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A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma
- 作者:Chandrasekaran Kaliaperumal (1)
Ayman Khalil (1) Eoin Fenton (1) Uchenna Okafo (1) George Kaar (1) Michael O’Sullivan (1) Charles Marks (1)
- 关键词:Chronic subdural haematoma ; Subdural drain ; Subperiosteal drain ; Burr ; hole craniostomy ; Modified Rankin Scale
- 刊名:Acta Neurochirurgica
- 出版年:2012
- 出版时间:November 2012
- 年:2012
- 卷:154
- 期:11
- 页码:2083-2089
- 全文大小:161KB
- 参考文献:1. Adhiyaman V, Asghar M, Ganeshram K, Bhowmick B (2002) Chronic subdural haematoma in the elderly. Postgrad Med J 78:71-5 CrossRef
2. Baechli H, Nordmann A, Bucher H, Gratzl O (2004) Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 27:263-66 CrossRef 3. Bellut D, Woernle CM, Burkhardt JK, Kochro RA, Bertalnffy KN (2011) Subdural drainage versus subperiostal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas. World Neurosurg 77:111-18 CrossRef 4. Chen J, Levy M (2000) Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 11:399-06 5. Cenic A, Bhandari M, Reddy K (2005) Management of chronic subdural hematoma: a national survey and literature review. Can J Neurol Sci 32:501-06 6. Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez-Rumbo R (2005) Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 107:223-29 CrossRef 7. Gazzeri R, Galarza M, Neroni M, Canova A, Refice GM, Esposito S (2007) Continuous subgaleal suction drainage for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 149:487-93, discussion 493 CrossRef 8. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: A practical scale. Lancet 305:480-84 CrossRef 9. Luxon LM, Harrison M (1979) Chronic subdural haematoma. QJM 189:43-3 10. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374:1067-073 CrossRef 11. Santarius T, Hutchinson PJ (2004) Chronic subdural haematoma: time to rationalize treatment? Br J Neurosurg 18:328-32 CrossRef 12. Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ (2008) The management of primary chronic subdural haematoma: a questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg 22:529-34 CrossRef 13. Weigl R, Schmiedek P, Krauss J (2003) Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:937-43 CrossRef 14. Zumofen D, Regli L, Levivier M, Krayenbuhl N (2009) Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system. Neurosurgery 64:1116-121, discussion 1121- CrossRef
- 作者单位:Chandrasekaran Kaliaperumal (1)
Ayman Khalil (1) Eoin Fenton (1) Uchenna Okafo (1) George Kaar (1) Michael O’Sullivan (1) Charles Marks (1)
1. Department of Neurosurgery, Cork University Hospital, Cork, Republic of Ireland
文摘
Background The usage of a drain following evacuation of a chronic subdural haematoma (CSDH) is known to reduce recurrence. In this study we aim to compare the clinical outcomes and recurrence rate of utilising two different types of drains (subperiosteal and subdural drain) following drainage of a CSDH. Methods Prospective randomised single-centre study analysing 50 patients who underwent CSDH treatment. Two types of drains, subperiosteal (SPD) and subdural (SDD), were utilised on consecutive alternate patients following burr-hole craniostomy, with a total of 25 patients in each group. The drains were left in for 48-h duration and then removed. The modified Rankin Scale (mRS) was used for outcome measurement at 3 and 6?months. Results Data analysis was performed by unpaired t test with Welch’s correction. It was observed that none of the patients in either group had haematoma recurrence during a 6-month follow-up, and a significant difference in outcome was noted at 6?months (p--.0118) more than at 3?months (p--.0493) according to the statistical analysis. Postoperative seizure and inadvertent placement of the subdural drain into the brain parenchyma were the two complications noted in this study. Anticoagulant use prior to the surgery did not affect the outcome in either group. Conclusions We conclude there was no recurrence of CSDH utilising the SDD and SPD following burr-hole craniostomy. The mRS measurement at the 6-month follow-up was found to be statistically significant, with better outcomes with utilisation of the SPD. The SPD may thus prove to be more beneficial than the SDD in the treatment of CSDH. A multi-centre study with a larger group of patients is recommended to reinforce the results from our study.
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