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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Supervised valsalva maneuver after burr hole evacuation of chronic subdural haematomas – a prospective cohort study

Angeleitetes Valsalva-Manöver nach Bohrlochtrepanation und Blutungsevakuation des chronischen Subduralhämatoms – eine prospektive Kohortenstudie

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  • presenting/speaker Sae-Yeon Won - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland; University Rostock, Neurosurgery, Rostock, Deutschland
  • Daniel Dubinski - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland; University Rostock, Neurosurgery, Rostock, Deutschland
  • Bedjan Behmanesh - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland
  • Joshua Bernstock - Brigham and Women’s Hospital, Neurosurgery, Boston, MA, Vereinigte Staaten
  • Fee Keil - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland
  • Thomas Freiman - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland; University Rostock, Neurosurgery, Rostock, Deutschland
  • Jürgen Konczalla - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland
  • Volker Seifert - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland
  • Florian Gessler - Goethe University Hospital Frankfurt am Main, Neurosurgery, Frankfurt am Main, Deutschland; University Rostock, Neurosurgery, Rostock, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV117

doi: 10.3205/21dgnc112, urn:nbn:de:0183-21dgnc1126

Published: June 4, 2021

© 2021 Won et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Research on chronic subdural hematoma (cSDH) management has primarily focused on potential recurrence after surgical evacuation. Herein, we present a novel postoperative/non-invasive treatment that includes a supervised Valsalva maneuver (SVM) which may serve to reduce SDH recurrence. Accordingly, the aims of the study were to investigate the effects of SVM on SDH recurrence rates and functional outcomes.

Methods: A prospective study was conducted from December 2016 until December 2019 at our institution. Of the 204 adult patients with surgically treated cSDH that had subdural drains placed, 94 patients were assigned to the SVM group and 82 patients were assigned to the control group. The SVM was performed by having patients blow into a self-made SVM-device at least 2 times/hour for 12 hours/day. The primary endpoint was SDH recurrence rate whilst secondary outcomes were morbidity and functional outcomes at 3-months of follow-up.

Results: SDH recurrence was observed in 16 of 94 patients (17%) in the SVM group which was a significant reduction as compared to the control group which had 24 of 82 patients (29.3%; p=0.05) develop recurrent SDHs. Furthermore, the infection rate (e.g.pneumonia) was significantly lower in the SVM group (1.1%) compared to the control group (13.4%; p<0.001; Odds ratio [OR] 0.1). At the 3-month follow-up, 85 of 94 patients (90.4%) achieved favorable outcomes in the SVM group compared to 62 of 82 patients (75.6%) in the control group (p=0.008; OR 3.0). Independent predictors for favorable outcome at follow-up were age (OR 0.9) and infection (OR 0.2).

Conclusion: SVM appears to be safe and effective in the postoperative management of cSDHs, reducing both recurrence rates and infections after surgical evacuation thereby resulting in favorable outcomes at follow-up.