Artikel
Opening the internal hematoma membrane does not alter the recurrence rate of chronic subdural hematomas – A prospective randomized study
Suche in Medline nach
Autoren
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C. Unterhofer
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Austria
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C. Freyschlag
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Austria
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C. Thomé
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Austria
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M. Ortler
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Austria
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Treatment of chronic subdural hematomas (CSDHs) varies from twist drill craniostomy to open craniotomy and the factors determining recurrence are still not clear. Opening the internal hematoma membrane during surgery may enhance brain expansion postoperatively. This monocentric study aimed to investigate whether splitting the inner hematoma membrane influences the recurrence rate in patients undergoing enlarged burr-hole craniotomy for CSDH.
Methods: Between February 2008 to January 2010 56 awake patients undergoing surgery for CSDH were prospectively randomized to either opening the inner hematoma membrane (group A) or not (group B) after hematoma evacuation and prior to insertion of a drain in the hematoma cavity. Both groups were comparable with regard to demographic, clinical and imaging variables. Outcome was assessed after six weeks for the combined outcome variable of reoperation and/or residual hematoma thickness ≥ one third on CT at this time. Analysis was by intention to treat. Dichotomized outcome data were analyzed using the Chi-squared or the Fisher test. A P < 0.05 was considered statistically significant. Relative risk (RR) and absolute risk reduction (ARR) with 95% CIs were calculated.
Results: Fourteen patients underwent reoperation for clinical deterioration and/or conspicuous residual hematoma during follow-up (n = 6 in Group A, 21%, n = 8 in Group B, 28%) (P = 0.537). Residual hematoma of ≥ one third not requiring surgery was present in n = 7 patients of group A (25%) and n = 10 patients of group B (36%) (P = 0.383). The overall cumulative outcome was 13/28 (46%) in Group A and 18/28 in Group B (P = 0.178). The RR was 0.722 (95% CI 0.445 to 1.172), and the ARR -16% (95% CI -38% to 8%). Opening the internal hematoma membrane was not associated with a higher morbidity.
Conclusions: This study demonstrates that opening the internal hematoma membrane does not influence the rate of patients requiring revision surgery and the number of patients showing a marked residual hematoma after six weeks following evacuation of a chronic subdural hematoma (CSDH).
