Department of Neurosurgery, Lishui Central Hospital, Lishui, China.
Br J Neurosurg. 2021 Jun;35(3):324-328. doi: 10.1080/02688697.2020.1812520. Epub 2020 Sep 1.
Burr-hole craniostomy with a closed drainage system is the most commonly used technique for chronic subdural hematoma(CSDH), but the reoperation rate for hematoma recurrence is still high. This retrospective study aimed to compare the complications and recurrence of two subdural drains placement with tips frontal-occipital position (TFOP) versus one subdural drain placement with tip frontal position(OFP) following single burr-hole evacuation for the treatment of chronic subdural hematoma(CSDH).
The authors analyzed data of all CSDH patients who underwent single burr-hole surgery with placement of subdural closed-drainage system(TFOP or OFP techniques) between January 2013 and December 2017. Data analysis included general patient data, complications, recurrence and clinical outcome.
A total of 331 patients were included(85 TFOP and 246 OFP). The TFOP group and OFP group were statistically comparable with respect to baseline characteristics except for preoperative Markwalder score ( = 0.019). Midline shift and subdural fluid thickness on first postoperative day were greater in OFP group than the TFOP group ( = 0.028; and = 0.007, respectively). In addition, patients with OFP had a lower percent of hematoma change after surgery and much more residual subdural air than those with TFOP ( = 0.001; and < 0.001, respectively). Postoperative complications and clinical outcome between the two groups showed no significant differences. During the 3-month follow-up, the rate of hematoma recurrence was significantly lower among patients treated with TFOP than those treated with OFP ( = 0.039).
The postoperative complications rate did not differ between TFOP group and OFP group for patients with CSDH. Considering the lower rate of recurrence, TFOP following single burr-hole evacuation might be a safe and promising option for CSDH treatment.
颅骨钻孔术联合闭式引流是治疗慢性硬膜下血肿（CSDH）最常用的方法，但血肿复发的再手术率仍然很高。本回顾性研究旨在比较两种不同的硬膜下引流方法在慢性硬膜下血肿（CSDH）单孔引流术后的并发症和复发率，即额顶位双管引流（TFOP）与额前位单管引流（OFP）。
作者分析了 2013 年 1 月至 2017 年 12 月期间所有接受单孔颅骨钻孔术联合硬膜下闭式引流系统（TFOP 或 OFP 技术）治疗的 CSDH 患者的数据。数据分析包括一般患者数据、并发症、复发和临床结果。
共纳入 331 例患者（85 例 TFOP 和 246 例 OFP）。TFOP 组和 OFP 组在基线特征方面除术前 Markwalder 评分外（=0.019），无统计学差异。OFP 组患者术后第 1 天的中线移位和硬膜下积液厚度大于 TFOP 组（=0.028；=0.007）。此外，OFP 组患者术后血肿变化百分比较低，硬膜下残余气体较多（=0.001；=0.000，分别）。两组患者术后并发症和临床结果无显著差异。在 3 个月的随访中，TFOP 组患者的血肿复发率明显低于 OFP 组（=0.039）。
对于 CSDH 患者，TFOP 组和 OFP 组的术后并发症发生率无差异。考虑到复发率较低，TFOP 可能是治疗 CSDH 的一种安全且有前途的选择。
