Skip to main content
Top
Published in: BMC Surgery 1/2017

Open Access 01-12-2017 | Research article

A comparative study of irrigation versus no irrigation during burr hole craniostomy to treat chronic subdural hematoma

Authors: Qiang-Ping Wang, Ye Yuan, Jun-Wen Guan, Xiao-Bing Jiang

Published in: BMC Surgery | Issue 1/2017

Login to get access

Abstract

Background

Burr hole craniostomy is a widely used method for the evacuation of CSDH. However it is not clear whether the irrigation during operation improves the prognosis or gives rise to additional complications instead. This retrospective cohort study was conducted to determine this issue.

Methods

Patients attending two medical centers in China who underwent burr hole drainage with irrigation (BHDI) or burr hole drainage without irrigation (BHD) for unilateral CSDH during January 2013 to December 2016 were included in this study. The patients’ clinical information and follow-up data were retrospectively reviewed, and the radiologic findings were processed using the 3D Slicer software. The differences in outcomes were identified using t-test, chi-square test, or Fisher’s exact test.

Results

A total of 151 patients comprising 63 patients in the BHD group and 88 patients in the BHDI group were included. Patients in the BHDI group had a higher volume of pneumocrania on the first postoperative day than that of patients in the BHD group (p < 0.05). No significant differences were observed between the two approaches in rates of rebleeding, recurrence and other complications (p > 0.05).

