Kamenova Maria, Lutz Katharina, Schaedelin Sabine, Fandino Javier, Mariani Luigi, Soleman Jehuda
Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
World Neurosurg. 2020 Jul;139:e113-e120. doi: 10.1016/j.wneu.2020.03.134. Epub 2020 Apr 2.
The chronic subdural hematoma (cSDH)-Drain trial compared recurrence rates and clinical outcome associated with the use of subperiosteal drain (SPD) and subdural drain (SDD) after burr-hole drainage for cSDH. This subgroup analysis aimed to determine whether one drain type is preferable for patients treated with platelet inhibitors (PI) or anticoagulants (AC).
This subanalysis included 133 patients treated with PI/AC of the 220 patients from the preceding cSDH-Drain trial. For these patients the association between the drain type used and recurrence rates, mortality, as well as clinical outcome at 6 weeks and 12 months follow-up were analyzed using a logistic regression analysis model. Additionally, recurrence rates, clinical outcome, and mortality were assessed for each PI or AC type separately.
The insertion of SPD was associated with 7.35% recurrence rates compared to 13.85% with SDD in patients treated with PI or AC (OR 0.41, 95% CI 0.06-2.65, P = 0.36). Outcome measurements and mortality did not differ significantly between both groups at 6-week and 12-month follow-up. In addition, there was no statistically significant association between drain type and recurrence rate or mortality when comparing data for each PI or AC type. At 24 hours postoperatively, significantly more patients under phenprocoumon and natrium-dalteparin had a Glasgow Coma Scale score between 13 and 15 in the SDD group compared with the SPD group (P = 0.006), whereaas at 6-week follow-up significantly more patients in the SDD group treated with ASA had a good modified Rankin scale score (P = 0.01). At 12 months, no significant difference in outcome measurements was seen for all PI and AC types.
In patients treated with PI or AC, the insertion of SPD after burr-hole drainage of cSDH showed comparable recurrence, mortality, and long term outcome rates when compared with SDD.
慢性硬膜下血肿（cSDH）-引流试验比较了钻孔引流治疗cSDH后使用骨膜下引流（SPD）和硬膜下引流（SDD）的复发率及临床结局。该亚组分析旨在确定对于接受血小板抑制剂（PI）或抗凝剂（AC）治疗的患者，哪种引流类型更优。
该亚分析纳入了先前cSDH-引流试验220例患者中接受PI/AC治疗的133例患者。对于这些患者，使用逻辑回归分析模型分析所使用的引流类型与复发率、死亡率以及6周和12个月随访时的临床结局之间的关联。此外，还分别评估了每种PI或AC类型的复发率、临床结局和死亡率。
在接受PI或AC治疗的患者中，SPD置入后的复发率为7.35%，而SDD为13.85%（比值比0.41，95%置信区间0.06-2.65，P = 0.36）。在6周和12个月随访时，两组的结局指标和死亡率无显著差异。此外，比较每种PI或AC类型的数据时，引流类型与复发率或死亡率之间无统计学显著关联。术后24小时，与SPD组相比，SDD组中接受苯丙香豆素和达肝素钠治疗的患者格拉斯哥昏迷量表评分在13至15分之间的显著更多（P = 0.006），而在6周随访时，接受阿司匹林治疗的SDD组患者改良Rankin量表评分良好的显著更多（P = 0.01）。在12个月时，所有PI和AC类型的结局指标均无显著差异。
对于接受PI或AC治疗的患者，cSDH钻孔引流后置入SPD与SDD相比，复发率、死亡率和长期结局率相当。
