Efficacy of Burrhole Craniostomy in Chronic Subdural Hematoma. A Retrospective 9-Year Study

Yıl 2023, Cilt: 9 Sayı: 1, 20 - 30, 28.02.2023

Hıdır Özer , Ömer Faruk Şahin

https://doi.org/10.19127/mbsjohs.1179140

Öz

Objective: To demonstrate the effectiveness, possible complications, and difference of Burr-hole craniostomy surgical technique applied to patients diagnosed with chronic subdural hematoma from other surgical techniques.

Methods: The surgical techniques and postoperative clinical and radiological details of 36 patients who were operated on with the diagnosis of chronic subdural hematoma in the Neurosurgery Clinic of Ordu University Training and Research Hospital between 01.01.2013 and 15.08.2022 were retrospectively analyzed. In all patients in the post-op period, control brain CT was taken within the first 24 hours and compared with the pre-op CT. Again, at the end of post-op 1st, 2nd week and 1st month, control brain CT was taken for all patients and GCS was compared with pre-op scores. After determining the post-op complications, the treatment and results of these complications were examined.

Results: One patient who was operated on with Burr-Hole developed motor dysphasia in the post-op period, and intraparenchymal hemorrhage was detected in the post-op tomography of this patient. . Post-op clinical and radiological results of patients who underwent burr-hole craniostomy were significantly better than pre-op clinical and radiological results, and the recurrence rate was low, consistent with the literature. All drains placed in the subdural area after the burr hole opened during the operation were removed before discharge.

Conclusions: Although the drainage of chronic subdural hematoma with bur-hole craniostomy has a higher recurrence rate compared to the craniotomy method, it has a lower complication rate and is a more easily applicable surgical technique. In our study, some important points about patients who underwent burrhole craniostomy for cSDH evacuation were highlighted. It was observed that our patients who underwent burrhole craniostomy had higher reoperation rates compared to our patients who underwent craniotomy. We think that the presence of residual hematoma in the controls performed with CT in the post-op period should not be the sole criterion for re-operation. We think that CT controls are sufficient if there is improvement in the neurological status of the patient and a better GCS score in the post-op follow-up.

Anahtar Kelimeler

Chronic subdural Hematoma, Burr-Hole craniostomy, Craniotomy

Kronik Subdural Hematomda Burrhole Kraniostominin Etkinliği. Retrospektif 9 Yıllık Bir Çalışma