Conclusions

Irrigation had no improvement in the long-term curative effect on CSDH, but it increased the risk of short-term complication in terms of pneumocrania. Therefore, this study suggests that irrigation is not an obligatory procedure during burr hole drainage.
Appendix
Available only for authorised users
Literature
1.
go back to reference Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg. 2011;114(1):72–6.CrossRefPubMed Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg. 2011;114(1):72–6.CrossRefPubMed
2.
go back to reference Santarius T, Kirkpatrick PJ, Kolias AG, Hutchinson PJ. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg. 2010;57:112–22.PubMed Santarius T, Kirkpatrick PJ, Kolias AG, Hutchinson PJ. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg. 2010;57:112–22.PubMed
3.
go back to reference De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A, et al. Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One. 2013;8(7):e68732.CrossRefPubMedPubMedCentral De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A, et al. Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One. 2013;8(7):e68732.CrossRefPubMedPubMedCentral
4.
go back to reference Belkhair S, Pickett G. One versus double burr holes for treating chronic subdural hematoma meta-analysis. Can J Neurol Sci. 2013;40:56–60.CrossRefPubMed Belkhair S, Pickett G. One versus double burr holes for treating chronic subdural hematoma meta-analysis. Can J Neurol Sci. 2013;40:56–60.CrossRefPubMed
5.
go back to reference Tahsim-Oglou Y, Beseoglu K, Hänggi D, Stummer W, Steiger HJ. Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis. Acta Neurochir. 2012;154(6):1063–7. discussion 1068CrossRefPubMed Tahsim-Oglou Y, Beseoglu K, Hänggi D, Stummer W, Steiger HJ. Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis. Acta Neurochir. 2012;154(6):1063–7. discussion 1068CrossRefPubMed
6.
go back to reference Ivamoto HS, Lemos HP Jr, Atallah AN. Surgical treatments for chronic subdural hematomas: a comprehensive systematic review. World Neurosurgery. 2016;86:399–418.CrossRefPubMed Ivamoto HS, Lemos HP Jr, Atallah AN. Surgical treatments for chronic subdural hematomas: a comprehensive systematic review. World Neurosurgery. 2016;86:399–418.CrossRefPubMed
7.
go back to reference Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H. A comparative study of the treatment of chronic subdural hematoma-burr hole drainage versus burr hole irrigation. Surg Neurol. 2002;57(6):405–9.CrossRefPubMed Okada Y, Akai T, Okamoto K, Iida T, Takata H, Iizuka H. A comparative study of the treatment of chronic subdural hematoma-burr hole drainage versus burr hole irrigation. Surg Neurol. 2002;57(6):405–9.CrossRefPubMed
8.
go back to reference Suzuki K, Sugita K, Akai T, Takahata T, Sonobe M, Takahashi S. Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surg Neurol. 1998;50:231–4.CrossRefPubMed Suzuki K, Sugita K, Akai T, Takahata T, Sonobe M, Takahashi S. Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surg Neurol. 1998;50:231–4.CrossRefPubMed
9.
go back to reference Kuroki T, Katsume M, Harada N, Yamazaki T, Aoki K, Takasu N. Strict closed-system drainage for treating chronic subdural haematoma. Acta Neurochir. 2001;143:1041–4.CrossRefPubMed Kuroki T, Katsume M, Harada N, Yamazaki T, Aoki K, Takasu N. Strict closed-system drainage for treating chronic subdural haematoma. Acta Neurochir. 2001;143:1041–4.CrossRefPubMed
10.
go back to reference Aoki N. Subdural tapping and irrigation for the treatment of chronic subdural hematoma in adults. Neurosurgery. 1984;14:545–8.CrossRefPubMed Aoki N. Subdural tapping and irrigation for the treatment of chronic subdural hematoma in adults. Neurosurgery. 1984;14:545–8.CrossRefPubMed
11.
go back to reference Jang KM, Kwon JT, Hwang SN, Park YS, Nam TK. 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. Korean J Neurotrauma. 2015;11(2):75–80.CrossRefPubMedPubMedCentral Jang KM, Kwon JT, Hwang SN, Park YS, Nam TK. 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. Korean J Neurotrauma. 2015;11(2):75–80.CrossRefPubMedPubMedCentral
12.
go back to reference Senturk S, Guzel A, Bilici A, Takmaz I, Guzel E, Aluclu MU, et al. CT and MR imaging of chronic subdural hematomas: a comparative study. Swiss Med Wkly. 2010;140:335–40.PubMed Senturk S, Guzel A, Bilici A, Takmaz I, Guzel E, Aluclu MU, et al. CT and MR imaging of chronic subdural hematomas: a comparative study. Swiss Med Wkly. 2010;140:335–40.PubMed
13.
go back to reference White M, Mathieson CS, Campbell E, Lindsay KW, Murray L. Treatment of chronic subdural haematomas-a retrospective comparison of minicraniectomy versus burrhole drainage. Br J Neurosurg. 2010;24:257–60.CrossRefPubMed White M, Mathieson CS, Campbell E, Lindsay KW, Murray L. Treatment of chronic subdural haematomas-a retrospective comparison of minicraniectomy versus burrhole drainage. Br J Neurosurg. 2010;24:257–60.CrossRefPubMed
