AccScience Publishing / EJMO / Online First / DOI: 10.36922/ejmo.8532
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ORIGINAL RESEARCH ARTICLE

Reduction of cortical injury using a subdural catheter guidance device: A comparative study on burr hole drainage for chronic subdural hematoma

Pasut Limchoopornwikul1 ,  Chunxia Wang2 ,  Yibo Han1,3 ,  Ganlin Li1 ,  Shengda Xiao1 ,  Zhiwei Wu4 ,  Zhipeng Li1 ,  Yibao Wang1 ,  Yong Wang1*
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1 Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
2 Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Lens Research Laboratory of Liaoning Province, Shenyang, Liaoning Province, China
3 Department of Organ and Tissue Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
4 Department of Neurosurgery, Shenyang Ninth People’s Hospital, Shenyang, Liaoning Province, China
EJMO, 8532 https://doi.org/10.36922/ejmo.8532
Submitted: 14 January 2025 | Revised: 4 March 2025 | Accepted: 10 March 2025 | Published: 26 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Chronic subdural hematoma (CSDH) is a chronic hemorrhagic lesion caused by the accumulation of blood between the arachnoid mater and the dura mater. Currently, the most commonly used surgical approach for CSDH is burr hole craniotomy. However, this procedure employs a blind technique, making the cerebral cortex susceptible to injury. The use of a subdural catheter guidance device combined with burr hole drainage in the treatment of CSDH can prevent intraoperative cerebral cortex damage and reduce its potential impact. This study retrospectively analyzed a total of 518 patients with CSDH who underwent surgical treatment at the hospital. Of these, 361 were male (69.69%) and 157 were female (30.31%), with a median age of 59.5 years (range: 12 – 92 years). All patients underwent preoperative head computed tomography and/or magnetic resonance imaging scans, which revealed crescent-shaped mixed-density or iso-dense shadows beneath the inner table of the skull. Informed consent for the burr hole decompression procedure was obtained from all patients. Subsequently, the 518 patients were randomly divided into two groups: The control group (undergoing the procedure without a “guidance device”) and the experimental group (undergoing the procedure with a “guidance device”). All patients provided consent for the publication of their clinical details and related images. In the control group, 274 patients with CSDH were treated, among whom 6 cases had post-operative cortical injury complications, with an incidence rate of 2.19%. In the experimental group, 244 patients with CSDH were treated, and no cortical injury complications occurred post-operatively, with an incidence rate of 0. Fisher’s exact test (two-tailed) showed p=0.0427, indicating a significant reduction in cortical injury complications with the use of the guidance device. In addition, the conditional maximum-likelihood estimate (CMLE) odds ratio for Fisher’s exact test was 0, with a 95% confidence interval ranging from 0.0 to 0.9447, further reflecting the relationship between the relevant factors. This indicates that incorporating a subdural catheter guidance device during burr hole drainage for CSDH can assist surgeons in avoiding damage to the cerebral cortex.

Keywords
Chronic subdural hematoma
One burr-hole craniotomy
Subdural catheterization guidance device
Cortex damage
Drainage tubes
Funding
None.
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
References
  1. Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005;107(3):223-229. doi: 10.1016/j.clineuro.2004.09.015

 

  1. Desai VR, Scranton RA, Britz GW. Management of recurrent subdural hematomas. Neurosurg Clin N Am. 2017;28(2):279-286. doi: 10.1016/j.nec.2016.11.010

 

  1. Cofano F, Pesce A, Vercelli G, et al. Risk of recurrence of chronic subdural hematomas after surgery: A multicenter observational cohort study. Front Neurol. 2020;11:560269. doi: 10.3389/fneur.2020.560269

 

  1. Singh H, Patir R, Vaishya S, Miglani R, Gupta A, Kaur A. Endoscopic evacuation of septated chronic subdural hemorrhage - Technical considerations, results, and outcome. Surg Neurol Int. 2022;13:8. doi: 10.25259/SNI_963_2021

 

  1. Tyngkan L, Malik N. Brainstem bleed after chronic subdural hematoma drainage. Indian J Neurotrauma. 2020;18:66-68. doi: 10.1055/s-0040-1714177

 

  1. Holl DC, Volovici V, Dirven CM, et al. Pathophysiology and nonsurgical treatment of chronic subdural hematoma: From past to present to future. World Neurosurg. 2018;116:402-411.e2. doi: 10.1016/j.wneu.2018.05.037

 

  1. Blaauw J, Boxum AG, Jacobs B, et al. Prevalence of cognitive complaints and impairment in patients with chronic subdural hematoma and recovery after treatment: A systematic review. J Neurotrauma. 2021;38(2):159-168. doi: 10.1089/neu.2020.7206

 

  1. Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo). 2001;41(8):382-386. doi: 10.2176/nmc.41.382

 

  1. Rohde V, Graf G, Hassler W. Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: A retrospective analysis of 376 patients. Neurosurg Rev. 2002;25(1-2):89-94. doi: 10.1007/s101430100182

 