Öz

ÖZET
Amaç: Kronik subdural hematom tanısı alan hastalara uygulanan Burr-hole kraniostomi cerrahi tekniğinin etkinliğinin, olası komplikasyonlarının, diğer cerrahi tekniklerle farkının gösterilmesidir.
Gereç ve Yöntemler: Ordu Üniversitesi Eğitim ve Araştırma Hastanesi Nöroşirürji Kliniği'nde 01.01.2013-15.08.2022 tarihleri arasında kronik subdural hematom tanısı ile ameliyat edilen 36 hastanın cerrahi teknikleri ve ameliyat sonrası klinik ve radyolojik detayları retrospektif olarak incelendi. Olguların 28'i (%77.7) erkek, 8'i (%22.3) kadındı. Ortalama yaş 70, yaş aralığı 54-87 idi. Vakaların 10'unun GCS'si 15 (%28), 20'sinin GCS'si 13-14 (%56) ve 6'sının GCS'si 8-12 idi. Hastaların en belirgin şikayetleri baş ağrısı ve kafa karışıklığıydı. 22 hastada (%61.1) kafa travması öyküsü varken, 14 hastada (%38.9) travma öyküsü yoktu. 9 hastada (%25) antikoagülan veya antiagregan ilaç kullanım öyküsü mevcuttu. Ameliyat sonrası dönemde tüm hastalarda ilk 24 saat içinde kontrol beyin BT'si çekildi ve ameliyat öncesi BT ile karşılaştırıldı. Yine ameliyat sonrası 1.2. hafta ve 1. ay sonunda tüm hastalara kontrol beyin BT çekildi ve GKS ameliyat öncesi skorları ile karşılaştırıldı. Ameliyat sonrası komplikasyonlar belirlendikten sonra bu komplikasyonların tedavisi ve sonuçları incelendi.
Bulgular: Post-op Dönemdeki bütün hastalara ilk 24 saat içerisinde kontrol beyin ct çekilmiş ve pre-op ct ile karşılaştırılmıştır. Yine bütün hastalara post-op 1.ve 2. Hafta ve 1. Ay sonunda kontrol beyin CT çekilmiş ve GKS pre-op dönemdeki skorları ile karşılaştırılmıştır. 6 hastaya post-op dönemde rezidü- nüks kanamalarının olması ve nörolojik durumlarında iyileşme olmaması nedeni ile kraniotomi + membranektomi ameliyatı yapılmıştır. Kraniotomi ile opere edilen hastalardan biri ileri dönemde sepsis nedeni ile eks olmuştur. Burr-Hole ile opere edilen 1 hastada post-op dönemde motor disfazi gelişmiş olup bu hastanın çekilen post-op tomografisinde intraparankimal kanama tespit edilmiştir. Bu hastanın post-op 1. ay sonunda disfazisi düzelmiştir. Burr-hole kraniostomi yapılan 9 hastada post-op dönemde pnömosefali gelişmesine rağmen cerrahi tedavi gerektirmemiş ve spontan rezorbe oldukları görülmüştür. Ayrıca Burr-hole kraniostmi yapılan 4 Hastada post-op dönemde yara yeri enfeksiyonu gelişmiştir. Bu hastalara uygun antibiyotik tedavisi verilmiştir.1.hafta sonunda 18 hastanın CT ile yapılan radyolojik incelemesinde rezidüel hematom ve nüks hematom izlenmemiştir. 10 hastanın radyolojik olarak düzelmesi 1.ay sonunda ve 7 hastanın radyolojik olarak düzelmesi 3.ay sonunda tamamlanmıştır. Burr-hole kraniostomi uygulanan hastaların post-op klinik ve radyolojik sonuçları pre-op klinik ve radyolojik sonuçlarına göre anlamı derecede iyiydi ve nüks oranı literatür ile uyumlu derecede düşüktü.
Sonuç: Bur-hole kraniostomi ile kronik subdural hematomun drenajı kraniotomi yöntemine kıyasla daha fazla nüks oranına sahip olsada daha düşük komplikasyon oranına sahiptir ve daha kolay uygulanabilir bir cerrahi tekniktir. Çalışmamızda cSDH tahliyesi için burrhole kraniyostomi uygulanan hastalarda bazı önemli noktalar vurgulanmıştır. Burrhole kraniyostomi uygulanan hastalarımızın kraniyotomi uygulanan hastalarımıza göre daha yüksek reoperasyon oranlarına sahip olduğu gözlendi. Post-op dönemde BT ile yapılan kontrollerde rezidü hematom varlığının tekrar ameliyat için tek kriter olmaması gerektiğini düşünüyoruz. Hastanın nörolojik durumunda düzelme ve ameliyat sonrası izlemde daha iyi GKS skoru varsa BT kontrollerinin yeterli olduğunu düşünüyoruz.

