title: Recurrence of the Chronic Subdural Hematoma after Burr-Hole Drainage with or without Intraoperative Saline Irrigation.
abstract: OBJECTIVE
  Although standard method has not been established for the chronic subdural hematoma (CSDH), burr-hole trephination and closed system drainage with or without irrigation has been widely accepted as the treatment of choice. The aim of this study is to analysis the post-operative recurrence rates after burr-hole trephination of the CSDH according to the conduction of irrigation.
  
  
  METHODS
  We retrospectively reviewed 184 patients with CSDH who underwent surgical treatment between January 2009 and December 2013. And 152 patients fulfilled the inclusion criteria as follows: 1) CSDH diagnosed on computed tomography (CT), 2) unilateral hematoma, 3) burr-hole trephination with closed system drainage, and 4) follow-up CT for at least 3 months. Those patients were divided into two groups. Group A (n=38) underwent burr-hole trephination without irrigation, and Group B (n=114), burr-hole trephination with saline irrigation.
  
  
  RESULTS
  The overall post-operative recurrence rate was 19.1% (n=29) in this study. The majority of recurrence showed in Group B. Twenty-eight patients (24.6%) of Group B had recurrence and only 1 patient (2.6%) of Group A showed recurrence. The recurrence rate was significantly higher in Group B compared with Group A (p=0.003). Another affecting factor for the recurrence was the amount of postoperative pneumocephalus (p=0.02). No catastrophic complications were found in postoperative course.
  
  
  CONCLUSIONS
  Although there was no difference of clinical outcome in both groups, the recurrence rate was higher in saline irrigation group compared with no irrigation group. We suggest that saline irrigation procedure be reserved only for selected cases in CSDH burr-hole surgery.
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Dong Hwan
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Hwan Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Kyoung Hyup
authors.initials: KH
authors.lastname: Nam
keywords: Drainage; Hematoma subdural chronic; Pneumocephalus; Recurrence; Therapeutic irrigation