An Exhaustive Drainage Strategy in Burr-hole Craniostomy for Chronic Subdural Hematoma

医学 慢性硬膜下血肿 外科 尿激酶 血肿 改良兰金量表 排水 内科学 生态学 生物 缺血 缺血性中风
作者
Yunwei Ou,Jinqian Dong,Liang Wu,Long Xu,Lei Wang,Baiyun Liu,Jing‐Sheng Li,Weiming Liu
出处
期刊:World Neurosurgery [Elsevier BV]
卷期号:126: e1412-e1420 被引量:27
标识
DOI:10.1016/j.wneu.2019.03.111
摘要

To introduce an effective strategy to treat patients with chronic subdural hematoma (CSDH) that can achieve a low recurrence rate and good outcome.Surgical patients with CSDH from August 2011 to May 2017 in our hospital were collected retrospectively. An exhaustive drainage strategy to treat CSDH with burr-hole craniostomy was conducted. All patients were drained, and catheter was removed when natural drainage ceased or when drainage was complete using urokinase. Clinical characteristics were reviewed and analyzed. Following this strategy, predictors of recurrence requiring reoperation and outcome were analyzed.In total, 1126 patients with CSDH who were treated with burr-hole craniostomy were included. Using the exhaustive drainage strategy, recurrence rate was only 1.9% (21/1117) with follow-up rate of 99.2%. 97.0% (1092/1117) of patients gained good outcome (modified Rankin scale scores 0-3) at 6 months after discharge. Postoperative hematoma volume (P = 0.001, B = 0.028, Exp (B) = 1.028, 95% CI 1.011-1.046), diabetes (P = 0.022, B = 1.082, Exp (B) = 2.950, 95% CI 1.169-7.440), bilateral hematoma (P = 0.011, B = 1.213, Exp (B) = 3.363, 95% CI 1.323-8.547), and complications (P = 0.013, B = 1.483, Exp (B) = 4.408, 95% CI 1.365-14.235) significantly increased the probability of recurrence. In contrast, use of urokinase (P = 0.007, B = -1.435, Exp (B) = 0.238, 95% CI 0.085-0.671) reduced recurrence. Finally, age (P = 0.026, B = 0.056, Exp (B) = 1.057, 95% CI 1.007-1.110), complications (P < 0.001, B = 1.710, Exp (B) = 5.529, 95% CI 2.104-14.531), and Bender grade (P < 0.001, B = 1.165, Exp (B) = 3.205, 95% CI 1.325-7.750) were significant predictors of outcome.The exhaustive drainage strategy is safe and effective for reducing recurrence rate and achieving good outcome in patients with CSDH. This procedure merits recommendation in clinical practice.
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