLUSIONS: The BTS technique is an effective alternative to reoperation with BHC.

Keywords

Burr hole craniostomy Butterfly needle Chronic subdural hematoma Percutaneous puncture Twist drill craniostomy

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MeSH Term

Humans
Hematoma, Subdural, Chronic
Suction
Craniotomy
Retrospective Studies
Trephining
Drainage
Treatment Outcome
Recurrence
Journal Article

Word Cloud

Created with Highcharts 10.0.0hematomaBTStechniqueneedlereoperationholecraniostomypuncturepatientspuncturesstudysubduralCSDHburrBHCevacuatedbutterflytapsuctionrecurrentchronicalternativeprocedurepercutaneoususingunderwentvolumecomplicationsgroupButterflyBACKGROUND:proposeinvestigateefficacysafetyinvolvescreatedprevioussurgerysubsequentevacuationMETHODS:retrospectiveincludedOgakiMunicipalHospitalJanuary2017December2020follow-upCTscansreviewedseveralweeksevaluatednumberrequiredresolveprocedure-relatedRESULTS:Twenty-sixenrolled21achievedresolutionalonemean22 ± 15Fiverecurrenceoneaccordingsurgeon'sdecisionpatientrequestsAmong55430 ± 160 mlper419 ± 164 mlBTS-alone494 ± 129 mlsignificantdifferencep = 025ThreecomplainedheadacheincludingintracranialhemorrhageinfectionreportedthereinCONCLUSIONS:effectivetechnique:treatmentBurrChronicPercutaneousTwistdrill

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