A comparative study of chronic subdural hematoma Burr hole craniostomy treatment: To irrigate or not to irrigate

Abstract

Background: Chronic subdural hematomas (CSDHs) are increasingly prevalent in the neurosurgical field and are treated using three general methods, of which the most common is the burr hole craniostomy (BHC). However, the efficacy of various methods of irrigation used during BHC remains uncertain. Objective: To investigate the use of no irrigation versus in situ irrigation in the BHC treatment of CSDH. Patients and methods: We retrospectively reviewed 258 CSDH cases at our institution between 2000 and 2014. Group A (N = 184) underwent BHC without irrigation, and Group B (N = 74) BHC with in situ irrigation. Fisher exact tests were used to compare postoperative recurrent CSDH and acute postoperative hemorrhagic complications (e.g., contusions, ICH, acute SDH) rates between the groups. Logistic regression analysis was used to determine clinical predictive factors for postoperative recurrent CSDH and acute postoperative hemorrhagic complications in both groups. Results: No differences were found in baseline characteristics between the two study groups. Overall, 194 study participants were male (75%). The mean age at diagnosis was 73 years (SD = 13.9). 19.4% (50/258) of patients had recurrent CSDH and 7.4% (19/258) had acute postoperative hemorrhagic complications. There was no significant difference in the number of recurrent CSDH cases (34/184 in Group A vs. 16/74 in Group B, p = 0.60) or the number of acute postoperative hemorrhagic complications (12/184 in Group A vs. 7/74 in Group B, p = 0.43) between the two groups. Also, there was no significant association between the type of irrigation, demographic or clinical factors and postoperative recurrent CSDH or acute postoperative hemorrhagic complications. Conclusions: This study results showed no differences in the recurrence of CSDH and acute postoperative hemorrhagic complications in patients undergoing BHC alone or with in situ irrigation. Future randomized controlled trials are needed to determine the clinical impact of the irrigation method in BHC. Keywords: Chronic subdural hematoma, CSDH, Burr hole craniostomy, Irrigation, Recurrence, Intracranial hemorrhage