gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Routine postoperative CT-scans after burr hole trepanation for chronic subdural hematoma – better before or after drainage removal?

Meeting Abstract

  • B. Brokinkel - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • C. Ewelt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • M. Holling - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • V. Hesselmann - Institut für Klinische Radiologie, Universitätsklinikum Münster
  • W.L. Heindel - Institut für Klinische Radiologie, Universitätsklinikum Münster
  • W. Stummer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • B.R. Fischer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.06.03

DOI: 10.3205/12dgnc205, URN: urn:nbn:de:0183-12dgnc2058

Published: June 4, 2012

© 2012 Brokinkel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Chronic subdural hematoma (cSDH) is common and burr hole trepanation with subsequent inlay of a subdural drainage remains a safe surgical measure. Since performance of scheduled postoperative CT-scans before or after drainage removal is still controversial, we retrospectively analyzed the value of CT imaging with subdural drains in situ.

Methods: 74 patients (20 females, 27% and 54 males, 73%) with primary cSDH were included. Routine CT-scans were performed after burr hole trepanation and placement of a subdural drain. Patients' sex, age, symptoms, anticoagulation therapy, side and thickness of initial hematoma were recorded. The influence of routine postoperative CT-scanning with or without indwelling subdural drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow-up by single factor analyses. Subgroup analyses were performed for 29 patients (39%) receiving anticoagulant drugs at the time of admission.

Results: Median age was 75 years (32–92 years). Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent surgery (p = 0.721; burr hole trepanation p = 1.000 or craniotomy p = 0.576), duration of hospitalization (p = 0.808), outcome at discharge (p = 0.543) or numbers of subsequent CT-scans (p = 0.469). Middle-term follow-up was available for 35 patients. Among those, beneficial effects of CT-scanning with inlaying drainage could not be shown. Subgroup analyses revealed CT-scanning with inlaying drainage to be associated with marginally better short-term outcome (p = 0.056) in patients receiving anticoagulant drugs.

Conclusions: Performance of scheduled postoperative cranial imaging with indwelling drains was not shown to reduce subsequent CT-scans or to be beneficial and may miss information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal.