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J Neurol Surg A Cent Eur Neurosurg 2015; 76(05): 415-417
DOI: 10.1055/s-0034-1396435
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

The Nelaton Catheter Guard for Safe and Effective Placement of Subdural Drain for Two-Burr-Hole Trephination in Chronic Subdural Hematoma: A Technical Note

Jens Fichtner
1   Department of Neurosurgery, Inselspital Bern University of Bern, Bern, Switzerland
,
Jürgen Beck
1   Department of Neurosurgery, Inselspital Bern University of Bern, Bern, Switzerland
,
A. Raabe
1   Department of Neurosurgery, Inselspital Bern University of Bern, Bern, Switzerland
,
Lennart Henning Stieglitz
2   Department of Neurosurgery, Zurich University Hospital, Zurich, Switzerland
› Institutsangaben
Weitere Informationen

Publikationsverlauf

11. August 2013

15. September 2014

Publikationsdatum:
16. Januar 2015 (online)

    Lizenzen und Reprints

Abstract

Background For chronic subdural hematoma, placement of a Blake drain with a two-burr-hole craniotomy is often preferred. However, the placement of such drains carries the risk of penetrating the brain surface or damaging superficial venous structures.

Objective To describe the use of a Nelaton catheter for the placement of a subdural drain in two-burr-hole trephination for chronic subdural hematoma.

Method A Nelaton catheter was used to guide placement of a Blake drain into the subdural hematoma cavity and provide irrigation of the hematoma cavity. With the two-burr-hole method, the Nelaton catheter could be removed easily via the frontal burr hole after the Blake drain was in place.

Results We used the Nelaton catheters in many surgical procedures and found it a safe and easy technique. This method allows the surgeon to safely direct the catheter into the correct position in the subdural space.

Conclusions This tool has two advantages. First, the use of a small and flexible Nelaton catheter is a safe method for irrigation of a chronic subdural hematoma cavity. Second, in comparison with insertion of subdural drainage alone through a burr hole, the placement of the Nelaton catheter in subdural space is easier and the risk of damaging relevant structures such as cortical tissue or bridging veins is lower. Thus this technique may help to avoid complications when placing a subdural drain.

Keywords

cerebral catheterization - chronic subdural hematoma - subdural drain
 

  • References

  • 1 Ducruet AF, Grobelny BT, Zacharia BE , et al. The surgical management of chronic subdural hematoma. Neurosurg Rev 2012; 35 (2) 155-169 ; discussion 169
    CrossrefPubMedGoogle Scholar
  • 2 Liu Y, Xia JZ, Wu AH, Wang YJ. Burr-hole craniotomy treating chronic subdural hematoma: a report of 398 cases. Chin J Traumatol 2010; 13 (5) 265-269
    PubMedGoogle Scholar
  • 3 Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma—craniotomy versus burr hole trepanation. Br J Neurosurg 2009; 23 (6) 612-616
    CrossrefPubMedGoogle Scholar
  • 4 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 (2) 87-92
    CrossrefPubMedGoogle Scholar
  • 5 Tahsim-Oglou Y, Beseoglu K, Hänggi D, Stummer W, Steiger HJ. Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis. Acta Neurochir (Wien) 2012; 154 (6) 1063-1067 ; discussion 1068
    CrossrefPubMedGoogle Scholar
  • 6 Santarius T, Kirkpatrick PJ, Ganesan D , et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009; 374 (9695) 1067-1073
    CrossrefPubMedGoogle Scholar
  • 7 Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ. The management of primary chronic subdural haematoma: a questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg 2008; 22 (4) 529-534
    CrossrefPubMedGoogle Scholar
  • 8 Taussky P, Fandino J, Landolt H. Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg 2008; 22 (2) 279-282
    CrossrefPubMedGoogle Scholar
  • 9 Bellut D, Woernle CM, Burkhardt JK, Kockro RA, Bertalanffy H, Krayenbühl N. Subdural drainage versus subperiosteal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas. World Neurosurg 2012; 77 (1) 111-118
    CrossrefPubMedGoogle Scholar
  • 10 Pavlov V, Bernhard G, Chibbaro S. Chronic subdural haematoma management: an iatrogenic complication. Case report and literature review. BMJ Case Rep 2012; ; pii: bcr1220115397. DOI: 10.1136/bcr.12.2011.5397
    PubMedGoogle Scholar
  • 11 Sucu HK, Gökmen M, Ergin A, Bezircioğlu H, Gökmen A. Is there a way to avoid surgical complications of twist drill craniostomy for evacuation of a chronic subdural hematoma?. Acta Neurochir (Wien) 2007; 149 (6) 597-599
    CrossrefPubMedGoogle Scholar
  • 12 Kaliaperumal C, Khalil A, Fenton E , et al. 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) 2083-2088 ; discussion 2088–2089
    CrossrefPubMedGoogle Scholar