Single versus double drainage in chronic subdural hematomas treated with burr-holes
Keywords:
chronic subdural hematoma, surgical treatment, drainage.Abstract
Introduction: Chronic subdural hematoma is a frequent type of intracranial hemorrhage. Treatment for symptomatic cases is generally surgical. Burr-hole completion is the method of choice. Objective: To analyze the placement of a single versus double drain in patients with chronic subdural hematoma operated through burr-holes.Methods: An analytical correlational retrospective study was carried out in patients who underwent surgery for chronic subdural hematoma, between January 2018 and December 2020. The patients were divided into 2 groups based on the number of drains used: double or single. The variables were: age, morbidities, preoperative Glasgow Score, hematoma characteristics (laterality, internal architecture, maximum diameter, and midline shift), complications, and hospital stay. The probability value < 0.05 was considered statistically significant.
Results: Of the 99 patients in the study, 39 were older than 75 years. The most frequent pattern was B with 25 cases (25,3 %). The diameter of the chronic subdural hematoma was more than 20 mm in 61 cases, and in 32 cases the displacement of the midline structures was greater than 10 mm. The average hospital stays 5,8 days. The most frequent complication was nosocomial pneumonia with eleven cases (11,11 %). The double drainage group showed fewer complications at 30 days.
Conclusions: The placement of double subdural drainage in patients with chronic subdural hematoma operated through single or double burr-holes, and is related to fewer complications than those with single drainage.
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References
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13. Nakaguchi H, Tanishima T, Yoshimasu N. Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage. J Neurosurg. 2000 [acceso: 14/08/2022]; 93(5):791-5. Disponible en: https://thejns.org/view/journals/j-neurosurg/93/5/article-p791.xml
14. Wu Q, Liu Q, Chen D, Chen Z, Huang X, Luo M, et al. Subdural drainage techniques for single burr-hole evacuation of chronic subdural hematoma: two drains frontal-occipital position versus one drain frontal position. Br J Neurosurg. 2021 [acceso: 14/08/2022];35(3):324-8. Disponible en: https://www.tandfonline.com/doi/full/10.1080/02688697.2020.1812520
15. Gernsback J, Kolcun JPG, Jagid J. To Drain or Two Drains: Recurrences in Chronic Subdural Hematomas. World Neurosurg. 2016 [acceso: 14/08/2022]; 95:447-50. Disponible en: https://www.sciencedirect.com/science/article/pii/S1878875016307379
2. Yang W, Huang J. Chronic Subdural Hematoma: Epidemiology and Natural History. Neurosurg Clin. 2017 [acceso: 14/08/2022]; 28(2):205-10. Disponible en: https://www.neurosurgery.theclinics.com/article/S1042-3680(16)30099-7/fulltext
3. Wong-Achi X, Cabrera D. Pathogenesis and pathophysiology of chronic subdural hematoma. Rev Mex Neurocienc. 2016 [acceso: 14/08/2022]; 17(4):78-85. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=69098
4. Tamura R, Sato M, Yoshida K, Toda M. History and current progress of chronic subdural hematoma. J Neurol Sci. 2021 [acceso: 14/08/2022]; 429:118066. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0022510X21007620
5. Shen J, Yuan L, Ge R, Wang Q, Zhou W, Jiang XC, et al. Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study. Injury. 2019 [acceso: 14/08/2022]; 50(10):1634-40. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31445831/
6. Shlobin NA, Kedda J, Wishart D, Garcia RM, Rosseau G. Surgical Management of Chronic Subdural Hematoma in Older Adults: A Systematic Review. Magaziner J, editor. J Gerontol Ser A. 2021 [acceso: 14/08/2022]; 76(8):1454-62. Disponible en: https://academic.oup.com/biomedgerontology/article/76/8/1454/5998257
7. Pahatouridis D, Alexiou GA, Fotakopoulos G, Mihos E, Zigouris A, Drosos D, et al. Chronic subdural haematomas: a comparative study of an enlarged single burr hole versus double burr hole drainage. Neurosurg Rev. 2013 [acceso: 14/08/2022]; 36(1):151-5. Disponible en: http://link.springer.com/10.1007/s10143-012-0412-3
8. Miah IP, Tank Y, Rosendaal FR, Peul WC, Dammers R, Lingsma HF, et al. Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis. Neuroradiology. 2021 [acceso: 14/08/2022]; 63(1):27-40. Disponible en: https://link.springer.com/10.1007/s00234-020-02558-x
9. Takei J, Hirotsu T, Hatano K, Ishibashi T, Inomata T, Noda Y, et al. Modified Computed Tomography Classification for Chronic Subdural Hematoma Features Good Interrater Agreement: A Single-Center Retrospective Cohort Study. World Neurosurg. 2021 [acceso: 14/08/2022]; 151:e407-17. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33892165/
10. Jensen TSR, Andersen-Ranberg N, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. The Danish Chronic Subdural Hematoma Study-comparison of hematoma age to the radiological appearance at time of diagnosis. Acta Neurochir (Wien). 2020 [acceso: 14/08/2022]; 162(9):2007-13. Disponible en: https://link.springer.com/10.1007/s00701-020-04472-w
11. Salama H. Outcome of single burr hole under local anesthesia in the management of chronic subdural hematoma. Egypt J Neurosurg. 2019 [acceso: 14/08/2022]; 34(1):8. Disponible en: https://EJNS.springeropen.com/articles/10.1186/s41984-019-0033-z
12. Glancz LJ, Poon MTC, Coulter IC, Hutchinson PJ, Kolias AG, Brennan PM. Does Drain Position and Duration Influence Outcomes in Patients Undergoing Burr-Hole Evacuation of Chronic Subdural Hematoma? Lessons from a UK Multicenter Prospective Cohort Study. Neurosurgery. 2019 [acceso: 14/08/2022];85(4):486-93. Disponible en: https://journals.lww.com/10.1093/neuros/nyy366
13. Nakaguchi H, Tanishima T, Yoshimasu N. Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage. J Neurosurg. 2000 [acceso: 14/08/2022]; 93(5):791-5. Disponible en: https://thejns.org/view/journals/j-neurosurg/93/5/article-p791.xml
14. Wu Q, Liu Q, Chen D, Chen Z, Huang X, Luo M, et al. Subdural drainage techniques for single burr-hole evacuation of chronic subdural hematoma: two drains frontal-occipital position versus one drain frontal position. Br J Neurosurg. 2021 [acceso: 14/08/2022];35(3):324-8. Disponible en: https://www.tandfonline.com/doi/full/10.1080/02688697.2020.1812520
15. Gernsback J, Kolcun JPG, Jagid J. To Drain or Two Drains: Recurrences in Chronic Subdural Hematomas. World Neurosurg. 2016 [acceso: 14/08/2022]; 95:447-50. Disponible en: https://www.sciencedirect.com/science/article/pii/S1878875016307379
Published
2023-04-21
How to Cite
1.
Horta-Tamayo EE, Acosta-Gonzalez LC, Ortega-Raez DR, Parra-Vidal LN, Suarez-Cruz M. Single versus double drainage in chronic subdural hematomas treated with burr-holes. Rev Cubana Med Milit [Internet]. 2023 Apr. 21 [cited 2025 Apr. 3];52(2):e02302515. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/2515
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