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

被引:53
作者
Glancz, Laurence Johann [1 ]
Poon, Michael Tin Chung [2 ]
Coulter, Ian Craig [3 ]
Hutchinson, Peter John [4 ,5 ]
Kolias, Angelos Georgiou [4 ,5 ]
Brennan, Paul Martin [2 ]
机构
[1] Queens Med Ctr, Dept Neurosurg, Derby Rd, Nottingham NG7 2UH, England
[2] Univ Edinburgh, Translat Neurosurg, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland
[3] Royal Victoria Infirm, Dept Neurosurg, Newcastle, England
[4] Univ Cambridge, Div Neurosurg, Dept Clin Neurosci, Addenbrookes Hosp, Cambridge, England
[5] Surg Theme Cambridge Clin Trials Unit, Cambridge Biomed Campus, Cambridge, England
关键词
Burr-hole craniostomy; Chronic subdural hematoma; Drains; Outcome; Recurrence; INDEPENDENT PREDICTORS; SUBPERIOSTEAL DRAINAGE; RISK-FACTORS; RECURRENCE; MANAGEMENT; TREPANATION;
D O I
10.1093/neuros/nyy366
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Drain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes. Objective: To examine whether this is influenced by variation in drain location, positioning or duration of placement. Methods: We performed a subgroup analysis of a previously reported multicenter, prospective cohort study of CSDH patients performed between May 2013 and January 2014. Data were analyzed relating drain location (subdural or subgaleal), position (through a frontal or parietal burr hole), and duration of insertion, to outcomes in patients aged >16 yr undergoing burr-hole drainage of primary CSDH. Primary outcomes comprised modified Rankin scale (mRS) at discharge and symptomatic recurrence requiring redrainage within 60 d. Results: A total of 577 patients were analyzed. The recurrence rate of 6.7% (12/160) in the frontal subdural drain group was comparable to 8.8% (30/343) in the parietal subdural drain group. Only 44/577 (7.6%) patients underwent subgaleal drain insertion. Recurrence rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups (P = .95). We found no significant differences in discharge mRS between these groups. Recurrence rates were comparable between patients with postoperative drainage for 1 or 2 d, 6.4% and 8.4%, respectively (P = .44). There was no significant difference in mRS scores between these 2 groups (P = .56). CONCLUSION: Drain insertion after CSDH drainage is important, but position (subgaleal or subdural) and duration did not appear to influence recurrence rate or clinical outcomes. Similarly, drain location did not influence recurrence rate nor outcomes where both parietal and frontal burr holes were made. Further prospective cohort studies or randomized controlled trials could provide further clarification.
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页码:486 / 493
页数:8
相关论文
共 23 条
[1]   Efficacy and Safety of Subdural Drains After Burr-Hole Evacuation of Chronic Subdural Hematomas: Systematic Review and Meta-Analysis of Randomized Controlled Trials [J].
Alcala-Cerra, Gabriel ;
Young, Adam M. H. ;
Rafael Moscote-Salazar, Luis ;
Paternina-Caicedo, Angel .
WORLD NEUROSURGERY, 2014, 82 (06) :1148-1157
[2]   Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study [J].
Baechli, H ;
Nordmann, A ;
Bucher, HC ;
Gratzl, O .
NEUROSURGICAL REVIEW, 2004, 27 (04) :263-266
[3]   Subdural Drainage versus Subperiosteal Drainage in Burr-Hole Trepanation for Symptomatic Chronic Subdural Hematomas [J].
Bellut, David ;
Woernle, Christoph Michael ;
Burkhardt, Jan-Karl ;
Kockro, Ralf Alfons ;
Bertalanffy, Helmut ;
Krayenbuehl, Niklaus .
WORLD NEUROSURGERY, 2012, 77 (01) :111-118
[4]   The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom [J].
Brennan, Paul M. ;
Kolias, Angelos G. ;
Joannides, Alexis J. ;
Shapey, Jonathan ;
Marcus, Hani J. ;
Gregson, Barbara A. ;
Grover, Patrick J. ;
Hutchinson, Peter J. ;
Coulter, Ian C. .
JOURNAL OF NEUROSURGERY, 2017, 127 (04) :732-739
[5]  
Chih ANW, 2017, MALAYS J MED SCI, V24, P21, DOI 10.21315/mjms2017.24.1.3
[6]   Proposal for a prospective multi-centre audit of chronic subdural haematoma management in the United Kingdom and Ireland [J].
Coulter, Ian C. ;
Kolias, Angelos G. ;
Marcus, Hani J. ;
Ahmed, Aminul I. ;
Alli, Saira ;
Al-Mahfoudh, Rafid ;
Borg, Anouk ;
Cowie, Christopher J. A. ;
Hill, Ciaran S. ;
Joannides, Alexis J. ;
Jones, Timothy L. ;
Kailaya-Vasan, Ahilan ;
Livermore, James L. ;
Narayanamurthy, Harsha ;
Ngoga, Desire ;
Shapey, Jonathan ;
Tarnaris, Andrew ;
Gregson, Barbara A. ;
Gray, William P. ;
Nelson, Richard J. ;
Hutchinson, Peter J. ;
Brennan, Paul M. .
BRITISH JOURNAL OF NEUROSURGERY, 2014, 28 (02) :199-203
[7]   Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence [J].
Escosa Bae, Marcos ;
Wessling, Heinrich ;
Calin Salca, Horia ;
de las Heras Echeverria, Pedro .
ACTA NEUROCHIRURGICA, 2011, 153 (05) :1097-1103
[8]   Continuous subgaleal suction drainage for the treatment of chronic subdural haematoma [J].
Gazzeri, R. ;
Galarza, M. ;
Neroni, M. ;
Canova, A. ;
Refice, G. M. ;
Esposito, S. .
ACTA NEUROCHIRURGICA, 2007, 149 (05) :487-493
[9]   Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma [J].
Guilfoyle, Mathew R. ;
Hutchinson, Peter J. A. ;
Santarius, Thomas .
ACTA NEUROCHIRURGICA, 2017, 159 (05) :903-905
[10]   Evacuation of chronic subdural hematomas with the Twist-Drill technique: Results of a randomized prospective study comparing 48-h and 96-h drainage duration [J].
Ibrahim, I. ;
Maarrawi, J. ;
Jouanneau, E. ;
Guenot, M. ;
Mertens, P. ;
Sindou, M. .
NEUROCHIRURGIE, 2010, 56 (01) :23-27