Is it necessary to perform irrigation of a haematoma during the operation of a chronic subdural haematoma via burr hole drainage?

Czech version

Authors: P. Stejskal; M. Vaverka; L. Hrabálek; M. Hampl; Š. Trnka; V. Novák; J. Jablonský; M. Halaj
Authors‘ workplace: Neurochirurgická klinika LF UP, a FN Olomouc
Published in: Cesk Slov Neurol N 2019; 82(4): 448-451
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2019448

Overview

Aim: There are a lot of modifications for the surgical treatment of chronic subdural haematoma; however, the burr hole drainage is the most common procedure. The aim of our study was to compare two particular surgical procedures: burr hole drainage with preoperative irrigation of the haematoma and simple burr hole drainage.

Patients and methods: Patients who were operated on the chronic subdural haematoma at our department between 2011–2016 were enrolled in the study. Burr hole drainage with irrigation was used till September 2013; since then, patients have undergone burr hole drainage without irrigation. This change in surgical technique at out department was influenced by the studies showing similar results of both surgical techniques. Thus, the distribution of patients according to the surgical technique was not influenced by selection bias. All the data needed for the evaluation of the results of both surgical techniques, especially focusing on assessing recurrences, were found retrospectively in the medical documentation.

Results: There were 230 patients in our study who were treated by one of two study procedures. Eightyone patients underwent surgery with irrigation of haematoma, out of which 19 patients (23.5%) developed recurrence and 4 patients (4.9%) had to finally undergo craniotomy and membranectomy. The surgical technique without irrigation of haematoma was performed in 149 patients, and the recurrence was observed in 42 patients (28.2%) and 9 patients (6.0%) had to undergo craniotomy and membranectomy. Statistical evaluation did not prove a significant difference in effectiveness between these two surgical techniques.

Conclusion: Simple burr hole drainage is as effective as burr hole drainage with irrigation according to up to date knowledge. The technique without irrigation, as less invasive and faster, seems to be better for the treatment of chronic subdural haematoma.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

在慢性硬膜下血肿手术中，是否有必要使用毛刺孔引流术来冲洗血肿?

目的：对慢性硬膜下血肿的手术治疗有很多修改；但是，毛刺孔引流术是最常见的步骤。我们研究的目的是比较两种特殊的外科手术方法：毛刺孔引流术前术中冲洗血肿和简单的毛刺孔引流术。

患者和方法：本研究纳入了2011-2016年间在我们科室进行的慢性硬膜下血肿手术的患者。截止到2013年9月，使用灌溉毛刺排水；从那时起，患者未经冲洗就接受了毛刺孔引流。外科手术技术的这种变化受到显示两种手术技术结果相似的研究的影响。因此，根据手术技术的患者分布不受选择偏倚的影响。回顾性地在医学文献中发现了评估这两种手术技术的结果所需的所有数据，尤其是侧重于评估复发率。

结果：本研究中有230例患者接受了两种研究程序之一的治疗。 81名患者接受了血肿冲洗手术，其中19例（23.5％）复发，4例（4.9％）不得不进行开颅手术和膜切开术。 149例患者进行了不冲洗血肿的手术技术，其中42例（28.2％）复发，9例（6.0％）不得不进行开颅手术和膜切开术。统计评估未证明这两种手术技术在有效性上有显着差异。

结论：根据最新知识，简单的毛刺孔引流术与毛刺孔引流一样有效。无需冲洗的技术，侵入性较小且速度更快，似乎对于治疗慢性硬膜下血肿更有效。

关键词：慢性硬膜下血肿–毛刺孔引流–血肿冲洗–复发

Keywords:

chronic subdural haematoma – burr hole drainage – irrigation of the haematoma – recurrence

Sources

1. Ivamoto HS, Lemos HP Jr, Atallah AN. Surgical treatments for chronic subdural hematomas: a comprehensive systematic review. World Neurosurgery 2016; 86: 399– 418. doi: 10.1016/ j.wneu.2015.10.025.

