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Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage?
Aydemir Kale1, İbrahim İlker Öz2, Eren Görkem Gün1
1a Faculty of Medicine, Department of Neurosurgery , Bülent Ecevit University , Zonguldak , Turkey.
Insights
Longer closed-system drainage after burr hole craniotomy for chronic subdural hematoma (CSDH) significantly reduces recurrence rates. Extending drainage to 5-7 days is more effective than 2-4 days without increasing complications.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Chronic subdural hematoma (CSDH) is a common intracranial hemorrhage, particularly in the elderly.
- Optimal surgical treatment for CSDH remains debated.
- Burr hole craniotomy with closed-system drainage is a standard CSDH treatment.
Purpose of the Study:
- To investigate the impact of prolonged closed-system drainage duration on CSDH treatment outcomes.
- To compare recurrence rates and residual hematoma thickness between different drainage durations.
- To evaluate the safety and efficacy of extended drainage in CSDH management.
Main Methods:
- A retrospective study of 105 CSDH cases treated between 2008 and 2016.
- Patients were divided into two groups: 2-4 days (Group A, n=40) and 5-7 days (Group B, n=50) of closed-system drainage.
- Recurrence was defined as symptomatic hematoma re-accumulation within six months post-surgery.
Main Results:
- Recurrence rates were significantly lower in the longer drainage group (3.3% in Group B vs. 15.6% in Group A, p=0.04).
- Postoperative residual hematoma thickness was also significantly reduced with longer drainage (p=0.05).
- No increase in complications was noted with extended drainage duration.
Conclusions:
- Closed-system drainage for 2-4 days is effective for CSDH.
- Extending drainage duration to 5-7 days offers improved outcomes, including reduced recurrence and residual hematoma.
- Longer drainage periods represent a safe and more effective treatment strategy for CSDH.
Objectives:
Chronic subdural hematoma (CSDH) is the most frequent type of intracranial hemorrhage which especially affects the elderly. Various surgical techniques have been reported for CSDH treatment; optimal treatment methods are still controversial. In this study, the effects of long drainage durations on results and recurrences were investigated in patients on whom closed system drainage with burr hole craniotomy was applied due to CSDH.
Methods:
90 patients with 105 CSDH were operated between 2008 and 2016. Patients were divided into two groups based on the duration of drainage. Group A (n = 40) was determined as 2-4 days of closed-system drainage, while Group B (n = 50) was recorded as 5-7 days of closed-system drainage. Recurrence was defined as accumulation of blood in the operation area and recurrence of symptoms within the monitoring period of six months.
Results:
Recurrence was observed in 7 (15.6) of the Group A patients and 2 (3.3%) of the Group B patients. There was a statistically significant difference between groups in terms of recurrence rate (p = 0.04). Postoperative thickness of hematoma was measured in the first month follow-up computerized tomography. There was a statistically significant difference between groups in terms of postoperative thickness of residual hematoma (p = 0.05).
Conclusion:
2-4 days of closed system drainage following burr hole craniotomy is an effective and reliable choice of treatment in CSDH. Nevertheless, increasing the duration of drainage to 5-7 days provided better results without increasing the risk of complication.
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