Hematoma Recurrence in Burr Hole Drainage Compared to Burr Hole Irrigation as Treatment of Chronic Subdural Hematoma: A Systematic Review and Meta-analysis

Sri Maliawan; Made Bhuwana  Putra; Tjokorda GB Mahadewa; I Putu Eka  Widyadharma

doi:10.3889/oamjms.2020.3344

Authors

Sri Maliawan Department of Neurosurgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
Made Bhuwana Putra Department of Neurosurgery, Mangusada General Hospital, Badung Regency, Bali, Indonesia
Tjokorda GB Mahadewa Department of Neurosurgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
I Putu Eka Widyadharma 3Department of Neurology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.3344

Keywords:

Burr hole drainage, Burr hole irrigation, Chronic subdural hematoma

Abstract

BACKGROUND: Subdural hematoma is a common phenomenon following a traumatic brain injury where a hematoma is formed below the dura mater of brain meningeal layer, usually with a coup-contrecoup mechanism of injury. The chronic counterpart of subdural hematoma is frequently occurring in elderly patients. There are several techniques being used by many practitioners, including burr hole with or without irrigation, with little evidence of which technique is favorable, especially in terms of recurrence rates following the procedure.

AIM: This study aimed to compare the recurrences of chronic subdural hematoma (CSDH) following burr hole with and without saline irrigation technique by systematic review and meta-analysis.

METHODS: This study included all articles that describe the two specified burr hole techniques in treating patients with a CSDH. We extracted the eligibility criteria into keywords using Boolean Operator. In this study, we used keywords (CSDH) and (burr hole) and (irrigation) and ((drainage) or no irrigation)) in PubMed, directory of open access journal, and Google Scholar database.

RESULTS: This study included seven retrospective cohort studies from 2002 to 2017 with a total of 635 samples. The incidence of hematoma recurrences between burr hole irrigation and burr hole drainage was 14.7% and 12.0%, respectively. Based on random effect model with high heterogeneity (I2 = 60%; X2 = 14.92; p = 0.02), pooled risk ratio between burr hole irrigation and burr hole drainage on hematoma recurrences was 1.05 (p = 0.92; 95% confidence interval, 0.43–2.54).

CONCLUSION: There was no superiority between one procedure toward other in preventing recurrences of chronic subdural hematoma.

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