医学
慢性硬膜下血肿
血肿
外科
前瞻性队列研究
改良兰金量表
队列
队列研究
急性硬膜下血肿
内科学
缺血
缺血性中风
作者
Laurence Glancz,Michael T C Poon,Ian C. Coulter,Peter J. Hutchinson,Angelos G. Kolias,Paul M. Brennan
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2018-08-29
卷期号:85 (4): 486-493
被引量:45
标识
DOI:10.1093/neuros/nyy366
摘要
Abstract Background Drain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes. Objective To examine whether this is influenced by variation in drain location, positioning or duration of placement. Methods We performed a subgroup analysis of a previously reported multicenter, prospective cohort study of CSDH patients performed between May 2013 and January 2014. Data were analyzed relating drain location (subdural or subgaleal), position (through a frontal or parietal burr hole), and duration of insertion, to outcomes in patients aged >16 yr undergoing burr-hole drainage of primary CSDH. Primary outcomes comprised modified Rankin scale (mRS) at discharge and symptomatic recurrence requiring redrainage within 60 d. Results A total of 577 patients were analyzed. The recurrence rate of 6.7% (12/160) in the frontal subdural drain group was comparable to 8.8% (30/343) in the parietal subdural drain group. Only 44/577 (7.6%) patients underwent subgaleal drain insertion. Recurrence rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups ( P = .95). We found no significant differences in discharge mRS between these groups. Recurrence rates were comparable between patients with postoperative drainage for 1 or 2 d, 6.4% and 8.4%, respectively ( P = .44). There was no significant difference in mRS scores between these 2 groups ( P = .56). CONCLUSION Drain insertion after CSDH drainage is important, but position (subgaleal or subdural) and duration did not appear to influence recurrence rate or clinical outcomes. Similarly, drain location did not influence recurrence rate nor outcomes where both parietal and frontal burr holes were made. Further prospective cohort studies or randomized controlled trials could provide further clarification.
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