TY - JOUR
T1 - Clinical investigation of chronic subdural hematoma
T2 - Relationship between surgical approach, drainage location, use of antithrombotic drugs and postoperative recurrence
AU - Gazzeri, Roberto
AU - Laszlo, Adrienn
AU - Faiola, Andrea
AU - Colangeli, Mario
AU - Comberiati, Antonio
AU - Bolognini, Andrea
AU - Callovini, Giorgio
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - Objectives: Chronic subdural hematoma (CSDH) is one of the most common diseases in the routine neurosurgical practice. The most usual procedures for CSDH treatment include single or multiple burr hole drainage craniectomy. There is still controversy, however, about the risks and benefits of the different surgical approaches and types of drainage. The aim of the current study is to evaluate the postoperative complications of the various surgical techniques of CSDH. Patients and Methods: We conducted a single center retrospective analysis on 414 patients surgically treated for CSDH over a period of 6 years. Comparisons were made after dividing the patients into 4 groups based on the surgical technique and type of drainage: Single burr hole with subdural drainage (Group Ia), single burr hole with subgaleal drainage (Group Ib), craniotomy with subdural drainage (Group IIa), and craniotomy with subgaleal drainage (Group IIb). 238 cases underwent burr hole with irrigation, while 290 cases were treated with craniotomy. Of the analysed patients, subdural drainage was inserted in 382 cases, while subgaleal drain was used only in 146 patients, for a total of 528 procedures. Results: Re-operation was performed in 9.47 % of cases. The frequency of re-intervention for recurrences appeared to be lower in the Group I a (5.06 %), while the frequency of the re-intervention was higher in the craniotomy with subdural drainage group (Group IIa, 11.6 %). 14 patients (2.65 %) developed acute subdural rebleeding in the immediate postoperative period with 6 of them on antiplatelets/anticoagulants in the preoperative period. Conclusion: Recurrence rate and functional outcome after surgical drainage of CSDH does not appear to be affected by surgical technique (craniotomy vs burrhole) and drainage location. To our opinion, surgeons may elect procedures on a case-by-case basis.
AB - Objectives: Chronic subdural hematoma (CSDH) is one of the most common diseases in the routine neurosurgical practice. The most usual procedures for CSDH treatment include single or multiple burr hole drainage craniectomy. There is still controversy, however, about the risks and benefits of the different surgical approaches and types of drainage. The aim of the current study is to evaluate the postoperative complications of the various surgical techniques of CSDH. Patients and Methods: We conducted a single center retrospective analysis on 414 patients surgically treated for CSDH over a period of 6 years. Comparisons were made after dividing the patients into 4 groups based on the surgical technique and type of drainage: Single burr hole with subdural drainage (Group Ia), single burr hole with subgaleal drainage (Group Ib), craniotomy with subdural drainage (Group IIa), and craniotomy with subgaleal drainage (Group IIb). 238 cases underwent burr hole with irrigation, while 290 cases were treated with craniotomy. Of the analysed patients, subdural drainage was inserted in 382 cases, while subgaleal drain was used only in 146 patients, for a total of 528 procedures. Results: Re-operation was performed in 9.47 % of cases. The frequency of re-intervention for recurrences appeared to be lower in the Group I a (5.06 %), while the frequency of the re-intervention was higher in the craniotomy with subdural drainage group (Group IIa, 11.6 %). 14 patients (2.65 %) developed acute subdural rebleeding in the immediate postoperative period with 6 of them on antiplatelets/anticoagulants in the preoperative period. Conclusion: Recurrence rate and functional outcome after surgical drainage of CSDH does not appear to be affected by surgical technique (craniotomy vs burrhole) and drainage location. To our opinion, surgeons may elect procedures on a case-by-case basis.
KW - Chronic subdural hematoma
KW - Craniectomy
KW - Craniotomy
KW - Drain
KW - Hemorrhage
KW - Recurrence
KW - Subdural drainage
KW - Subgaleal drainage
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U2 - 10.1016/j.clineuro.2020.105705
DO - 10.1016/j.clineuro.2020.105705
M3 - Article
C2 - 32035359
AN - SCOPUS:85078828655
VL - 191
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
SN - 0303-8467
M1 - 105705
ER -