Valve-controlled chronic subdural hematoma drainage: A feasibility study

Vasileios Anagnostopoulos; Alexandros G Brotis; Christos Tzerefos; Alexandra Charalambidou; Anastasia Tasiou; Antonios Karavelis; Konstantinos N Paterakis

doi:10.1016/j.bas.2022.101693

Valve-controlled chronic subdural hematoma drainage: A feasibility study

Brain Spine. 2022 Nov 22:2:101693. doi: 10.1016/j.bas.2022.101693. eCollection 2022.

Authors

Vasileios Anagnostopoulos¹, Alexandros G Brotis¹, Christos Tzerefos¹, Alexandra Charalambidou², Anastasia Tasiou¹, Antonios Karavelis¹, Konstantinos N Paterakis¹

Affiliations

¹ Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larisa, Greece.
² Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece.

Abstract

Introduction: Pneumocephalus after chronic subdural hematoma (CSDH) evacuation is a potential predictor of hematoma recurrence.

Research question: To study the feasibility and safety of a novel CSDH evacuation technique using a valve-controlled method to avoid pneumocephalus.

Material and methods: In a retrospective case series, we evacuated CSDH using very low-pressure valve-controlled drains and recorded the neurological, radiological, and functional outcomes. Patients with primary CSDH, without previous neurosurgical intervention, and who did not receive antiplatelet or anticoagulant therapy the week prior to the index surgery, were included in the study. Exclusion criteria were the evacuation with other treatment techniques and incomplete data files. Patients were assessed according to the Bender grading system to record the neurological status. The hematoma volume was estimated using the formula for ellipsoid volumes.

Results: Thirty-six patients with a mean age of 73 years (±9 years) fulfilled our eligibility criteria. Our technique was effective since it decreased the CSDH volume from 141 ml (IQR 97 ml) to 20.6 ml (IQR 26.59 ml; p < 0.001) and improved the neurological status according to the Bender grading system from two (IQR 0.25) to 1 (IQR 0). However, pneumocephalus and hematoma recurrence occurred in one case each (2.8%). At six months, all patients returned to their previous status, except for two patients (5.6%) who died due to irrelevant pathologies.

Conclusions: Valve-controlled CSDH evacuation aiming to decrease the postoperative pneumocephalus and hematoma recurrence constitutes an effective and safe alternative. However, larger randomized controlled studies are required to establish its role in CSDH management.

Keywords: Chronic subdural hematoma; Evacuation; Outcome; Pneumocephalus; Recurrence; Volume.