Anahtar Kelimeler

KRONİK SUBDURAL HEMATOM, BURR HOLE KRANİYOSTOMİ, KRANİYOTOMİ

Kaynakça

• 1. Feghali J, Yang W, Huang J. Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment, and Outcome. World Neurosurg 2020; 141:339-345.
• 2- Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 2017;14(1):108.
• 3- Májovský M, Netuka D. Chronic subdural hematoma-review article. Chronický subdurální hematom přehled. Rozhl Chir 2018;97(6):253-257.
• 4- Kageyama H, Toyooka T, Tsuzuki N, Oka K. Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. J Neurosurg 2013;119(2):332-337.
• 5- Laldjising ERA, Cornelissen FMG, Gadjradj PS. Practice variation in the conservative and surgical treatment of chronic subdural hematoma. Clin Neurol Neurosurg 2020; 195:105899.
• 6-Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012;154(9):1541-1548.
• 7-Mehta V, Harward SC, Sankey EW, Nayar G, Codd PJ. Evidence based diagnosis and management of chronic subdural hematoma: A review of the literature. J Clin Neurosci 2018; 50:7-15.
• 8-Amano T, Miyamatsu Y, Otsuji R, Nakamizo A. Efficacy of endoscopic treatment for chronic subdural hematoma surgery. J Clin Neurosci 2021; 92:78-84.
• 9- Fiorella D, Arthur AS. Middle meningeal artery embolization for the management of chronic subdural hematoma. J Neurointerv Surg 2019;11(9):912-915.
• 10- Zhuang Y, Jiang M, Zhou J, Liu J, Fang Z, Chen Z. Surgical Treatment of Bilateral Chronic Subdural Hematoma. Comput Intell Neurosci 2022:2823314.
• 11- Soleman J, Kamenova M, Lutz K, Guzman R, Fandino J, Mariani L. Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice. World Neurosurg 2017; 104:528-536.
• 12- Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009;374(9695):1067-1073.
• 13- Rønn Jensen TS, Andersen-Ranberg N, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. National guidelines for treatment of chronic subdural haematoma. Ugeskr Laeger. 2018;180(42):V03180160.
• 14- Ishida T, Inoue T, Inoue T, Saito A, Suzuki S, Uenohara H, et al. Functional Outcome in Patients with Chronic Subdural Hematoma: Postoperative Delirium and Operative Procedure. Neurol Med Chir (Tokyo) 2022;62(4):171-176.
• 15. Fujita T, Iwamoto Y, Takeuchi H, Tsujino H, Hashimoto N. Lumbar subdural hematoma detected after surgical treatment of chronic intracranial subdural hematoma. World Neurosurg 2020; 134:472–476.
• 16. Zolfaghari S, Bartek J, Djärf F, Wong SS, Storma I, Stahl N, et al. Risk factors for need of reoperation in bilateral chronic subdural haematomas. Acta Neurochirurgica 2021;163(7):1849–1856.
• 17- René O, Martin H, Pavol S, Kristián V, Tomáš F, Branislav K. Factors influencing the results of surgical therapy of non-acute subdural haematomas [published correction appears in Eur J Trauma Emerg Surg. 2019 Nov 18;]. Eur J Trauma Emerg Surg 2021;47(5):1649-1655.
• 18- Turgut M, Akhaddar A, Turgut AT. Calcified or Ossified Chronic Subdural Hematoma: A Systematic Review of 114 Cases Reported During Last Century with a Demonstrative Case Report. World neurosurgery 2020; 134:240-263.
• 19- Cristaldi PMF, Cristofori AD, Fiori L, Giussani CG. Pathogenesis of spontaneous chronic subdural hematoma of the posterior fossa. Acta neurologica Belgica 2022;122(2):567-569.
• 20- Shlobin NA, Kedda J, Wishart D, Garcia RM, Rosseau G. Surgical Management of Chronic Subdural Hematoma in Older Adults: A Systematic Review. J Gerontol A Biol Sci Med Sci 2021;76(8):1454-1462.
• 21- Ewbank F, Durnford A, Akarca D, Sadek AR, Hempenstall J. Surgical Treatment of Chronic Subdural Hematomas in Nonagenarians: Who to Treat? World Neurosurg 2021;145:e274-e277.
• 22- Chen K, Wang K, Chen D, Niu H, Yang S, Wang Y. Surgical Procedure in the Treatment of Organized Chronic Subdural Hematoma: A Single-Center Experience. J Neurol Surg A Cent Eur Neurosurg 2021;82(3):241-247.
• 23- Deora, Harsh et al. “Paediatric chronic subdural haematoma: what are the predisposing factors and outcomes in management of these cases?.” Child's nervous system: ChNS: official journal of the International Society for Pediatric Neurosurgery 2022;(38,1):123-132.
