Reducing morbidity associated with subdural drain placement after burr-hole drainage of unilateral chronic subdural hematomas: a retrospective series comparing conventional and modified Nelaton catheter techniques,Acta Neurochirurgica

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Reducing morbidity associated with subdural drain placement after burr-hole drainage of unilateral chronic subdural hematomas: a retrospective series comparing conventional and modified Nelaton catheter techniques
Acta Neurochirurgica ( IF 1.9 ) Pub Date : 2023-03-06 , DOI: 10.1007/s00701-023-05537-2
Manuel Moser ₁ , Daniel Coluccia ₁ , Christoph Watermann ₂ , Dirk Lehnick ₃ , Serge Marbacher ₄ , Karl F Kothbauer ₅ , Edin Nevzati ₁

Affiliation

Purpose

Placement of a subdural drain after burr-hole drainage of chronic subdural hematoma (cSDH) significantly reduces risk of its recurrence and lowers mortality at 6 months. Nonetheless, measures to reduce morbidity related to drain placement are rarely addressed in the literature. Toward reducing drain-related morbidity, we compare outcomes achieved by conventional insertion and our proposed modification.

Methods

In this retrospective series from two institutions, 362 patients underwent burr-hole drainage of unilateral cSDH with subsequent subdural drain insertion by conventional technique or modified Nelaton catheter (NC) technique. Primary endpoints were iatrogenic brain contusion or new neurological deficit. Secondary endpoints were drain misplacement, indication for computed tomography (CT) scan, re-operation for hematoma recurrence, and favorable Glasgow Outcome Scale (GOS) score (≥ 4) at final follow-up.

Results

The 362 patients (63.8% male) in our final analysis included drains inserted in 56 patients by NC and 306 patients by conventional technique. Brain contusions or new neurological deficits occurred significantly less often in the NC (1.8%) than conventional group (10.5%) (P = .041). Compared with the conventional group, the NC group had no drain misplacement (3.6% versus 0%; P = .23) and significantly fewer non-routine CT imaging related to symptoms (36.5% versus 5.4%; P < .001). Re-operation rates and favorable GOS scores were comparable between groups.

Conclusion

We propose the NC technique as an easy-to-use measure for accurate drain positioning within the subdural space that may yield meaningful benefits for patients undergoing treatment for cSDH and vulnerable to complication risks.

中文翻译：

降低单侧慢性硬膜下血肿钻孔引流后硬膜下引流管放置相关的发病率：比较传统和改良 Nelaton 导管技术的回顾性系列

目的

慢性硬膜下血肿 (cSDH) 钻孔引流后放置硬膜下引流管可显着降低其复发风险并降低 6 个月时的死亡率。尽管如此，文献中很少提及降低与引流放置相关的发病率的措施。为了减少与引流相关的发病率，我们比较了传统插入和我们提出的修改所取得的结果。

方法

在这两个机构的回顾性系列中，362 名患者接受了单侧 cSDH 的钻孔引流，随后通过传统技术或改良的 Nelaton 导管 (NC) 技术插入硬膜下引流管。主要终点是医源性脑挫裂伤或新的神经功能缺损。次要终点是引流管错位、计算机断层扫描 (CT) 扫描指征、血肿复发再次手术以及最终随访时良好的格拉斯哥结果量表 (GOS) 评分 (≥ 4)。

结果

我们最终分析的 362 名患者（63.8% 男性）中，其中 56 名患者采用 NC 技术插入引流管，306 名患者采用传统技术插入引流管。NC 组 (1.8%) 中脑挫裂伤或新的神经功能缺损的发生率明显低于传统组 (10.5%) ( P = .041)。与传统组相比，NC 组没有引流管错位（3.6% vs 0%；P = .23），并且与症状相关的非常规 CT 成像显着减少（36.5% vs 5.4%；P < .001）。各组之间的再手术率和良好的 GOS 评分具有可比性。