Servicio Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Servicio Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Neurocirugia (Astur : Engl Ed). 2024 Sep-Oct;35(5):241-246. doi: 10.1016/j.neucie.2024.07.002. Epub 2024 Jul 6.
Chronic subdural hematoma (CSDH) is one of the most common pathologies in our daily practice. The standard treatment is the evacuation making a burr-hole and placement of a subdural drainage, which has shown to decrease its recurrence. However, this procedure can entail risks such as parenchymal damage, infection, or the onset of seizures, prompting the consideration of subgaleal drainage as an alternative. Our objective is to compare the use of subdural and subgaleal drainage in a cohort of patients undergoing intervention for CSDH, as well as to analyze the differences in complication rates and recurrence between the two groups.
A retrospective analytical observational study was conducted, analyzing 152 patients diagnosed with CSDH who underwent intervention at our center from January 2020 to April 2022. Patients in whom drainage was not placed were excluded. In all patients, a burr-hole was performed and the type of drainage was chosen by the neurosurgeon.
Out of the 152 patients, subdural drainage was placed in 80 cases (52.63%), while subgaleal drainage was used in 72 cases (47.37%). There were no significant differences in the recurrence rate (30% in the subdural drainage group vs. 20.83% in the subgaleal drainage group; P = .134) or in the complication rate (7.5% in the subdural drainage group vs. 5.5% in the subgaleal drainage group; P = .749).
Subgaleal drainage shows similar clinical outcomes with a recurrence and complication rate comparable to subdural drainage, suggesting it as a safe and effective alternative to subdural drainage in the treatment of CSDH.
慢性硬脑膜下血肿（CSDH）是我们日常实践中最常见的疾病之一。标准治疗是通过颅骨钻孔和放置硬脑膜下引流来清除血肿，这已被证明可以降低其复发率。然而，该手术可能会带来一些风险，如实质损伤、感染或癫痫发作的发生，这促使我们考虑使用皮下引流作为替代方法。我们的目的是比较一组接受 CSDH 干预的患者使用硬脑膜下和皮下引流的效果，并分析两组之间并发症发生率和复发率的差异。
我们进行了一项回顾性分析观察性研究，分析了 2020 年 1 月至 2022 年 4 月期间在我们中心接受 CSDH 干预的 152 名患者。排除未放置引流的患者。在所有患者中，均进行颅骨钻孔，并由神经外科医生选择引流类型。
在 152 名患者中，80 例（52.63%）放置了硬脑膜下引流，72 例（47.37%）使用了皮下引流。两组复发率（硬脑膜下引流组为 30%，皮下引流组为 20.83%；P=0.134）或并发症发生率（硬脑膜下引流组为 7.5%，皮下引流组为 5.5%；P=0.749）均无显著差异。
皮下引流的临床效果与硬脑膜下引流相似，复发率和并发症发生率与硬脑膜下引流相当，表明在治疗 CSDH 时，皮下引流是一种安全有效的替代方法。