• 24- Zhang P, Li Y, Huang J, Zhang H, Wang X, Dong L, et al. Chronic subdural haematoma in antithrombotic cohorts: characteristics, surgical outcomes, and recurrence. Br J Neurosurg 2020;34(4):408-415.
• 25- Younsi A, Riemann L, Habel C, Fischer J, Beynon C, Unterberg AW, et al. Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma. Neurosurg Rev 2022;45(1):729-739.
• 26- Santarius T, Kirkpatrick PJ, Kolias AG, Hutchinson PJ. Working toward rational and evidence-based treatment of chronic subdural hematoma. Clin Neurosurg 2010;57:112-122.
• 27-Liu LX, Cao XD, Ren YM, Zhou LX, Yang CH. Risk Factors for Recurrence of Chronic Subdural Hematoma: A Single Center Experience. World Neurosurg 2019;132:e506-e513.
• 28- Smith MD, Kishikova L, Norris JM. Surgical management of chronic subdural haematoma: one hole or two?. Int J Surg 2012;10(9):450-452.
• 29- Opšenák R, Fejerčák T, Hanko M, Snopko P, Varga K, Richterova R, et al. Is there an impact of subdural drainage duration and the number of burr holes on the recurrence rate of unilateral chronic subdural haematoma? Rozhl Chir 2020;99(1):29-33.
• 30- Raghavan A, Smith G, Onyewadume L, Peck MR, Herring E, Pace J, et al. Morbidity and Mortality After Burr Hole Craniostomy Versus Craniotomy for Chronic Subdural Hematoma Evacuation: A Single-Center Experience. World Neurosurg 2020;134:e196-e203.
• 31- Matsumoto H, Hanayama H, Okada T, Sakurai Y, Minami H, Masuda A, et al. Which surgical procedure is effective for refractory chronic subdural hematoma? Analysis of our surgical procedures and literature review. J Clin Neurosci 2018; 49:40-47.
• 32- Zhang J, Chen J. The therapeutic effects of craniotomy versus endoscopic-assisted trepanation drainage for isolated chronic subdural haematoma (ICSH): A single-centre long-term retrospective comparison study. Brain research bulletin 2020;161:94-97.
• 33- Idowu OE, Vitowanu JM, Oyeleke SO. Demographic Profile and Outcome in Surgically Managed Patients with Chronic Subdural Haematoma: A 9-Year Retrospective Cohort Study. West Afr J Med 2021;38(9):835-838.
• 34- Rauhala M, Helén P, Huhtala H, Heikkila P, Iverson GL, Niskakangas T, et al. Chronic subdural hematoma-incidence, complications, and financial impact. Acta Neurochir (Wien) 2020;162(9):2033-2043.
• 35- Nakajima H, Yasui T, Nishikawa M, Kishi H, Kan M. The role of postoperative patient posture in the recurrence of chronic subdural hematoma: a prospective randomized trial. Surg Neurol 2002;58(6):385-387.
• 36- Frechon P, Emery E, Gaberel T. Is there an interest in performing a systematic CT scan within the first two months after chronic subdural hematoma evacuation? A ten-year single-center retrospective study. Clin Neurol Neurosurg 2020;191:105682.
• 37- Abecassis IJ, Kim LJ. Craniotomy for Treatment of Chronic Subdural Hematoma. Neurosurg Clin N Am. 2017;28(2):229-237.
• 38- Watanabe S, Kato N, Sato M, Aiyama H, Fujiwara Y, Goto M, et al. Treatment Outcomes of Burr-Hole Surgery for Chronic Subdural Hematoma in the Elderly Living Beyond Life Expectancy: A Study Comparing Cure, Recurrence, and Complications in Patients Aged ≥80 Years versus ≤79 Years. World Neurosurg 2019;132:e812-e819.
• 39- Yokota K, Sorimachi T, Atsumi H, Yonemochi T, Shioyama S, Matsumae M. Posterior Fossa Chronic Subdural Hematoma Associated with Supratentorial Chronic Subdural Hematoma. World Neurosurg 2022;162:e394-e400.
• 40- Sherrod BA, Baker C, Gamboa N, McNally S, Grandhi R. Preoperative MRI characteristics predict chronic subdural haematoma postoperative recurrence: a meta-analysis. Br J Neurosurg 2021;35(5):527-531.
• 41- Shen J, Shao X, Wang Q, Ge R, Zhang J. Comparison of Clinical and Radiologic Characteristics and Prognosis of Patients with Chronic Subdural Hematoma with and without a History of Head Trauma. World Neurosurg. 2019;132:e391-e398.