Subdural drainage techniques for single burr-hole evacuation of chronic subdural hematoma: two drains frontal-occipital position versus one drain frontal position
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Published on: March 26, 2019
Qiangjun Wu1, Qin Liu1, Duoning Chen1
1Department of Neurosurgery, Lishui Central Hospital, Lishui, China.
Insights
Two subdural drains in a frontal-occipital position (TFOP) significantly reduced chronic subdural hematoma recurrence compared to one drain in the frontal position (OFP). Both techniques showed similar complication rates, making TFOP a promising option for CSDH treatment.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Background:
- Chronic subdural hematoma (CSDH) is commonly treated with burr-hole craniostomy and closed drainage.
- High recurrence rates necessitate improved treatment strategies for CSDH.
Purpose of the Study:
- To compare the recurrence and complication rates of two subdural drain placement techniques for CSDH.
- Evaluate the efficacy of two subdural drains (tips frontal-occipital position - TFOP) versus one drain (tip frontal position - OFP) after single burr-hole evacuation.
Main Methods:
- Retrospective analysis of 331 CSDH patients undergoing single burr-hole surgery with TFOP or OFP drainage systems (January 2013 - December 2017).
- Data collected included patient demographics, complications, recurrence rates, and clinical outcomes.
- Statistical comparison between TFOP and OFP groups.
Main Results:
- The TFOP group (85 patients) and OFP group (246 patients) were comparable in baseline characteristics, except for the Markwalder score.
- Greater midline shift and subdural fluid thickness were observed post-operatively in the OFP group.
- The TFOP group demonstrated a significantly lower rate of CSDH recurrence (p=0.039) over 3-month follow-up, with no significant difference in postoperative complications or clinical outcomes.
Conclusions:
- The placement of two subdural drains in a tips frontal-occipital position (TFOP) is associated with a lower recurrence rate for chronic subdural hematoma compared to a single drain in the frontal position (OFP).
- TFOP represents a safe and potentially more effective surgical option for CSDH treatment, offering reduced recurrence without increased complications.
Objective:
Burr-hole craniostomy with a closed drainage system is the most commonly used technique for chronic subdural hematoma(CSDH), but the reoperation rate for hematoma recurrence is still high. This retrospective study aimed to compare the complications and recurrence of two subdural drains placement with tips frontal-occipital position (TFOP) versus one subdural drain placement with tip frontal position(OFP) following single burr-hole evacuation for the treatment of chronic subdural hematoma(CSDH).
Methods:
The authors analyzed data of all CSDH patients who underwent single burr-hole surgery with placement of subdural closed-drainage system(TFOP or OFP techniques) between January 2013 and December 2017. Data analysis included general patient data, complications, recurrence and clinical outcome.
Results:
A total of 331 patients were included(85 TFOP and 246 OFP). The TFOP group and OFP group were statistically comparable with respect to baseline characteristics except for preoperative Markwalder score (p = 0.019). Midline shift and subdural fluid thickness on first postoperative day were greater in OFP group than the TFOP group (p = 0.028; and p = 0.007, respectively). In addition, patients with OFP had a lower percent of hematoma change after surgery and much more residual subdural air than those with TFOP (p = 0.001; and p < 0.001, respectively). Postoperative complications and clinical outcome between the two groups showed no significant differences. During the 3-month follow-up, the rate of hematoma recurrence was significantly lower among patients treated with TFOP than those treated with OFP (p = 0.039).
Conclusions:
The postoperative complications rate did not differ between TFOP group and OFP group for patients with CSDH. Considering the lower rate of recurrence, TFOP following single burr-hole evacuation might be a safe and promising option for CSDH treatment.
