1
|
Moran-Guerrero JA, Martínez HR, Gonzalez-Sanchez DG, Perez-Martinez LE, Flores-Salcido RE, Ferrigno AS, Caro-Osorio E, Salazar-Alejo M, Avalos-Montes PJ, Figueroa-Sanchez JA. Backup Frontal Drainage System for Urgent Tension Pneumocephalus Management After Chronic Subdural Hematoma Surgery: A Retrospective Cohort Study. World Neurosurg 2024; 188:68-75. [PMID: 38692567 DOI: 10.1016/j.wneu.2024.04.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To describe a simple variation of burr hole craniostomy for the management of chronic subdural hematoma (CSDH) that uses a frontal drainage system to facilitate timely decompression in the event of tension pneumocephalus and spares the need for additional surgery. METHODS We conducted a retrospective analysis of 20 patients with CSDH who underwent burr hole craniostomy and 20 patients who underwent the same procedure alongside the placement of a 5 Fr neonatal feeding tube as a backup drainage for the anterior craniostomy. Depending on the situation, the secondary drain stayed for a maximum of 72 hours to be opened and used in emergency settings for drainage, aspiration, or as a 1-way valve with a water seal. RESULTS The outcomes of 20 patients who underwent this procedure and 20 controls are described. One patient from each group presented tension pneumocephalus. One was promptly resolved by opening the backup drain under a water seal to evacuate pneumocephalus and the other patient had to undergo a reopening of the craniostomy. CONCLUSIONS The described variation of burr hole craniostomy represents a low-cost and easy-to-implement technique that can be used for emergency decompression of tension pneumocephalus. It also has the potential to reduce reoperation rates and CSDH recurrence. Prospective controlled research is needed to validate this approach further.
Collapse
Affiliation(s)
- Jose A Moran-Guerrero
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Hector R Martínez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | | | - Luis E Perez-Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Rogelio E Flores-Salcido
- Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Ana S Ferrigno
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - E Caro-Osorio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Misael Salazar-Alejo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Pablo J Avalos-Montes
- Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Jose A Figueroa-Sanchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico.
| |
Collapse
|
2
|
Huang J, Tian Y, Song Y, Hu R, Zhang S, Gong Z, Liu X, Luo H, Gao C, Wang D, Feng H, Zhang J, Jiang R. Effect of Different Factors on the Short-Term Outcome of Chinese Patients With Primary Chronic Subdural Hematoma at Different Age Groups: A Two-Center Retrospective Study. Front Aging Neurosci 2019; 11:325. [PMID: 31849637 PMCID: PMC6895020 DOI: 10.3389/fnagi.2019.00325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of symptomatic chronic subdural hematoma (CSDH) is increasing in Chinese aging population, but its clinical and demographic knowledge is still lacking. This study sought to outline the clinical and demographic data of CSDH patients from two medical centers in Tianjin and Chongqing to provide a better understanding for CSDH treatment in China. Methods Age, sex, etiologies, conscious level on admission, treatment strategies, outcome at discharge, recurrence, and concomitant disease of enrolled patients were recorded. The data were further analyzed after the patients were sub-grouped into young/middle (less than 60 years old) and old (over than 60 years old) age groups. Results A total of 1281 CSDH patients were enrolled. Of these, 85.01% were male and 51.91% were aged between 60 and 80 years. 57.61% patients encountered head trauma before diagnosing CSDH. The top three clinical symptoms at admission were headache (58.55%), dyskinesia (36.92%), and dizziness (33.96%). Headache as well as dizziness often happened in young/middle age group, while dyskinesia often occurred in the old age group. The most common concomitant diseases were cardio-cerebrovascular system diseases (41.14%). The concomitant respiratory diseases in aged patients led to unfavorable outcomes (p = 0.049, OR:0.357). The prognosis of old age subgroup receiving conservative treatment was better than those who received burr-hole drainage treatment (p < 0.015, OR:4.091). Conclusion CSDH mostly occurs in aged and male population with a history a head trauma. The respiratory disease often results in unfavorable outcomes in aged patients. Conservative treatment might benefit some patients.
Collapse
Affiliation(s)
- Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Yiming Song
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Rong Hu
- Key Laboratory of Neurotrauma, Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shuixian Zhang
- Key Laboratory of Neurotrauma, Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Hongliang Luo
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Hua Feng
- Key Laboratory of Neurotrauma, Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.,The State Key Laboratory of Neurotrauma Repair and Regeneration, Ministry of Education and Tianjin City, Tianjin, China
| |
Collapse
|
3
|
Lee KS. How to Treat Chronic Subdural Hematoma? Past and Now. J Korean Neurosurg Soc 2018; 62:144-152. [PMID: 30486622 PMCID: PMC6411568 DOI: 10.3340/jkns.2018.0156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022] Open
Abstract
Treatment of chronic subdural hematoma (CSDH) is relatively straightforward, however, there is still some debate regarding the best strategy for treatment. The most practical recommendations of up to date were identified by a review of literature. The author reviewed the literature on CSDH management from the past to now to identify the best methods. Till 1970s, craniotomy was the most commonly used method. Burr hole (BH) became the most preferred method from 1980s. In 1977, twist drill (TD) craniostomy was introduced. Closed system drainage after a BH or a TD became the most frequently used surgical method. Although nonsurgical treatment is often successful, trephination has more advantages, such as rapid resolution of the symptoms and short period of hospitalization. Nonsurgical treatment is possible in asymptomatic patients with a small CSDH. For the symptomatic patients with CSDH, trephination is the treatment of choice, either by BH or TD. In gray zone between surgery and medical treatment, shared decision making can be an ideal approach. For the recurrent CSDHs, repeated trephination is still effective for patients with a low risk of recurrence. If the risk of recurrence is high, additional management would be helpful. For the refractory CSDHs, it is necessary to obliterate the subdural space.
Collapse
Affiliation(s)
- Kyeong-Seok Lee
- Department of Neurosurgery, Soonchunhyang University Chonan Hospital, Chonan, Korea
| |
Collapse
|