The efficacy and safety of burr-hole craniotomy without continuous drainage for chronic subdural hematoma and subdural hygroma in children under 2 years of age.
OBJECTIVE
Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2 years old. We also aimed to determine the predictors of CSDH/SDHy recurrence.


METHODS
We conducted a retrospective chart review of 25 children under 2 years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period. We analyzed the relationship between CSDH/SDHy recurrence and factors such as abusive head trauma, laterality of CSDH/SDHy, and subdural fluid collection type (hematoma or hygroma).


RESULTS
CSDH/SDHy recurred in 5 of the 25 patients (20 %), requiring a second operation at an average of 0.92 ± 1.12 months after the initial procedure. The mean follow-up period was 25.1 ± 28.6 months. There were no complications related to either operation. None of the assessed factors were statistically associated with recurrence.


CONCLUSIONS
Burr-hole craniotomy without continuous drainage for CSDH/SDHy appears safe in children aged under 2 years and results in a relatively low recurrence rate. No predictors of CSDH/SDHy recurrence were identified. Advantages of this method include avoiding external subdural drainage-related complications. However, burr-hole drainage may be more effective for CSDH, which our data suggests is more likely to recur than SDHy, providing the procedure is performed with specific efforts to reduce complications.
Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo, 654-0081, Japan. kkmatsuo@outlook.jp.|Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. kkmatsuo@outlook.jp.
Kazuya
http://orcid.org/0000-0001-6721-1353
K
Matsuo
Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo, 654-0081, Japan.
Nobuyuki
N
Akutsu
Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan.
Kunitoshi
K
Otsuka
Department of Neurosurgery, Kakogawa Hospital Organization, Kakogawa West-City Hospital, 384-1 Hiratsu, Yoneda-cho, Kakogawa, Hyogo, 675-8611, Japan.
Kazuki
K
Yamamoto
Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo, 654-0081, Japan.
Atsufumi
A
Kawamura
Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo, 654-0081, Japan.
Tatsuya
T
Nagashima
D003399:Craniotomy / Q000379:methods*; D004322:Drainage; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013353:Subdural Effusion / Q000601:surgery*
Abusive head trauma; Irrigation; Recurrence; Subdural fluid collection