Choi, Jongwook
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Whang, Kum
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Cho, Sungmin
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Kim, Jongyeon
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Purpose: Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or...
Purpose: Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or without irrigation in patients with CSDH. Methods: Eighty-two CSDH patients treated with burr-hole drainage at Wonju Severance Christian Hospital from March 2015 to June 2016 were enrolled in this study. The subjects were divided into three groups based on the surgical technique performed as follows: single burr-hole drainage without irrigation (group A, n=47), single burr-hole drainage with irrigation (group B, n=14), or double burr-hole drainage with irrigation (group C, n=21). These three groups were compared with respect to clinical and radiological factors and the recurrence rate, and independent factors predicting recurrence were sought. Results: After burr-hole drainage, CSDH recurred in 15 (18.3%) of the 82 patients, and six patients (7.3%) required reoperation. More specifically, recurrence was observed in 12 patients (25.5%) in group A, one (7.1%) in group B, and two (9.5%) in group C. The number of burr-holes did not significantly affect recurrence (odds ratio [OR]=0.38; 95% confidence interval [CI]: 0.60-2.38), but irrigation had a significant effect (OR=0.20; 95% CI: 0.04-0.97). Conclusions: This study shows that irrigation during burr-hole surgery in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burr-holes used. We therefore recommend the use of active irrigation during burr-hole drainage surgery in CSDH patients.
Purpose: Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or without irrigation in patients with CSDH. Methods: Eighty-two CSDH patients treated with burr-hole drainage at Wonju Severance Christian Hospital from March 2015 to June 2016 were enrolled in this study. The subjects were divided into three groups based on the surgical technique performed as follows: single burr-hole drainage without irrigation (group A, n=47), single burr-hole drainage with irrigation (group B, n=14), or double burr-hole drainage with irrigation (group C, n=21). These three groups were compared with respect to clinical and radiological factors and the recurrence rate, and independent factors predicting recurrence were sought. Results: After burr-hole drainage, CSDH recurred in 15 (18.3%) of the 82 patients, and six patients (7.3%) required reoperation. More specifically, recurrence was observed in 12 patients (25.5%) in group A, one (7.1%) in group B, and two (9.5%) in group C. The number of burr-holes did not significantly affect recurrence (odds ratio [OR]=0.38; 95% confidence interval [CI]: 0.60-2.38), but irrigation had a significant effect (OR=0.20; 95% CI: 0.04-0.97). Conclusions: This study shows that irrigation during burr-hole surgery in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burr-holes used. We therefore recommend the use of active irrigation during burr-hole drainage surgery in CSDH patients.
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제안 방법
All patients underwent single or double burr-hole trephination operations with closed drainage under general anesthesia. After dural incision and hemostasis, the outer membrane enclosing the hematoma was opened.
After surgery, the drainage catheter was connected to a closed drainage system, and all patients were maintained in the supine position and supplied with sufficient fluid to promote brain expansion. All patients underwent brain CT 3 days after surgery to confirm CSDH reduction, and subsequently at 1-week intervals to check for recurrence. All patients were evaluated for recurrence through at least 10 days of inpatient treatment and at follow-up visits extending for at least 3 months.
These measures were compared across the three surgical methods using ANOVA for age and the chi-square test for other parameters to justify combining the three groups of patients (Table 2). No significant differences were found among the three surgical methods.
데이터처리
The associations of all variables with recurrence were evaluated using the two-sample t-test or the chi-square test (Fisher’s exact test).
In group C, two large burr-holes were used with massive irrigation through each hole to provide more effective subdural space irrigation. Group selection bias was checked using analysis of variance (ANOVA) or the chi-square test. During the follow-up period, non-recurrence was defined as the absence of new neurological symptoms with no increase in hemorrhage on follow-up brain computed tomography (CT).
The associations of all variables with recurrence were evaluated using the two-sample t-test or the chi-square test (Fisher’s exact test). Logistic regression analysis was used to identify the degree to which the surgical method could predict CSDH recurrence, and the results were expressed as odds ratio (ORs) with 95% confidence intervals (CIs). Statistical significance was accepted for p-values <0.
성능/효과
Additionally, logistic regression analysis showed that intraoperative irrigation resulted in a statistically significant decrease in the CSDH recurrence rate (OR=0.20; 95% CI:0.04–0.97), but the use of two burr-holes showed no statistical significance (OR=0.38; 95% CI: 0.60–2.38) (Table 5).
후속연구
Based on our observation that intraoperative irrigation reduced CSDH recurrence, we suggest that additional research is needed to optimize the irrigation procedure. Shimamura et al.
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