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Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma

BACKGROUND: Drain insertion following chronic subdural haematoma (CSDH) evacuation reduces recurrence and improves outcomes. The mechanism of this improvement is uncertain. We assessed whether drains result in improved postoperative imaging, and which radiological factors are associated with recurre...

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Autores principales: Glancz, Laurence Johann, Poon, Michael Tin Chung, Hutchinson, Peter John, Kolias, Angelos Georgiou, Brennan, Paul Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235065/
https://www.ncbi.nlm.nih.gov/pubmed/32338300
http://dx.doi.org/10.1007/s00701-020-04356-z
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author Glancz, Laurence Johann
Poon, Michael Tin Chung
Hutchinson, Peter John
Kolias, Angelos Georgiou
Brennan, Paul Martin
author_facet Glancz, Laurence Johann
Poon, Michael Tin Chung
Hutchinson, Peter John
Kolias, Angelos Georgiou
Brennan, Paul Martin
author_sort Glancz, Laurence Johann
collection PubMed
description BACKGROUND: Drain insertion following chronic subdural haematoma (CSDH) evacuation reduces recurrence and improves outcomes. The mechanism of this improvement is uncertain. We assessed whether drains result in improved postoperative imaging, and which radiological factors are associated with recurrence and functional outcome. METHODS: A multi-centre, prospective cohort study of CSDH patients was performed between May 2013 and January 2014. Patients aged > 16 years undergoing burr hole evacuation of primary CSDH with pre- and postoperative imaging were included in this subgroup analysis. Baseline and clinical details were collected. Pre- and postoperative maximal subdural width and midline shift (MLS) along with clot density were recorded. Primary outcomes comprised mRS at discharge and symptomatic recurrence requiring re-drainage. Comparisons were made using multiple logistic regression. RESULTS: Three hundred nineteen patients were identified for inclusion. Two hundred seventy-two of 319 (85%) patients underwent drain insertion at the time of surgery versus 45/319 (14%) who did not. Twenty-nine of 272 patients who underwent drain insertion experienced recurrence (10.9%) versus 9 of 45 patients without drain insertion (20.5%; p = 0.07). Overall change in median subdural width was significantly greater in the drain versus ‘no drain’ groups (11 mm versus 6 mm, p < 0.01). Overall change in median midline shift (MLS) was also significantly greater in the drain group (4 mm versus 3 mm, p < 0.01). On multivariate analysis, change in maximal width and MLS were significant predictors of recurrence, although only the former remained a significant predictor for functional outcome. CONCLUSIONS: The use of subdural drains results in significantly improved postoperative imaging in burr hole evacuation of CSDH, thus providing radiological corroboration for their recommended use. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-020-04356-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-72350652020-05-20 Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma Glancz, Laurence Johann Poon, Michael Tin Chung Hutchinson, Peter John Kolias, Angelos Georgiou Brennan, Paul Martin Acta Neurochir (Wien) Original Article - Brain Trauma BACKGROUND: Drain insertion following chronic subdural haematoma (CSDH) evacuation reduces recurrence and improves outcomes. The mechanism of this improvement is uncertain. We assessed whether drains result in improved postoperative imaging, and which radiological factors are associated with recurrence and functional outcome. METHODS: A multi-centre, prospective cohort study of CSDH patients was performed between May 2013 and January 2014. Patients aged > 16 years undergoing burr hole evacuation of primary CSDH with pre- and postoperative imaging were included in this subgroup analysis. Baseline and clinical details were collected. Pre- and postoperative maximal subdural width and midline shift (MLS) along with clot density were recorded. Primary outcomes comprised mRS at discharge and symptomatic recurrence requiring re-drainage. Comparisons were made using multiple logistic regression. RESULTS: Three hundred nineteen patients were identified for inclusion. Two hundred seventy-two of 319 (85%) patients underwent drain insertion at the time of surgery versus 45/319 (14%) who did not. Twenty-nine of 272 patients who underwent drain insertion experienced recurrence (10.9%) versus 9 of 45 patients without drain insertion (20.5%; p = 0.07). Overall change in median subdural width was significantly greater in the drain versus ‘no drain’ groups (11 mm versus 6 mm, p < 0.01). Overall change in median midline shift (MLS) was also significantly greater in the drain group (4 mm versus 3 mm, p < 0.01). On multivariate analysis, change in maximal width and MLS were significant predictors of recurrence, although only the former remained a significant predictor for functional outcome. CONCLUSIONS: The use of subdural drains results in significantly improved postoperative imaging in burr hole evacuation of CSDH, thus providing radiological corroboration for their recommended use. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-020-04356-z) contains supplementary material, which is available to authorized users. Springer Vienna 2020-04-27 2020 /pmc/articles/PMC7235065/ /pubmed/32338300 http://dx.doi.org/10.1007/s00701-020-04356-z Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Article - Brain Trauma
Glancz, Laurence Johann
Poon, Michael Tin Chung
Hutchinson, Peter John
Kolias, Angelos Georgiou
Brennan, Paul Martin
Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
title Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
title_full Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
title_fullStr Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
title_full_unstemmed Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
title_short Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
title_sort drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
topic Original Article - Brain Trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235065/
https://www.ncbi.nlm.nih.gov/pubmed/32338300
http://dx.doi.org/10.1007/s00701-020-04356-z
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