14.
go back to reference Zhang Y. Various magnetic resonance imaging patterns of chronic subdural hematomas: indicators of the pathogenesis? Neurol Med Chir (Tokyo). 2006;46:339.CrossRef Zhang Y. Various magnetic resonance imaging patterns of chronic subdural hematomas: indicators of the pathogenesis? Neurol Med Chir (Tokyo). 2006;46:339.CrossRef
16.
go back to reference Sato S, Suzuki J. Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg. 1975;43:569–78.CrossRefPubMed Sato S, Suzuki J. Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg. 1975;43:569–78.CrossRefPubMed
17.
go back to reference Yamashima T, Yamamoto S, Friede RL. The role of endothelial gap junctions in the enlargement of chronic subdural hematomas. J Neurosurg. 1983;59:298–303.CrossRefPubMed Yamashima T, Yamamoto S, Friede RL. The role of endothelial gap junctions in the enlargement of chronic subdural hematomas. J Neurosurg. 1983;59:298–303.CrossRefPubMed
18.
go back to reference Hueng DY, Yen CH. Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas. J Neurosurg. 2011;114:1204.CrossRefPubMed Hueng DY, Yen CH. Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas. J Neurosurg. 2011;114:1204.CrossRefPubMed
19.
go back to reference Kenning TJ, Dalfino JC, Drazin D, German JW, Adamo MA. Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas. J Neurosurg. 2011;114:1204–5.CrossRef Kenning TJ, Dalfino JC, Drazin D, German JW, Adamo MA. Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas. J Neurosurg. 2011;114:1204–5.CrossRef
20.
go back to reference Tempaku A, Yamauchi S, Ikeda H, Tsubota N, Furukawa H, Maeda D, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature. Interv Neuroradiol. 2015;21(3):366–71.CrossRefPubMedPubMedCentral Tempaku A, Yamauchi S, Ikeda H, Tsubota N, Furukawa H, Maeda D, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature. Interv Neuroradiol. 2015;21(3):366–71.CrossRefPubMedPubMedCentral
21.
go back to reference Avezaat C. Burr hole evacuation of chronic subdural hematoma followed by continuous inflow and outflow irrigation. Acta Neurochir. 1999;141:176. Avezaat C. Burr hole evacuation of chronic subdural hematoma followed by continuous inflow and outflow irrigation. Acta Neurochir. 1999;141:176.
22.
go back to reference Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010;113:615–21.CrossRefPubMed Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010;113:615–21.CrossRefPubMed
23.
go back to reference Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry. 2003;74(7):937–43.CrossRefPubMedPubMedCentral Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry. 2003;74(7):937–43.CrossRefPubMedPubMedCentral
24.
go back to reference Horn EM, Feiz-Erfan I, Bristol RE, Spetzler RF, Harrington TR. Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surg Neurol. 2006;65:150–3.CrossRefPubMed Horn EM, Feiz-Erfan I, Bristol RE, Spetzler RF, Harrington TR. Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surg Neurol. 2006;65:150–3.CrossRefPubMed
25.
go back to reference Velazquez ER, Parmar C, Jermoumi M, Mak RH, van Baardwijk A, Fennessy FM, et al. Volumetric CT-based segmentation of NSCLC using 3D-Slicer. Sci Rep. 2013;18(3):3529.CrossRef Velazquez ER, Parmar C, Jermoumi M, Mak RH, van Baardwijk A, Fennessy FM, et al. Volumetric CT-based segmentation of NSCLC using 3D-Slicer. Sci Rep. 2013;18(3):3529.CrossRef
26.
go back to reference Rodt T, Ratiu P, Becker H, Bartling S, Kacher DF, Anderson M, et al. 3D visualisation of the middle ear and adjacent structures using reconstructed multi-slice CT datasets, correlating 3D images and virtual endoscopy to the 2D cross-sectional images. Neuroradiology. 2002;44(9):783–90.CrossRefPubMed Rodt T, Ratiu P, Becker H, Bartling S, Kacher DF, Anderson M, et al. 3D visualisation of the middle ear and adjacent structures using reconstructed multi-slice CT datasets, correlating 3D images and virtual endoscopy to the 2D cross-sectional images. Neuroradiology. 2002;44(9):783–90.CrossRefPubMed
27.
go back to reference Yi Y, Wang QP, Zhou ZM, Guan JW. A comparative study of burr hole drainage and burr hole drainage with irrigation to treat chronic subdural hematoma. West China Med J. 2017;32(2):1–4. Yi Y, Wang QP, Zhou ZM, Guan JW. A comparative study of burr hole drainage and burr hole drainage with irrigation to treat chronic subdural hematoma. West China Med J. 2017;32(2):1–4.
Metadata
Title
A comparative study of irrigation versus no irrigation during burr hole craniostomy to treat chronic subdural hematoma
Authors
Qiang-Ping Wang
Ye Yuan
Jun-Wen Guan
Xiao-Bing Jiang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2017
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-017-0295-x

Other articles of this Issue 1/2017

BMC Surgery 1/2017 Go to the issue