A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation
- 1 March 2013
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 118 (3), 694-700
- https://doi.org/10.3171/2012.11.jns12689
Abstract
Object The traditional methods for managing symptomatic chronic subdural hematoma (SDH) include evacuation via a bur hole or craniotomy, both with or without drain placement. Because chronic SDH frequently occurs in elderly patients with multiple comorbidities, the bedside approach afforded by the subdural evacuating port system (SEPS) is an attractive alternative method that is performed under local anesthesia and conscious sedation. The goal of this study was to evaluate the radiographic and clinical outcomes of SEPS as compared with traditional methods. Methods A prospectively maintained database of 23 chronic SDHs treated by bur hole or craniotomy and of 23 chronic SDHs treated by SEPS drainage at Tufts Medical Center was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcome was collected. The volume of SDH before and after treatment was semiautomatically measured using imaging software. Results There was no significant difference in initial SDH volume (94.5 cm(3) vs 112.6 cm(3), respectively; p = 0.25) or final SDH volume (31.9 cm(3) vs 28.2 cm(3), respectively; p = 0.65) between SEPS drainage and traditional methods. In addition, there was no difference in mortality (4.3% vs 9.1%, respectively; p = 0.61), length of stay (11 days vs 9.1 days, respectively; p = 0.48), or stability of subdural evacuation (94.1% vs 83.3%, respectively; p = 0.60) for the SEPS and traditional groups at an average follow-up of 12 and 15 weeks, respectively. Only 2 of 23 SDHs treated by SEPS required further treatment by bur hole or craniotomy due to inadequate evacuation of subdural blood. Conclusions The SEPS is a safe and effective alternative to traditional methods of evacuation of chronic SDHs and should be considered in patients presenting with a symptomatic chronic SDH.Keywords
This publication has 25 references indexed in Scilit:
- Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomasJournal of Neurosurgery, 2010
- A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomasJournal of Neurosurgery, 2010
- Choosing the best operation for chronic subdural hematoma: a decision analysisJournal of Neurosurgery, 2010
- Chronic Subdural Hematomas : A Comparative Study of Three Types of Operative ProceduresJournal of Korean Neurosurgical Society, 2009
- Continuous subgaleal suction drainage for the treatment of chronic subdural haematomaActa Neurochirurgica, 2007
- Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary?Surgical Neurology, 2004
- ReviewNatural history of chronic subdural haematomaBrain Injury, 2004
- Acute subdural haematoma in the conscious patient: Outcome with initial non-operative managementActa Neurochirurgica, 1993
- Chronic Subdural Hematoma May be Preceded by Persistent Traumatic Subdural EffusionNeurologia medico-chirurgica, 1993
- Traumatic Subdural HygromaNeurosurgery, 1992