Korean J Neurotrauma.  2015 Oct;11(2):75-80. 10.13004/kjnt.2015.11.2.75.

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

• Jang KM
• Kwon JT
• Hwang SN
• Park YS
• Nam TK

• KMID: 2378262
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.75

Abstract

OBJECTIVE
Chronic subdural hematoma (CSDH), a disease commonly encountered by neurosurgeons, is treated by burr hole drainage (BHD). However, the optimal surgical technique among the three types of BHD has not been determined.
METHODS
We conducted a retrospective study on BHD performed on 93 patients who were diagnosed with CSDH. The subjects were divided into three groups based on the surgical technique performed: single BHD without irrigation (Group A, n=31), double BHD without irrigation (Group B, n=32), and double BHD with irrigation (Group C, n=30). The clinical factors, radiological factors and recurrences were compared between the three groups. Moreover, independent factors affecting the recurrence were analyzed.
RESULTS
The change in hematoma thickness was 29.77+/-7.94%, 49.73+/-12.87%, and 75.29+/-4.32% for Group A, B, and C, respectively, while the change in midline shift was 40.81+/-15.47%, 51.78+/-10.94%, and 56.16+/-16.16%, respectively. Thus, Group C showed the most effective for resolution of hematoma and midline shift (p<0.05). Group A, B, and C had 12 cases (38.7%), 8 cases (25.0%), and 3 cases (10.0%) of recurrences, respectively. Group C had a statistically significantly fewer recurrence rate than Group A (p<0.05). Double burr hole, irrigation, and coagulopathy were each identified as independent factors that reduce recurrence (p<0.05).
CONCLUSION
Among the three techniques, the double BHD with saline irrigation resulted in the fewest recurrences. It is probably the most effective technique for preventing the recurrence of CSDH.

Keyword

Hematoma, subdural, chronic; Trephining; Drainage; Therapeutic irrigation

MeSH Terms

Drainage*
Hematoma
Hematoma, Subdural, Chronic*
Humans
Recurrence*
Retrospective Studies
Therapeutic Irrigation
Trephining

Figure

• 

  FIGURE 1 The internal architectures of chronic subdural hematoma (CSDH). A: Axial view of non-enhance brain computed tomography shows a homogenous internal architecture of CSDH. B: Heterogeneous internal architecture.

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