Complications Following Comparison of Surgery for Chronic Subdural Hematoma, With and Without Postoperative Drainage Tube

  • Imran Altaf Department of Neurosurgery, Khawja Muhammad Safdar Medical College, Sialkot – Pakistan
  • Shahzad Shams Department of Neurosurgery, Mayo Hospital, Lahore – Pakistan

Abstract

Objectives:  Chronic subdural hematoma (CSDH) is one of the most common entities treated in neurosurgery. Postoperative subdural drainage employed after burr hole evacuation for treating CSDH reduces recurrence, but whether it leads to increased surgical complications compared to no postoperative drainage is debatable. The present study was designed to assess whether postoperative subdural drainage leads to increased surgical complications following burr hole evacuation of CSDH compared to no drainage.

Materials and Methods:  The medical records of 69 patients treated with burr hole evacuation for chronic subdural hematoma between July 2013 to April 2014 were retrospectively analyzed. The patients were divided into two groups. In group A patients, postoperative subdural drainage had been employed following burr hole evacuation of CSDH, while in group B patients there was no drainage. The two groups were then compared for the development of surgical complications other than recurrence.

Results:  Sixteen patients developed complications. Acute Subdural hematoma formed in 3 patients. There was intraparenchymal drain insertion in 6 patients. An empyema developed in 2 patients, while one patient each developed an Extradural hematoma, fits, contusion, and hemorrhagic infarction. All the complications occurred in the group A patients receiving postoperative subdural drainage. Postoperative subdural drainage tube was found to be significantly associated (p = 0.0017) with complications.

Conclusion:  We conclude that postoperative subdural drainage following burr hole evacuation of chronic subdural hematoma is associated with increased surgical complications compared to no drainage.

References

1. Hyun Seok Lee, Sang Woo Song, Young Il Chun, Woo Jin Choe, Joon Cho, Chang Taek Moon, and Young-Cho Koh. Complications Following Burr Hole Craniostomy and Closed-System Drainage for Subdural Lesions. Korean J Neurotrauma, 2018; 14 (2): 68–75.
2. Minna Rauhala, Pauli Helén, Heini Huhtala, Paula Heikkilä, Grant L. Iverson, Tero Niskakangas, Juha Öhman and Teemu M. Luoto. Chronic subdural hematoma—incidence, complications, and financial impact. Acta Neurochir (Wien), 2020; 162 (9): 2033–2043.
3. Fernand Nathan Imoumby, Franck Kouakou, Yao C. Hugues Dokponou, Abad Cherif El Asri, Miloud Gazzaz. Brain Stroke as a Post-Operative Lethal Complication of a Bilateral Chronic Subdural Hematoma: A Case Report. Open Journal of Modern Neurosurgery, 2021; 11 (2): 122–127.
4. Tetsuhisa Yamada, Yoshihiro Natori. Evaluation of Seizures in Patients with Chronic Subdural Hematoma Treated by Burr-Hole Surgery and Risk Factors for Seizures. Int J Brain Disord Treat. 2017; 3 (1): 1–8.
5. Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014; 121 (3): 665-73.
6. Lee JM, Park JC, Kim JH. Retrospective analysis of risk factors for recurrent chronic subdural hematoma. Nerve. 2016; 2 (2): 54-58.
7. Jeong SI, Kim SO, Won YS, Kwon YJ, Choi CS. Clinical Analysis of Risk Factors for Recurrence in Patients with Chronic Subdural Hematoma Undergoing Burr Hole Trephination. Korean J Neurotrauma, 2014; 10 (1): 15–21.
8. Kim DH, Kim HS, Choi HJ, Han IH, Cho WH, Nam KH. Recurrence of the Chronic Subdural Hematoma after Burr-Hole Drainage with or without Intraoperative Saline Irrigation. Korean J Neurotrauma, 2014; 10 (2): 101–105.
9. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma. J Korean Neurosurg Soc. 2008; 43 (1): 11–15.
10. Escosa Baé M, Wessling H, Salca HC, de Las Heras Echeverría P. Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence. Acta Neurochir (Wien), 2011; 153 (5): 1097-103.
11. Soleman J, Kamenova M, Lutz K, Guzman R, Fandino J, Mariani L. Drain Insertion in Chronic Subdural Hematoma: An International Survey of
Practice. World Neurosurg. 2017; 104: 528-536.
12. Rohde V, Graf G, Hassler W. Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev. 2002; 25 (1-2): 89-94.
13. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009; 374 (9695): 1067-73.
14. Peng D, Zhu Y. External drains versus no drains after burr-hole evacuation for the treatment of chronic subdural haematoma in adults. Cochrane Database Syst Rev. 2016; 2016 (8): CD011402.
15. Singh AK, Suryanarayanan B, Choudhary A, Prasad A, Singh S, Gupta LN. A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma. Neurol India, 2014; 62 (2): 169-74.
16. Dhanapal Pattanam Velappan, Ponnaiyan Natesan Palaniappan, Anbarasi Pandian A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma. Int Surg J. 2018; 5 (6): 2304-2307.
17. Chih AN, Hieng AW, Rahman NA, Abdullah JM. Subperiosteal Drainage versus Subdural Drainage in the management of Chronic Subdural Hematoma (A Comparative Study). Malays J Med Sci. 2017; 24 (1): 21-30.
18. Soleman J, Lutz K, Schaedelin S, Kamenova M, Guzman R, Mariani L, Fandino J. Subperiosteal vs Subdural Drain After Burr-Hole Drainage of Chronic Subdural Hematoma: A Randomized Clinical Trial (cSDH-Drain-Trial). Neurosurgery, 2019; 85 (5): E825-E834.
19. Häni L, Vulcu S, Branca M, Fung C, Z'Graggen WJ, Murek M, et al. Subdural versus subgaleal drainage for chronic subdural hematomas: a post hoc analysis of the TOSCAN trial. J Neurosurg. 2019: 1-9.
20. Kaliaperumal C, Khalil A, Fenton E, Okafo U, Kaar G, O'Sullivan M, Marks C. A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma. Acta Neurochir (Wien), 2012; 154 (11): 2083-8; Discussion 2088-9.
21. Cofano F, Pesce A, Vercelli G, Mammi M, Massara A, Minardi M, et al. Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study. Front Neurol. 2020; 11: 560269.
22. Guilfoyle MR, Hutchinson PJ, Santarius T. Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma. Acta Neurochir (Wien), 2017; 159 (5): 903-905.
23. Alcalá-Cerra G, Young AM, Moscote-Salazar LR, Paternina-Caicedo A. Efficacy and safety of subdural drains after burr-hole evacuation of chronic subdural hematomas: systematic review and meta-analysis of randomized controlled trials. World Neurosurg. 2014; 82 (6): 1148-57.
Published
2021-09-30
Section
Original Articles