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Net Drainage as a Novel Metric for Irrigating Drainage Systems in Chronic Subdural Hematoma Management: A Case Report
Alexander S Himstead1, Jordan Davies2, Diem Kieu Tran2
1School of Medicine, University of California, Irvine, Irvine, California, USA.
Insights
A novel irrigation and drainage protocol using the IRRAflow system improved outcomes for chronic subdural hematoma (cSDH) patients. This method demonstrated rapid recovery and symptom resolution in a recent case study.
Area of Science:
- Neurosurgery
- Medical Devices
- Clinical Protocols
Background:
- Chronic subdural hematoma (cSDH) is increasingly prevalent in the aging population.
- Traditional treatments include burr hole drainage or craniotomy.
- Improved management strategies are needed for cSDH.
Observation:
- A 75-year-old male presented with neurological deficits due to a large cSDH.
- The patient underwent craniotomy with placement of an IRRAflow irrigating drain.
- The drain utilized a high irrigation rate with consistent net fluid output.
Findings:
- The IRRAflow system facilitated early irrigation and monitored net fluid output.
- Postoperative imaging showed a significant decrease in the subdural collection.
- The patient experienced complete resolution of neurological symptoms rapidly.
Implications:
- This novel protocol may offer an effective approach for managing cSDH.
- The IRRAflow system shows promise in improving postoperative outcomes for cSDH.
- Further research into this irrigation and drainage technique is warranted.
Background And Importance:
Chronic subdural hematoma (cSDH) is a common neurosurgical pathology with a projected increase in prevalence as the elderly population grows. Traditional treatment for cSDH involves burr hole drainage or craniotomy with or without a subdural drain. This case describes a novel irrigation and drainage protocol using IRRAflow dual-lumen catheter system that utilizes early irrigation and measurement of the net fluid output to improve postoperative outcomes.
Clinical Presentation:
A 75-yr-old male presented to the emergency department with 2 wk of progressive dizziness, headache, confusion, and left-sided weakness over the past week. Computed tomography (CT) of the head showed 25-mm-thick, right-sided cSDH with 7 mm of right-to-left midline shift. The patient was taken to the operating room for right-sided craniotomy for subdural hematoma evacuation with placement of IRRAflow irrigating drain in the subdural space. The IRRAflow drain irrigated at 100 cc/h for 23 h with net output consistently greater than irrigation rate. Head CT the following day showed a progressive decrease in subdural collection. The patient was discharged on postoperative day 2 and had complete resolution of his neurological symptoms by postoperative day 11.
Conclusion:
As cSDHs become more prevalent in the aging population, development of improved management strategies is imperative. This report describes the use of an IRRAflow dual-lumen catheter with a novel protocol consisting of a high rate of irrigation but net fluid output, which led to rapid recovery and resolution of neurological deficits in a patient with a cSDH.
