Predictors and Outcomes of Subdural Hematomas Managed via Subdural Evacuation Port System

James Mooney; Nicholas Erickson; Ben Saccomano; Pedram Maleknia; Winfield S Fisher 3rd

doi:10.1016/j.wnsx.2022.100145

Predictors and Outcomes of Subdural Hematomas Managed via Subdural Evacuation Port System

World Neurosurg X. 2022 Oct 5:17:100145. doi: 10.1016/j.wnsx.2022.100145. eCollection 2023 Jan.

Authors

James Mooney¹, Nicholas Erickson¹, Ben Saccomano¹, Pedram Maleknia², Winfield S Fisher 3rd¹

Affiliations

¹ Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA.
² School of Medicine, University of Alabama at Birmingham, Alabama, USA.

Abstract

Background: Subacute subdural hematoma (SDH) is a common pathology most frequently affecting older patients and may be treated operatively through burr holes versus craniotomy or minimally invasively with bedside twist drill craniostomy. Less invasive intervention is favored when possible given a frequently comorbid population. The subdural evacuation port system (SEPS) is a popular treatment option that warrants investigation and reporting of its use and outcomes.

Methods: A retrospective review of consecutive patients undergoing SEPS drain placement for chronic or mixed density SDH between 2010 and 2021 was conducted. Outcomes of SDH recurrence, need for operating room procedure after SEPS placement, discharge disposition other than home, and modified Rankin Scale score <3 at discharge were modeled with logistic regression using multiple demographic, clinical, and radiographic features.

Results: Ultimately, 86 patients (mean age 68) were included in the analysis with 66 (78%) presenting with mixed-density SDHs. Radiographic factors such as hematoma thickness and midline shift were not associated with the need for an operating room procedure after SEPS placement or discharge disposition. However, the presence of septations and mixed-density SDH versus chronic SDH was significantly associated with increased odds of requiring an operative intervention after SEPS placement.

Conclusions: Subacute SDHs are a frequent neurosurgical issue in patient populations where less invasive measures are favored. SEPS drainage continues to be an effective treatment option. However, the presence of septations and mixed-density SDHs has a significantly increased odds of requiring surgical intervention that must be considered in the decision to pursue SEPS drainage.

Keywords: Burr hole; CI, Confidence interval; Craniostomy; GCS, Glasgow Coma Scale; Midline shift; OR, Operating room; SDH, Subdural hematoma; SEPS, Subdural evacuating port system; Septations; Subacute subdural hematoma; Subdural evacuating port system; TDC, Twist drill craniostomy; cSDH, Chronic subdural hematoma; mRS, Modified Rankin scale.