Turkish Neurosurgery 2013 , Vol 23 , Num 4
Routine Postoperative Ct-Scans After Burr Hole Trepanation for Chronic Subdural Hematoma ľ Better Before or After Drainage Removal?
Benjamin BROKINKEL1, Christian EWELT1, Markus HOLLING1, Volker HESSELMANN2, Walter Leonard HEINDEL2, Walter STUMMER1, Bernhard Robert FISCHER1
1University Hospital Muenster, Department of Neurosurgery, Muenster, Germany
2University Hospital Muenster, Institute of Clinical Radiology, Muenster, Germany
DOI : 10.5137/1019-5149.JTN.7269-12.0 Aim: To evaluate timing of scheduled CT-scans after burr hole trepanation for chronic subdural hematoma (cSDH).

Material and Methods: 131 patients with primary cSDH were included. Scheduled CT-scans were performed after burr hole trepanation and placement of a subdural drain. The influence of CT-scanning with or without indwelling drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow up by single factor analyses. Subgroup analyses were performed for patients receiving anticoagulant drugs.

Results: Median age was 74 years. Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent burr hole trepanations (p=0.243), craniotomies (p=1.000) and outcome at discharge (p=0.297). Mean duration of hospitalization (11 vs. 8 days, p=0.013) was significantly longer and number of subsequent CT-scans was higher when CT scan was performed with indwelling drain (2.3 vs. 1.4, p=0.001). In middle-term follow-up, beneficial effects of CT-scanning with inlaying drainage could neither be shown. Moreover, advantageous effects of CT-scans with indwelling drains could neither be shown for patients receiving anticoagulant drugs.

Conclusion: Scheduled postoperative cranial imaging with indwelling drains was not shown to be beneficial and misses information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal. Keywords : cSDH, Chronic subdural hematoma, CT, Computed tomography, Burr hole trepanation

Corresponding author : Benjamin Brokřnkel, benjamin.brokinkel@ukmuenster.de