2. Williams GR, Baskaya MK, Menendez J et al. Burr-
-hole versus twist-drill drainage for the evacuation of chronic subdural haematoma: a comparison of clinical results. J Clin Neurosci 2001; 8(6): 551– 554. doi: 10.1054/ jocn.2000.0926.

3. Kuroki T, Katsume M, Harada N et al. Strict closed-system drainage for treating chronic subdural haematoma. Acta Neurochir 2001; 143(10): 1041– 1044.

4. Kim DH, Kim HS, Choi HJ et al. Recurrence of the chronic subdural hematoma after burr-hole drainage with or without intraoperative saline irrigation. Korean J Neurotrauma 2014; 10(2): 101– 105. doi: 10.13004/
kjnt.2014.10.2.101.

5. Wang QP, Yuan Y, Guan JW et al. A comparative study of irrigation versus no irrigation during burr hole craniostomy to treat chronic subdural hematoma. BMC Surgery 2017; 17(1): 99. doi: 10.1186/ s12893-017-0295-x.

6. Suzuki K, Sugita K, Akai T et al. Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surg Neurol 1998; 50(3): 231– 234.

7. Gurelik M, Aslan A, Gurelik B et al. Safe and effective method for treatment of chronic subdural haematoma. Can J Neurol Sci 2007; 34(1): 84– 87.

8. Gelabert GM, Iglesias PM, Garcia AA et al. Chronic subdural haematoma: surgical treatment and outcome in 1,000 cases. Clin Neurol Neurosurg 2005; 107(3): 223– 229. doi: 10.1016/ j.clineuro.2004.09.015.

9. Santarius T, Qureshi HU, Sivakumaran R et al. The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma. World Neurosurg 2010; 73(6): 747– 750. doi: 10.1016/ j.wneu.2010.03.031.

10. Sikahall ME, Salazar PN, Sandoval BB. Chronic subdural hematoma. Surgical management in 100 patients. Cir Cir 2008; 76(3): 199– 203.

11. Chon KH, Lee JM, Koh EJ et al. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012; 154(9): 1541– 1548. doi: 10.1007/ s00701-012-1399-9.

12. Ishibashi A, Yokokura Y, Adachi H et al. A comparative study of treatments for chronic subdural hematoma: burr hole drainage versus burr hole drainage with irrigation. Kurume Med J 2011; 58(1): 35– 39.

13. Murakami H, Hirose Y, Sagoh M et al. Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of trombomodulin in the mechanism. J Neurosurgery 2002; 96(5): 877– 884. doi: 10.3171/ jns.2002.96.5.0877.

14. Kawamaki Y, Chikama M, Tamiya T et. al. Coagulation and fibrinolysis in chronic subdural hematoma. Neurosurgery 1989; 25(1): 25– 29.

15. Chon KH, Lee JM, Koh EJ et al. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012; 154(9): 1541– 1548. doi: 10.1007/ s00701-012-1399-9.

16. Abouzari M, Rashidi A, Rezaii J et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery 2007; 61(4): 794– 797. doi: 10.1227/ 01.NEU.0000298908.94129.67.

17. Ohba S, Kinoshita Y, Nakagawa T et al. The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 2013; 36(1): 145– 149. doi: 10.1007/ s10143-012-0396-z.

18. Gonzalez GM, Pais IM, Allut GA et al. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005; 107(3): 223– 229. doi: 10.1016/ j.clineuro.2004.09.015.

19. Lee JK, Choi JH, Kim CH et al. Chronic subdural hematomas: a comparative study of three types of operative procedures. J Korean Neurosurg Soc 2009; 46(3): 210– 214. doi: 10.3340/ jkns.2009.46.3.210.

20. Seong HY, Park JB, Kwon SC et al. Effect of saline irrigation in the surgical treatment of chronic subdural hematoma. J Korean Neurotraumatol Soc 2008; 4: 19– 23.

21. Yuan Y, Wang QP, Cao YL et al. Burr hole drainage and burr hole drainage with irrigation to treat chronic subdural hematoma: a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97(33): e11827. doi: 10.1097/ MD.0000000000011827.