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European journal of trauma and emergency surgery : official publication of the European Trauma Society
Dec, 2024;50 (6): 3059-3067.

Comparative clinical outcomes of irrigation techniques in burr-hole craniostomy for chronic subdural hemorrhage: a multicenter cohort study.

Ho Seong Cho, Hyun-Seok Lee, Yoo Sung Jeon, Won Hee Lee, Kyung Rae Cho
Author Information
  1. Ho Seong Cho: Department of Neurosurgery, Konkuk University Medical Center, Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea.
  2. Hyun-Seok Lee: Department of Neurosurgery, Konkuk University Medical Center, Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea.
  3. Yoo Sung Jeon: Department of Neurosurgery, Konkuk University Medical Center, Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea.
  4. Won Hee Lee: Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea.
  5. Kyung Rae Cho: Department of Neurosurgery, Konkuk University Medical Center, Neungdong-Ro, Gwangjin-Gu, Seoul, Republic of Korea. 20200459@kuh.ac.kr.
PMID: 38951156 DOI: 10.1007/s00068-024-02586-9

Abstract

BACKGROUND: Chronic Subdural Hemorrhage(cSDH) is often treated with surgical blood drainage, but concerns about recurrence and outcomes persist. Surgical techniques, including irrigation, vary. This study compares the outcomes of irrigation in cSDH surgery.
MATERIALS AND METHODS: From September 2020 to September 2022, 92 cSDH patients underwent surgery. Two different irrigation methods were used: extensive irrigation (IG) and non-irrigation (NIG). Method of irrigation was selected by each surgeon's preference. Parameters measured included volume of hematoma changes, midline shifting, complications, and basic demographics. Recurrence was defined as symptomatic or hematoma expansion more than double the volume before surgery. Factors predicting recurrence and irrigation method impact were analyzed.
RESULTS: Eleven patients were excluded because of bilateral or related to other disease. We analyzed 81 patients (44 NIG, 37 IG). Recurrence occurred in 6 IG cases (16.2%) and 1 NIG case (2.3%). Irrigation method significantly affected recurrence (P = 0.043). Age, gender, medication, medical history, and preoperative measurements had no major impact on recurrence. NIG had unexpected cases of intracerebral hemorrhage.
CONCLUSION: Extensive irrigation may increase recurrence in cSDH drainage. Non-irrigation drainage had fewer recurrences, but unexpected complications arose. Careful drainage in non-irrigated cases is crucial.

Keywords

Burrhole Chronic subdural hemorrhage Craniostomy Irrigation Recurrence

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MeSH Term

Humans
Male
Hematoma, Subdural, Chronic
Therapeutic Irrigation
Female
Aged
Middle Aged
Recurrence
Aged, 80 and over
Drainage
Retrospective Studies
Craniotomy
Treatment Outcome
Trephining
Journal Article Multicenter Study Comparative Study

Word Cloud

Created with Highcharts 10.0.0irrigationrecurrencecSDHdrainageNIGoutcomessurgerypatientsIGRecurrencecasesChronictechniquesstudySeptembervolumehematomacomplicationsmethodimpactanalyzedIrrigationunexpectedhemorrhagesubduralBACKGROUND:SubduralHemorrhageoftentreatedsurgicalbloodconcernspersistSurgicalincludingvarycomparesMATERIALSANDMETHODS:2020202292underwentTwodifferentmethodsused:extensivenon-irrigationMethodselectedsurgeon'spreferenceParametersmeasuredincludedchangesmidlineshiftingbasicdemographicsdefinedsymptomaticexpansiondoubleFactorspredictingRESULTS:Elevenexcludedbilateralrelateddisease814437occurred6162%1case23%significantlyaffectedP = 0043AgegendermedicationmedicalhistorypreoperativemeasurementsmajorintracerebralCONCLUSION:ExtensivemayincreaseNon-irrigationfewerrecurrencesaroseCarefulnon-irrigatedcrucialComparativeclinicalburr-holecraniostomychronichemorrhage:multicentercohortBurrholeCraniostomy

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