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      Comparison of Outcomes and Recurrence in Chronic Subdural Hematoma Patients Treated by Burr-Hole Drainage with or without Irrigation = Comparison of Outcomes and Recurrence in Chronic Subdural Hematoma Patients Treated by Burr-Hole Drainage with or without Irrigation

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      https://www.riss.kr/link?id=A106965766

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      Purpose: Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and ...

      Purpose: Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or without irrigation in patients with CSDH.
      Methods: Eighty-two CSDH patients treated with burr-hole drainage at Wonju Severance Christian Hospital from March 2015 to June 2016 were enrolled in this study. The subjects were divided into three groups based on the surgical technique performed as follows: single burr-hole drainage without irrigation (group A, n=47), single burr-hole drainage with irrigation (group B, n=14), or double burr-hole drainage with irrigation (group C, n=21). These three groups were compared with respect to clinical and radiological factors and the recurrence rate, and independent factors predicting recurrence were sought.
      Results: After burr-hole drainage, CSDH recurred in 15 (18.3%) of the 82 patients, and six patients (7.3%) required reoperation. More specifically, recurrence was observed in 12 patients (25.5%) in group A, one (7.1%) in group B, and two (9.5%) in group C. The number of burr-holes did not significantly affect recurrence (odds ratio [OR]=0.38; 95% confidence interval [CI]: 0.60-2.38), but irrigation had a significant effect (OR=0.20; 95% CI: 0.04-0.97).
      Conclusions: This study shows that irrigation during burr-hole surgery in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burrholes used. We therefore recommend the use of active irrigation during burr-hole drainage surgery in CSDH patients.

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      참고문헌 (Reference)

      1 Gernsback J, "To drain or two drains : recurrences in chronic subdural hematomas" 95 : 447-450, 2016

      2 Santarius T, "The management of primary chronic subdural haematoma : a questionnaire survey of practice in the United Kingdom and the Republic of Ireland" 22 : 529-534, 2008

      3 Kansal R, "Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases" 17 : 428-429, 2010

      4 Kim DH, "Recurrence of the chronic subdural hematoma after burr-hole drainage with or without intraoperative saline irrigation" 10 : 101-105, 2014

      5 Lin CC, "Quantitative assessment of post-operative recurrence of chronic subdural haematoma using mean haematoma density" 28 : 1082-1086, 2014

      6 Leroy HA, "Predictors of functional outcomes and recurrence of chronic subdural hematomas" 22 : 1895-1900, 2015

      7 Saito K, "Plasmin-alpha 2-plasmin inhibitor complex and alpha 2-plasmin inhibitor in chronic subdural hematoma" 70 : 68-72, 1989

      8 Edlmann E, "Pathophysiology of chronic subdural haematoma:inflammation, angiogenesis and implications for pharmacotherapy" 14 : 108-, 2017

      9 Zakaraia AM, "Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia : an analysis" 69 : 608-615, 2008

      10 한홍준, "One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma" 대한신경외과학회 46 (46): 87-92, 2009

      1 Gernsback J, "To drain or two drains : recurrences in chronic subdural hematomas" 95 : 447-450, 2016

      2 Santarius T, "The management of primary chronic subdural haematoma : a questionnaire survey of practice in the United Kingdom and the Republic of Ireland" 22 : 529-534, 2008

      3 Kansal R, "Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases" 17 : 428-429, 2010

      4 Kim DH, "Recurrence of the chronic subdural hematoma after burr-hole drainage with or without intraoperative saline irrigation" 10 : 101-105, 2014

      5 Lin CC, "Quantitative assessment of post-operative recurrence of chronic subdural haematoma using mean haematoma density" 28 : 1082-1086, 2014

      6 Leroy HA, "Predictors of functional outcomes and recurrence of chronic subdural hematomas" 22 : 1895-1900, 2015

      7 Saito K, "Plasmin-alpha 2-plasmin inhibitor complex and alpha 2-plasmin inhibitor in chronic subdural hematoma" 70 : 68-72, 1989

      8 Edlmann E, "Pathophysiology of chronic subdural haematoma:inflammation, angiogenesis and implications for pharmacotherapy" 14 : 108-, 2017

      9 Zakaraia AM, "Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia : an analysis" 69 : 608-615, 2008

      10 한홍준, "One vs. Two Burr Hole Craniostomy in Surgical Treatment of Chronic Subdural Hematoma" 대한신경외과학회 46 (46): 87-92, 2009

      11 Taussky P, "Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma" 22 : 279-282, 2008

      12 Shimamura N, "Irrigation with thrombin solution reduces recurrence of chronic subdural hematoma in high-risk patients : preliminary report" 26 : 1929-1933, 2009

      13 Erol FS, "Irrigation vs. closed drainage in the treatment of chronic subdural hematoma" 12 : 261-263, 2005

      14 Chon KH, "Independent predictors for recurrence of chronic subdural hematoma" 154 : 1541-1548, 2012

      15 Yoon-Gyo Jung, "Independent Predictors for Recurrence of Chronic Subdural Hematoma" 대한신경외과학회 57 (57): 266-270, 2015

      16 Tahsim-Oglou Y, "Factors predicting recurrence of chronic subdural haematoma:the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis" 154 : 1063-1067, 2012

      17 Lee C, "Effect of intra-operative saline irrigation during burr hole surgery on the recurrence for chronic subdural hematomas" 1 : 26-29, 2015

      18 Jang KM, "Comparison of the outcomes and recurrence with three surgical techniques for chronic subdural hematoma: single, double burr hole, and double burr hole drainage with irrigation" 11 : 75-80, 2015

      19 Pahatouridis D, "Chronic subdural haematomas : a comparative study of an enlarged single burr hole versus double burr hole drainage" 36 : 151-154, 2013

      20 Borger V, "Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years" 154 : 1549-1554, 2012

      21 이준국, "Chronic Subdural Hematomas : A Comparative Study of Three Types of Operative Procedures" 대한신경외과학회 46 (46): 210-214, 2009

      22 Jae-Hong Kim, "Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment" 대한신경외과학회 50 (50): 103-108, 2011

      23 Lega BC, "Choosing the best operation for chronic subdural hematoma : a decision analysis" 113 : 615-621, 2010

      24 Tugcu B, "Can recurrence of chronic subdural hematoma be predicted? A retrospective analysis of 292 cases" 75 : 37-41, 2014

      25 Regan JM, "Burr hole washout versus craniotomy for chronic subdural hematoma : patient outcome and cost analysis" 10 : e0115085-, 2015

      26 Weigel R, "Angiotensin converting enzyme inhibition for arterial hypertension reduces the risk of recurrence in patients with chronic subdural hematoma possibly by an antiangiogenic mechanism" 61 : 788-792, 2007

      27 Javadi A, "A randomized controlled trial comparing the outcome of burr-hole irrigation with and without drainage in the treatment of chronic subdural hematoma : a preliminary report" 75 : 731-736, 2011

      28 Ishibashi A, "A comparative study of treatments for chronic subdural hematoma : burr hole drainage versus burr hole drainage with irrigation" 58 : 35-39, 2011

      29 Okada Y, "A comparative study of the treatment of chronic subdural hematoma--burr hole drainage versus burr hole irrigation" 57 : 405-409, 2002

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