Efficacy of exhaustive and fixed-time drainage for chronic subdural hematoma after burr hole craniostomy

TL;DR

This study compares two drainage methods after brain surgery for chronic subdural hematoma and finds that exhaustive drainage improves outcomes and reduces recurrence.

Contribution

The study provides evidence that exhaustive drainage is more effective than fixed-time drainage for chronic subdural hematoma.

Findings

Exhaustive drainage showed higher surgical efficacy (91.5%) compared to fixed-time drainage (79.7%).

The recurrence rate was significantly lower in the exhaustive drainage group (4.2% vs. 14.5%).

Exhaustive drainage resulted in better functional outcomes and lower mRS scores than fixed-time drainage.

Abstract

To compare the efficacy of exhaustive and fixed-time drainage for chronic subdural hematoma (CSHD) after burr hole craniostomy (BCT).

This single-center retrospective case-control study included 140 patients with CSHD who underwent BCT at the Third People’s Hospital of Yancheng City from December 2021 to April 2024. According to the surgical records, 69 patients underwent fixed-time drainage, which was removed after 48 hours (control group) and 71 patients underwent postoperative exhaustive drainage (observation group). The primary outcomes of interest included surgical efficacy and recurrence rate at six months after surgery. The secondary outcomes were Markwalder’s Grading Scale and Glasgow Coma Scale (MGS-GCS), modified Rankin scale (mRS) score and incidence of complications.

Six months after surgery, the total efficacy of the observation group (91.5%) was significantly higher than that of the control group (79.7%), while the recurrence rate was significantly lower (4.2% vs. 14.5% in the control group) (P<0.05). The MGS-GCS grading of both groups improved compared to preoperative levels and was significantly better in the observation group than the control group (P<0.05). Intervention led to a decrease in the mRS scores of both groups. The post-intervention mRS scores in the observation group were considerably lower than in the control group (P<0.05). The incidence of complications in the observation group (9.9%) was lower than that in the control group (20.3%), but the difference was not statistically significant (P>0.05).

Compared with fixed-time drainage, exhaustive drainage of CSDH after BCT can improve surgical efficacy and reduce the recurrence rate. Further multi-center randomized controlled trials are still needed to confirm the results.