Korean J Neurotrauma.  2013 Oct;9(2):87-91. 10.13004/kjnt.2013.9.2.87.

Effects of Newly Designed Drainage Catheter in Treating Chronic Subdural Hematoma

• Park BS
• Choi SW
• Kwon HJ
• Kim SH
• Koh HS
• Youm JY
• Song SH

• KMID: 2156106
• DOI: http://doi.org/10.13004/kjnt.2013.9.2.87

Abstract

OBJECTIVE
Chronic subdural hematoma (cSDH) is a common disorder that is readily surgically treated but has high recurrence rate. This is a preliminary report to evaluate the effectiveness of a newly designed catheter compared with the conventional one in treating cSDH.
METHODS
We conducted a retrospective study of 111 patients with unilateral chronic subdural hematoma treated by burr hole craniostomy with closed-system drainage from November 2009 to September 2012. Group A was defined as patients treated with an external ventricular drainage (EVD) catheter and B as patients treated with the new catheter. We measured changes of thickness of hematoma and midline shifting in brain computed tomography (CT), amount of drainage and recurrence rate in both groups.
RESULTS
Group A consisted of 54 and B of 57 cases. The mean duration for total removal of hematoma was 42.6+/-13.9 hours in group A and 30.3+/-11.9 hours in group B (p<0.05). The mean amount of drainage counted per six hours cumulatively differed significantly between groups. The result (p<0.05) showed that the newly designed catheter effectively removed the hematoma. The total recurrence rate in group A was 11% and 3.5% in group B.
CONCLUSION
The study showed that the newly designed catheter effectively removed the hematoma in less time than the conventional one. This helps re-expand the brain block CSF from flowing into the subdural space and decrease the recurrence rate.

Keyword

Chronic subdural hematoma; Recurrence; Catheter

MeSH Terms

Brain
Catheters*
Drainage*
Hematoma
Hematoma, Subdural, Chronic*
Humans
Recurrence
Retrospective Studies
Subdural Space

Figure

• 

  FIGURE 1. The newly designed catheter with 18 holes within 5 centimeters from the tip (A), and external ventricular drainage (EVD) catheter used to treat chronic subdural hematoma conventionally (B).

• 

  FIGURE 2. Improvement rate of maximum thickness one day (A) and one week (B) after the surgery. There is no difference between groups. ∗improvement rate: (1-value of 24 h after surgery/pre-operative value)×100.

• 

  FIGURE 3. Improvement rate of midline shift one day (A) and one week (B) after the surgery. There is no difference between groups. ∗improvement rate: (1-value of 24 h after surgery/pre-operative value)×100.

• 

  FIGURE 4. Mean cumulative amount of drainage in 6 hours (p< 0.05), 12 hours (p<0.05) and 24 hours (p<0.05) proportion to total amount after surgery, significantly larger in group B. ∗proportion to total vol.: cumulative vol./total vol.×100.

Reference

References

1. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Ale-ali H, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burrhole surgery. Neurosurgery. 61:794–797. ; discussion 797,. 2007.

2. Ali M, Khan Z, Sharafat S, Khan KM. Craniotomy for encapsulated chronic subdural haematoma. Pan Arab J Neurosurg. 15:12–14. 2011.

3. Benzel EC, Bridges RM Jr, Hadden TA, Orrison WW. The single burr hole technique for the evacuation of non-acute subdural hematomas. J Trauma. 36:190–194. 1994.

4. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg. 65:183–187. 1986.

5. Cameron MM. Chronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiatry. 41:834–839. 1978.

6. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Anderson K, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 35:155–169. ; discussion 169,. 2012.

7. Fukuhara T, Gotoh M, Asari S, Ohmoto T, Akioka T. The relationship between brain surface elastance and brain reexpansion after evacuation of chronic subdural hematoma. Surg Neurol. 45:570–574. 1996.

8. Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery. 33:67–72. 1993.

9. Khalid Khanzada MA. Management of chronic subdural haematoma. JPMI. 18:651–657. 2011.

10. Kim JH, Kang DS, Kim JH, Kong MH, Song KY. Chronic subdural hematoma treated by small or large craniotomy with membranectomy as the initial treatment. J Korean Neurosurg Soc. 50:103–108. 2011.

11. Kim JY, Hyun DK, Yoon SH, Park HS, Kim E, Park HC, et al. Prediction of postoperative drainage volume and brain expansion of chronic subdural hematoma: supplementary study-clinical study. J Korean Neurotraumatol Soc. 6:33–37. 2010.

12. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 54:637–645. 1981.

13. Markwalder TM. The course of chronic subdural hematomas after burrhole craniostomy with and without closed-system drainage. Neurosurg Clin N Am. 11:541–546. 2000.

14. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burrhole craniostomy and closed-system drainage. J Neurosurg. 55:390–396. 1981.

15. Miele VJ, Sadrolhefazi A, Bailes JE. Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma. Surg Neurol. 63:420–423. ; discussion 423,. 2005.

16. Mindiola N P-GM. Pérez-García I, Pérez-Guerra M. Chronics subdural hematoma. J Med Archives. 19:4–8. 2003.

17. Mino M, Nishimura S, Hori E, Kohama M, Yonezawa S, Midorikawa H, et al. Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma. Surg Neurol Int. 1:78. 2010.

18. Mohamed EE. Chronic subdural haematoma treated by craniotomy, durectomy, outer membranectomy and subgaleal suction drainage. Personal experience in 39 patients. Br J Neurosurg. 17:244–247. 2003.

19. Nakajima H, Yasui T, Nishikawa M, Kishi H, Kan M. The role of postoperative patient posture in the recurrence of chronic subdural hematoma: a prospective randomized trial. Surg Neurol. 58:385–387. ; discussion 387,. 2002.

20. 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. 57:405–409. ; discussion 410,. 2002.

21. Ram Z, Hadani M, Sahar A, Spiegelmann R. Continuous irrigation-drainage of the subdural space for the treatment of chronic subdural haematoma. A prospective clinical trial. Acta Neurochir (Wien). 120:40–43. 1993.

22. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg. 61:263–268. 1984.

23. Sato M, Iwatsuki K, Akiyama C, Kumura E, Yoshimine T. Implantation of a reservoir for refractory chronic subdural hematoma. Neurosurgery. 48:1297–1301. 2001.