Comparison of Outcome of Chronic Subdural Hematoma (SDH) In Terms of Recurrence with Drain and without Drain

Authors

  • Ehtisham Ahmed Afridi Neurosurgery
  • Adil Ihsan Departments of Neurosurgery, Ayub Teaching Hospital, Abbottabad
  • Shabana Naz Department of Pathology, Ayub Teaching Hospital, Abbottabad
  • Gohar Ali Department of Neurosurgery, Bacha Khan Medical College, Mardan – Pakistan
  • Asghar Ali Departments of Neurosurgery, Ayub Teaching Hospital, Abbottabad
  • Shah Khalid Departments of Neurosurgery, Ayub Teaching Hospital, Abbottabad

DOI:

https://doi.org/10.36552/pjns.v25i2.459

Keywords:

Chronic Subdural Hematoma, drainage, Burr Hole with Irrigation

Abstract

Background/Objectives:  Chronic subdural hematoma commonly reported in neurosurgical practices. Variations are reported in neurosurgical practices regarding the treatment of chronic subdural hematoma (SDH). This study determined the outcomes of SDH with Drain and without Drain in terms of recurrence and effectiveness.

Material and Methods:  A randomized control trial was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad. Group-A patients were subjected to drainage of chronic subdural hematoma without drain and Group-B patients were subjected to drainage with drain. All patients were followed up to one month for recurrence of subdural hematoma like on CT-scan.

Results:  Overall, the recurrence of chronic subdural hematoma in both groups was seen in 16.7% of patients and the procedures were effective in 83.3% of patients. In Group A, 79.6% of patients were successfully treated through burr hole with irrigation, while 20.4% of patients had recurrent chronic SDH. In Group B, only 13% of patients had a recurrence, while 87% of patients were successfully treated with burr with the closed continuous drainage system. An insignificant difference (p-value: 0.302) existed between groups for both types of procedures.

Conclusion:  The patients who were treated with burr hole and irrigation of the subdural space with normal saline had high recurrence incidence than those with burr hole with closed continuous drainage system.

References

1. Lee KS, Shim JJ, Yoon SM, Doh JW, Yun IG, Bae HG. Acute-on-chronic subdural hematoma: Not Uncommon Events. J Korean Neurosurg Soc. 2011; 50 (6): 512-6.
2. Mostofi K, Marnet D. Percutaneous Evacuation for treatment of Subdural Hematoma and outcome in 28 patients. Turkish Neurosurg. 2011; 21 (4): 522-6.
3. Soto-Granados M. Treatment of chronic subdural
hematoma through a burr hole. Cirugia y cirujanos, 2010; 78 (3): 203-7.
4. Ahmed S, Agrawal D, Kale SS, Mahapatra AK. A Comparative study of treatment of chronic subdural hematoma – burr hole drainage versus continuous closed drainage. Indian Journal of Neurotrauma, 2011; 8 (1): 17-24.
5. Lee KS. Natural history of chronic subdural haematoma. Brain Inj. 2004; 18 (4): 351-8.
6. Han HJ, Park CW, Kim EY, Yoo CJ, Kim YB, Kim WK. One vs. Two Burr hole craniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc. 2009; 46: 87-92.
7. Torihashi K, Sadamasa N, Yoshida K, Naurumi O, Chim M, Yamagata S. Independent predictors for recurrent chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery, 2008; 63: 1125-9.
8. Senturk S, Guzel A, Bilici A, Takmaz I, Guzel E, Aluclu MU, et al. CT and MR Imaging of chronic subdural haematoma: A comparative study. Swiss MED WKLY. 2010; 140 (23 – 24): 335-40.
9. Gelabert-Gonzalez M, Iglesias-pais M, Garcia Allut A, Martinez-Rumbo R. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neural Neurosurg. 2005; 107: 223-9.
10. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, Derosa PL, Anderson K et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012; 35 (2): 155-169.
11. Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev. 2004 Oct; 27 (4): 263-6.
12. Khan RD, Ali M, Ali M, Rizwan U. The etiology, symptomatology and surgical outcome in 60 cases of Chronic Subdural Hematoma. JPGMI. 2004; 2.
13. Erol FS, Topsakal C, Faik Ozveren M, Kalpan M, Tiftikel MT. Irrigation VS Closed Drainage in the treatment of Chronic Subdual Hematoma. J Clin Neurosci. 2005; 12: 261-3.
14. Oh HJ, Lee KS, Shim JJ, Yoon SM, Yun G, Bae HG. Postoperative course and recurrence of chronic subdural hematoma. J Korean Neurosurg Soc. 2010; 48 (6): 518-23.
15. Mulligan P, Raore B, Liu S, Olson JF. Neurological
and functional outcomes of subdural hematoma evacuation in patients over 70 years of age. J Neurosci Rural Pract. 2013; 4: 250-6.
16. Thapa A, Agrawal B. Mount Fuji Sign in Tension Pneumocphalus. Indian J Neurotrauma, 2009; 6:
161-2.
17. Gurunathan J. Treatment of chronic subdural hematoma with burr whole craniostomy and irrigation. Indian J Neurotrauma, 2005; 2 (2): 127-30.

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Published

2021-06-14

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