Prolonged drainage reduces the recurrence of chronic subdural hematoma. 2009

Guang Jie Yu, and Chong Zhen Han, and Ming Zhang, and Han Ting Zhuang, and Yong Gang Jiang
Department of Neurosurgery, Qingdao Haici Hospital, P.R. China. guangjie_yu@hotmail.com

Recurrence of chronic subdural hematoma (CSH) is a significant problem in neurosurgical practice. Various risk factors associated with patient's characteristics and the pathogenesis of CSH have been investigated in many studies, but controversial findings are not uncommon. Therefore we made a retrospectively investigation focusing mainly on the factors associated with surgical techniques. in order to find out the factors that may affect the recurrence rate of CSH. The medical records of 97 consecutive patients with 121 CSHs, who were treated with burr-hole craniostomy and continuous drainage, were retrospectively reviewed. The relationships between the recurrence rate and some factors associated with surgery, such as location of burr-hole, thickness of residual hematoma, location of drainage catheter, intracapsular air postsurgery, duration of drainage were investigated. The average recurrence rate was 6.6% in this whole series. For patients with less than three days of drainage, the recurrence rate was 16.3%, whereas for those with 3 and more days of drainage, the recurrence rate was only 1.3%. The duration of drainage significantly related to recurrence rate. In addition, a higher recurrence rate seemed to be associated with more intracapsular air postsurgery, but it did not reach statistically significant level in this study. Prolonged duration of drainage did not increase the frequency of infection in this series. We found in this study that the duration of drainage play an important role in the treatment of CSH and 3 full days of drainage seems to be necessary, especially for patients of 60 years and over. We presumed that it takes at least 3 days of drainage for outer membrane of CSH to get the restoration of a normal balance between coagulation and fibrinolysis after surgery, which is necessary for termination of the vicious cycle and resolution of the hematoma.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002908 Chronic Disease Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care (Dictionary of Health Services Management, 2d ed). For epidemiological studies chronic disease often includes HEART DISEASES; STROKE; CANCER; and diabetes (DIABETES MELLITUS, TYPE 2). Chronic Condition,Chronic Illness,Chronically Ill,Chronic Conditions,Chronic Diseases,Chronic Illnesses,Condition, Chronic,Disease, Chronic,Illness, Chronic
D004322 Drainage The removal of fluids or discharges from the body, such as from a wound, sore, or cavity.
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old

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