An Exhaustive Drainage Strategy in Burr-hole Craniostomy for Chronic Subdural Hematoma

Yunwei Ou; Jinqian Dong; Liang Wu; Long Xu; Lei Wang; Baiyun Liu; Jingsheng Li; Weiming Liu

doi:10.1016/j.wneu.2019.03.111

An Exhaustive Drainage Strategy in Burr-hole Craniostomy for Chronic Subdural Hematoma

World Neurosurg. 2019 Jun:126:e1412-e1420. doi: 10.1016/j.wneu.2019.03.111. Epub 2019 Mar 19.

Authors

Yunwei Ou¹, Jinqian Dong², Liang Wu³, Long Xu⁴, Lei Wang³, Baiyun Liu², Jingsheng Li³, Weiming Liu⁵

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China.
² Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
³ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
⁵ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Neurological Center, Ningxia People's Hospital, Ningxia, China. Electronic address: liuweimingnsok@sina.com.

PMID: 30902781
DOI: 10.1016/j.wneu.2019.03.111

Abstract

Objective: To introduce an effective strategy to treat patients with chronic subdural hematoma (CSDH) that can achieve a low recurrence rate and good outcome.

Methods: Surgical patients with CSDH from August 2011 to May 2017 in our hospital were collected retrospectively. An exhaustive drainage strategy to treat CSDH with burr-hole craniostomy was conducted. All patients were drained, and catheter was removed when natural drainage ceased or when drainage was complete using urokinase. Clinical characteristics were reviewed and analyzed. Following this strategy, predictors of recurrence requiring reoperation and outcome were analyzed.

Results: In total, 1126 patients with CSDH who were treated with burr-hole craniostomy were included. Using the exhaustive drainage strategy, recurrence rate was only 1.9% (21/1117) with follow-up rate of 99.2%. 97.0% (1092/1117) of patients gained good outcome (modified Rankin scale scores 0-3) at 6 months after discharge. Postoperative hematoma volume (P = 0.001, B = 0.028, Exp (B) = 1.028, 95% CI 1.011-1.046), diabetes (P = 0.022, B = 1.082, Exp (B) = 2.950, 95% CI 1.169-7.440), bilateral hematoma (P = 0.011, B = 1.213, Exp (B) = 3.363, 95% CI 1.323-8.547), and complications (P = 0.013, B = 1.483, Exp (B) = 4.408, 95% CI 1.365-14.235) significantly increased the probability of recurrence. In contrast, use of urokinase (P = 0.007, B = -1.435, Exp (B) = 0.238, 95% CI 0.085-0.671) reduced recurrence. Finally, age (P = 0.026, B = 0.056, Exp (B) = 1.057, 95% CI 1.007-1.110), complications (P < 0.001, B = 1.710, Exp (B) = 5.529, 95% CI 2.104-14.531), and Bender grade (P < 0.001, B = 1.165, Exp (B) = 3.205, 95% CI 1.325-7.750) were significant predictors of outcome.

Conclusions: The exhaustive drainage strategy is safe and effective for reducing recurrence rate and achieving good outcome in patients with CSDH. This procedure merits recommendation in clinical practice.

Keywords: CSDH; Chronic subdural hematoma; Drainage; Outcome; Recurrence; Strategy.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Drainage / methods*
Female
Hematoma, Subdural, Chronic / surgery*
Humans
Infant
Male
Middle Aged
Recurrence
Retrospective Studies
Trephining / methods*
Young Adult