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DOI: 10.1055/s-0042-1758658
Mini-Perforated Craniotomy with Subperiosteal Drain for Evacuation of Chronic Subdural Hematoma: A New Technique and Clinical Study
Abstract
Background Chronic subdural hematoma (cSDH) is a frequent disease of the elderly with favorable outcomes. The main choice of treatment is surgery. Along with many surgical techniques described for evacuation of cSDH, we are presenting the preliminary outcomes of a novel surgical method, mini-perforated craniotomy with a subperiosteal drain.
Material and Methods Patients in whom cSDH with thickness of >10 mm was observed in computed tomography (CT) scans with parenchymal compression and/or midline shift were included in this study. Age, sex, complaint, neurological status, and medical history were recorded along with CT findings. Mini-perforated craniotomy was performed on all patients. A subperiosteal drain was used. The postoperative follow-up period was 3 months.
Results Ten cSDH patients who were admitted to Prof. Dr. Cemil Tascioglu City Hospital between December 2020 and May 2021 were included in this study. The mean age was 64.3 ± 6.272, and the most common admission complaint was a headache. Postoperatively, one patient showed acute rebleeding after the operation due to dual anticoagulant therapy. Besides, in 3 months follow-up, rebleeding, subdural or epidural effusion, wound infection, or cosmetic problems were not observed.
Conclusion Mini-perforated craniotomy with a subperiosteal drain may be an alternative method for evacuation of cSDH with low complication rates especially when the hematoma is suspected to be septated.
Publication History
Article published online:
23 December 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Ducruet AF, Grobelny BT, Zacharia BE. et al. The surgical management of chronic subdural hematoma. Neurosurg Rev 2012; 35 (02) 155-169 , discussion 169
- 2 Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 2017; 28 (02) 205-210
- 3 Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 2001; 95 (02) 256-262
- 4 Lee KS. History of chronic subdural hematoma. Korean J Neurotrauma 2015; 11 (02) 27-34
- 5 Lee KS. Natural history of chronic subdural haematoma. Brain Inj 2004; 18 (04) 351-358
- 6 Huang J, Gao C, Dong J, Zhang J, Jiang R. Drug treatment of chronic subdural hematoma. Expert Opin Pharmacother 2020; 21 (04) 435-444
- 7 Santarius T, Kirkpatrick PJ, Kolias AG, Hutchinson PJ. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg 2010; 57: 112-122
- 8 Link TW, Rapoport BI, Paine SM, Kamel H, Knopman J. Middle meningeal artery embolization for chronic subdural hematoma: endovascular technique and radiographic findings. Interv Neuroradiol 2018; 24 (04) 455-462
- 9 Wakuta N, Abe H, Fukuda K. et al. Feasibility and safety of endoscopic procedure in burr-hole surgery for chronic subdural hematoma in patients of very advanced age. World Neurosurg 2020; 134: e1037-e1046
- 10 Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005; 107 (03) 223-229
- 11 Zumofen D, Regli L, Levivier M, Krayenbühl N. Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system. Neurosurgery 2009; 64 (06) 1116-1121 , discussion 1121–1122
- 12 Im TS, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG. The efficacy of titanium burr hole cover for reconstruction of skull defect after burr hole trephination of chronic subdural hematoma. Korean J Neurotrauma 2014; 10 (02) 76-81
- 13 Sahyouni R, Mahboubi H, Tran P, Roufail JS, Chen JW. Membranectomy in chronic subdural hematoma: meta-analysis. World Neurosurg 2017; 104: 418-429
- 14 Wu Q, Liu Q, Chen D. 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; 35 (03) 324-328
- 15 Jensen TSR, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. Drain type and technique for subdural insertion after burr hole evacuation of chronic subdural hematoma. Acta Neurochir (Wien) 2020; 162 (09) 2015-2017
- 16 Yadav YR, Parihar V, Chourasia ID, Bajaj J, Namdev H. The role of subgaleal suction drain placement in chronic subdural hematoma evacuation. Asian J Neurosurg 2016; 11 (03) 214-218
- 17 Mohamed EE. Chronic subdural haematoma treated by craniotomy, durectomy, outer membranectomy and subgaleal suction drainage. Personal experience in 39 patients. Br J Neurosurg 2003; 17 (03) 244-247
- 18 Yakar F, Egemen E, Dere UA. et al. Subdural hematoma evacuation via rigid endoscopy system: a cadaveric study. J Craniofac Surg 2021; 32 (05) e402-e405
- 19 Moshayedi P, Liebeskind DS. Middle meningeal artery embolization in chronic subdural hematoma: implications of pathophysiology in trial design. Front Neurol 2020; 11: 923
- 20 Xu C, Chen B, Xue L. et al. Randomized controlled study on the curative effects of twist-drill craniotomy and burr-hole craniotomy in the treatment of chronic subdural hematoma. Exp Ther Med 2018; 16 (02) 959-965
- 21 Gazzeri R, Laszlo A, Faiola A. et al. Clinical investigation of chronic subdural hematoma: relationship between surgical approach, drainage location, use of antithrombotic drugs and postoperative recurrence. Clin Neurol Neurosurg 2020; 191: 105705
- 22 Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg 2016; 11 (04) 330-342
- 23 You W, Zhu Y, Wang Y. et al. Prevalence of and risk factors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2018; 160 (05) 893-899
- 24 Zhang JJY, Wang S, Foo ASC. et al. Outcomes of subdural versus subperiosteal drain after burr-hole evacuation of chronic subdural hematoma: a multicenter cohort study. World Neurosurg 2019; 131: e392-e401
- 25 Glancz LJ, Poon MTC, Coulter IC, Hutchinson PJ, Kolias AG, Brennan PM. British Neurosurgical Trainee Research Collaborative (BNTRC). 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; 85 (04) 486-493
- 26 Soleman J, Lutz K, Schaedelin S. et al. Subperiosteal vs subdural drain after burr-hole drainage of chronic subdural hematoma: a randomized clinical trial (cSDH-Drain-Trial). Neurosurgery 2019; 85 (05) E825-E834
- 27 Vasella F, Akeret K, Smoll NR. et al; CORRECT SCAR study group. Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation-a retrospective pilot study. Acta Neurochir (Wien) 2018; 160 (11) 2129-2135