  1. Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg. 2016;11(4):330-342. doi: 10.4103/1793-5482.145102

 

  1. Cheshire EC, Malcomson RD, Sun P, Mirkes EM, Amoroso JM, Rutty GN. A systematic autopsy survey of human infant bridging veins. Int J Legal Med. 2018;132(2):449-461. doi: 10.1007/s00414-017-1714-3

 

  1. Tang D, Chen M, Huang X, et al. SRplot: A free online platform for data visualization and graphing. PloS One. 2023;18(11):e0294236. doi: 10.1371/journal.pone.0294236

 

  1. Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: Clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001;41(8):371-381. doi: 10.2176/nmc.41.371

 

  1. Guan F, Peng WC, Huang H, et al. Efficacy analysis of flexible neuroendoscopy combined with dry-field techniques in the treatment of chronic subdural hematoma. Chin Med J (Engl). 2019;132(11):1359-1362. doi: 10.1097/CM9.0000000000000249

 

  1. Rauhala M, Helén P, Huhtala H, et al. Chronic subdural hematoma-incidence, complications, and financial impact. Acta Neurochir (Wien). 2020;162(9):2033-2043. doi: 10.1007/s00701-020-04398-3

 

  1. Taussky P, Fandino J, Landolt H. Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg. 2008;22(2):279-282. doi: 10.1080/02688690701818885

 

  1. 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. doi: 10.1016/j.jocn.2018.01.050

 

  1. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: Evidence based review. J Neurol Neurosurg Psychiatry. 2003;74(7):937-943. doi: 10.1136/jnnp.74.7.937

 

  1. Yadav YR, Ratre S, Parihar V, Bajaj J, Sinha M, Kumar A. Endoscopic management of chronic subdural hematoma. J Neurol Surg Part Cent Eur Neurosurg. 2020;81(4):330-341. doi: 10.1055/s-0039-1698388

 

  1. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S. Independent predictors of recurrence of chronic subdural hematoma: Results of multivariate analysis performed using a logistic regression model. J Neurosurg. 2003;98(6):1217-1221. doi: 10.3171/jns.2003.98.6.1217

 

  1. Zhu F, Wang H, Li W, et al. Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses. EClinicalMedicine. 2022;43:101234. doi: 10.1016/j.eclinm.2021.101234

 

  1. Fogelholm R, Heiskanen O, Waltimo O. Chronic subdural hematoma in adults. Influence of patient’s age on symptoms, signs, and thickness of hematoma. J Neurosurg. 1975;42(1):43-46. doi: 10.3171/jns.1975.42.1.0043

 

  1. Buchanan IA, Mack WJ. Minimally invasive surgical approaches for chronic subdural hematomas. Neurosurg Clin N Am. 2017;28(2):219-227. doi: 10.1016/j.nec.2016.11.004

 

  1. Jadhav V, Solaroglu I, Obenaus A, Zhang JH. Neuroprotection against surgically induced brain injury. Surg Neurol. 2007;67(1):15-20; discussion 20. doi: 10.1016/j.surneu.2006.07.014

 

  1. Májovský M, Masopust V, Netuka D, Beneš V. Flexible endoscope-assisted evacuation of chronic subdural hematomas. Acta Neurochir (Wien). 2016;158(10):1987-1992. doi: 10.1007/s00701-016-2902-5

 

  1. Pavlov V, Bernard G, Chibbaro S. Chronic subdural haematoma management: An iatrogenic complication. Case report and literature review. BMJ Case Rep. 2012;2012:bcr1220115397. doi: 10.1136/bcr.12.2011.5397

 

  1. Schweitzer AD, Niogi SN, Whitlow CT, Tsiouris AJ. Traumatic brain injury: Imaging patterns and complications. Radiogr Rev Publ Radiol Soc N Am Inc. 2019;39(6):1571-1595. doi: 10.1148/rg.2019190076

 

  1. Häni L, Vulcu S, Branca M, et al. Subdural versus subgaleal drainage for chronic subdural hematomas: a post hoc analysis of the TOSCAN trial. J Neurosurg. 2020;133(4):1147-1155. doi: 10.3171/2019.5.JNS19858

 

  1. Li Y, Zhang H, Wang X, et al. Neuroendoscopic surgery versus external ventricular drainage alone or with intraventricular fibrinolysis for intraventricular hemorrhage secondary to spontaneous supratentorial hemorrhage: A systematic review and meta-analysis. PloS One. 2013;8(11):e80599. doi: 10.1371/journal.pone.0080599

 

  1. Ambesh SP, Kumar R. Neuroendoscopic procedures: Anesthetic considerations for a growing trend: A review. J Neurosurg Anesthesiol. 2000;12(3):262-270. doi: 10.1097/00008506-200007000-00011

 

  1. Buitelaar DR, Balm AJ, Antonini N, van Tinteren H, Huitink JM. Cardiovascular and respiratory complications after major head and neck surgery. Head Neck. 2006;28(7):595-602. doi: 10.1002/hed.20374

 

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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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