Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
World Neurosurg. 2019 Nov;131:e392-e401. doi: 10.1016/j.wneu.2019.07.168. Epub 2019 Jul 30.
Although the use of a postoperative drain after burr-hole evacuation of chronic subdural hematoma (CSDH) is known to improve surgical outcomes, the superiority of subdural over subperiosteal drains has not been firmly established. Evidence comparing these 2 drain types is largely restricted to single-center series with limited numbers. Using a multicenter cohort study, we aimed to show noninferiority of subperiosteal drains vis-à-vis subdural drains after burr-hole evacuation of CSDH.
We performed a retrospective analysis of all consecutive patients with CSDH aged 21 years and older who had undergone burr-hole craniostomy across 3 tertiary hospitals from 2010 to 2017. Primary outcome measures included CSDH recurrence and modified Rankin Scale (mRS) score at 6 months. Outcomes of patients in the subdural and subperiosteal drain groups were analyzed and confounders were adjusted for using multivariate logistic regression.
Of the 570 cases analyzed, 329 (57.7%) received a subdural drain and 241 (42.3%) received a subperiosteal drain. There was no significant difference between the 2 drain groups in CSDH recurrence (13.1% in the subdural group vs. 11.2% in the subperiosteal group; P = 0.502) or 6-month mRS score (27.2% with mRS 4-6 in the subdural group vs. 20.4% in the subperiosteal group; P = 0.188). Independent predictors of CSDH recurrence identified on multivariate analysis included premorbid mRS score 0-3 (P = 0.021), separated CSDH type on preoperative computed tomography scan (P = 0.002), and postoperative pneumocephalus of ≥15 mm (P = 0.005).
Outcomes of subdural and subperiosteal drains after burr-hole craniostomy for CSDH are largely equivalent based on our findings.
虽然已知在颅骨钻孔清除慢性硬脑膜下血肿（CSDH）后使用术后引流管可以改善手术效果，但硬膜下引流优于骨膜下引流的优势尚未得到明确证实。将这两种引流类型进行比较的证据主要局限于数量有限的单中心系列研究。本研究通过多中心队列研究，旨在证明颅骨钻孔清除 CSDH 后，骨膜下引流与硬膜下引流相比不劣效。
我们对 2010 年至 2017 年期间在 3 家三级医院接受颅骨钻孔颅骨切开术的所有年龄在 21 岁及以上的 CSDH 连续患者进行了回顾性分析。主要观察指标包括术后 6 个月时 CSDH 复发和改良 Rankin 量表（mRS）评分。对硬膜下引流组和骨膜下引流组患者的结果进行分析，并使用多变量逻辑回归调整混杂因素。
在分析的 570 例病例中，329 例（57.7%）接受了硬膜下引流，241 例（42.3%）接受了骨膜下引流。两组患者的 CSDH 复发率（硬膜下组为 13.1%，骨膜下组为 11.2%；P=0.502）或 6 个月 mRS 评分（硬膜下组 mRS 4-6 为 27.2%，骨膜下组为 20.4%；P=0.188）无显著差异。多变量分析确定的 CSDH 复发的独立预测因素包括：发病前 mRS 评分 0-3（P=0.021）、术前 CT 扫描显示分离型 CSDH（P=0.002）和术后 ≥15mm 的气颅（P=0.005）。
根据我们的研究结果，颅骨钻孔清除 CSDH 后，硬膜下引流和骨膜下引流的结果基本相当。
