Recurrence of the Chronic Subdural Hematoma After Burr-Hole Trephination With or Without Intra-Operative Saline...

Chronic subdural hematoma (CSDH) is a common condition in the elderly population, usually treated by burr-hole trephination and hematoma drainage. Although various surgical techniques have been described, the optimal surgical method remains controversial. This study aimed to compare the recurrence rate of CSDH after burr-hole drainage with or without intraoperative saline irrigation to identify the more effective surgical approach.

From January 2019 to December 2021, a total of 126 patients who underwent burr-hole trephination for CSDH were retrospectively reviewed. Among them, operative records of 145 procedures were analyzed. Patients were divided into two groups according to whether intraoperative saline irrigation was performed (n=91) or not (n=54). Demographic characteristics, medical history, radiologic findings, and recurrence or reoperation rates were compared between the groups.

Among 145 procedures, recurrence occurred in 33 cases (22.76%), and reoperation was required in 6 cases (4.14%). The recurrence rate was significantly lower in the irrigation group (14.81%) compared to the non-irrigation group (27.47%). The reoperation rate was also lower with irrigation (1.85% vs. 5.49%). Univariate analysis identified male sex, non-homogeneous hematoma type, and anticoagulation use as significant risk factors for recurrence. Multivariate analysis confirmed intraoperative saline irrigation as a significant independent protective factor.

This study demonstrates that intraoperative saline irrigation during burr-hole drainage for CSDH significantly reduces the rates of recurrence and reoperation, showing favorable clinical outcomes.