A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomas

Clinical article

Restricted access

Object

The Subdural Evacuating Port System (SEPS) was recently introduced as a novel method of treating chronic subdural hematomas (SDHs). This system is a variation of the existing twist-drill craniostomy methods for treating chronic SDH. Compared with craniotomy or bur hole treatment of chronic SDH, this system offers the possibility of treatment at bedside without general anesthesia. In comparison with existing twist-drill methods, the system theoretically offers the advantage of a hermetically closed system that can evacuate a hematoma without an intracranial catheter.

Methods

The authors performed a case-control study of all chronic SDHs treated at a single institution over a 5-year period and compared the efficacy and safety of the SEPS to bur hole evacuation. Patients were matched for age, injury mechanism, medical comorbidities, use of anticoagulation, and radiographic appearance of the SDH. The primary outcome of interest was the recurrence rate in each group, which was evaluated by radiographic evidence as well as the number of patients requiring a second procedure. Secondary outcomes examined were mortality, infection, acute hematoma formation, seizure, length of hospital stay, length of intensive care unit stay, and discharge location.

Results

The authors found that there were no appreciable differences in symptoms on presentation, existing comorbidities, home medications, or laboratory values between the treatment groups. The average Hounsfield units of preoperative CT scanning was similar in both groups. Radiographic recurrence was statistically similar between the SEPS group (25.9%) and the bur hole group (18.5%; p = 0.37). Although there was a trend toward higher reoperation rates in the SEPS group, the need for a subsequent procedure was also statistically similar between the SEPS group (25.9%) and the bur hole group (14.8%; p = 0.25). The mortality rate was not significantly different between the SEPS group (9.5%) and the bur hole group (4.8%; p = 0.50). The SEPS procedure provided a mean reduction in SDH thickness of 27.3% compared with 37.9% with bur hole (p = 0.05) when comparing the preoperative CT scan with the first postoperative CT scan. The percentage of reduction in SDH thickness when comparing the preoperative CT scan with the most recent postoperative CT scan was 40.5% in the SEPS group and 45.4% in the bur hole group (p = 0.31).

Conclusions

The SEPS offers an alternative type of twist-drill craniostomy for the treatment of chronic SDH with a trend toward higher recurrence in our experience. The efficacy and safety of SEPS is similar to that of other twist-drill methods reported in the literature. In the authors' experience, the efficacy of this treatment as measured by radiographic worsening or the need for a subsequent procedure is statistically similar to that of bur hole treatment. There was no difference in mortality or other adverse outcomes associated with SEPS.

Abbreviations used in this paper: HU = Hounsfield unit; SDH = subdural hematoma; SEPS = Subdural Evacuating Port System.

Article Information

Address correspondence to: Anand I. Rughani, M.D., University of Vermont, Division of Neurosurgery, 111 Colchester Avenue, Fletcher 507, Burlington, Vermont 05401. email: anand.rughani@vtmednet.org.

Please include this information when citing this paper: published online December 11, 2009; DOI: 10.3171/2009.11.JNS091244.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    The distribution of different surgical treatments for chronic SDH is represented over the past 7 years at our institution.

  • View in gallery

    The mean density of SDH fluid was measured in HU using the preoperative CT scan. For a given patient, the measurement consisted of the average of the highest and lowest HUs obtained from 3 different axial sections. The average HU did not differ significantly according to the treatment group (−27.7 HU in the bur hole group and −29.7 HU in the SEPS group; p = 0.35). ns = not significant.

  • View in gallery

    Graph showing the percentage of change in thickest portion of the SDH on axial sections from the preoperative CT scan to the first postoperative CT scan. The average decrease was 27.3% for SEPS and 37.9% for bur hole (p = 0.10).

  • View in gallery

    Graph showing the percentage of change in thickest portion of the SDH on axial sections from the preoperative CT to the last postoperative CT scan. The average decrease was 40.5% for the SEPS group and 45.4% for the bur hole group (p = 0.31).

References

1

Aoki N: Subdural tapping and irrigation for the treatment of chronic subdural hematoma in adults. Neurosurgery 14:5455481984

2

Asfora WTSchwebach L: A modified technique to treat chronic and subacute subdural hematoma: technical note. Surg Neurol 59:3293322003

3

Benes LEggers FAlberti OBertalanffy H: A new screw catheter kit for the bedside treatment of chronic subdural hematomas. J Trauma 52:5915942002

4

Camel MGrubb RL Jr: Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg 65:1831871986

5

Carlton CKSaunders RL: Twist drill craniostomy and closed system drainage of chronic and subacute subdural hematomas. Neurosurgery 13:1531591983

6

Hamilton MGFrizzell JBTranmer BI: Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery 33:67721993

7

Horn EMFeiz-Erfan IBristol RESpetzler RFHarrington TR: Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surg Neurol 65:1501542006

8

Hubschmann OR: Twist drill craniostomy in the treatment of chronic and subacute subdural hematomas in severely ill and elderly patients. Neurosurgery 6:2332361980

9

Miele VJSadrolhefazi ABailes JE: Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma. Surg Neurol 63:4204232005

10

Muzii VFBistazzoni SZalaffi ACarangelo BMariottini APalma L: Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study. J Neurosurg Sci 49:41472005

11

Ramnarayan RArulmurugan BWilson PMNayar R: Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method. Clin Neurol Neurosurg 110:7747782008

12

Rand BOWard AA JrWhite LE JrWhite LE Jr: The use of the twist drill to evaluate head trauma. J Neurosurg 25:4104151966

13

Reinges MHHasselberg IRohde VKüker WGilsbach JM: Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. J Neurol Neurosurg Psychiatry 69:40472000

14

Rychlicki FRecchioni MABurchianti MMarcolini PMessori APapo I: Percutaneous twist-drill craniostomy for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 113:38411991

15

Smely CMadlinger AScheremet R: Chronic subdural haematoma—a comparison of two different treatment modalities. Acta Neurochir (Wien) 139:8188261997

16

Sucu HKGökmen MErgin ABezircioğlu HGökmen A: Is there a way to avoid surgical complications of twist drill craniostomy for evacuation of a chronic subdural hematoma?. Acta Neurochir (Wien) 149:5975992007

17

Tabaddor KShulmon K: Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46:2202261977

18

Weigel RSchmiedek PKrauss JK: Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:9379432003

19

Williams GRBaskaya MKMenendez JPolin RWillis BNanda A: Burr-hole versus twist-drill drainage for the evacuation of chronic subdural haematoma: a comparison of clinical results. J Clin Neurosci 8:5515542001

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 78 78 21
Full Text Views 166 166 2
PDF Downloads 73 73 3
EPUB Downloads 0 0 0

PubMed

Google Scholar