Journal Article Ahead of print
PubMed: 42424115 DOI: 10.1227/neu.0000000000004152
Burr-Hole Drainage With or Without Irrigation for Chronic Subdural Hematoma, Postoperative Hematoma Volume, and Risk of Reoperation: A Post Hoc Analysis of the FINISH Trial.
Neurosurgery
Authors: Sanni Mustajoki, Eliisa Netti, Oula A Knuutinen, Pihla Tommiska, Teemu Luoto, Ville Leinonen, Timo Koivisto, Sami Tetri, Jussi P Posti, Kimmo Lönnrot, Rahul Raj
Affiliations
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
- Department of Neurosurgery, Neurocenter, Oulu University Hospital, Oulu, Finland.
- Research Unit of Clinical Medicine, Faculty of Medicine, Oulu University Hospital, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland.
- Department of Neurosurgery, Tampere University Hospital, Tampere University, Tampere, Finland.
- Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
- Neurocenter, Department of Neurosurgery, Turku Brain Injury Center, Turku University Hospital and Clinical Neurosciences, University of Turku, Turku, Finland.
Abstract
BACKGROUND AND OBJECTIVES
Burr-hole drainage with intraoperative irrigation of chronic subdural hematoma (CSDH) has recently been associated with decreased risk for reoperation, compared with the procedure without irrigation. Whether this benefit is mediated through greater hematoma volume reduction remains unknown.
METHODS
We conducted a post hoc analysis of the nationwide multicenter randomized FINISH study. We measured preoperative and 6-week postoperative CSDH volumes from the patient's head computed tomography images or magnetic resonance images using computer-assisted manual segmentation. We compared volumetric parameters between the irrigation and no-irrigation groups and analyzed their association with reoperation and functional outcome.
RESULTS
This study included 573 of 589 the FINISH trial patients with preoperative and postoperative images available for volumetric assessment. Volume reduction was similar between the irrigation and no-irrigation groups: absolute reduction 86 mL (IQR 54-117) vs 81 mL (IQR 49-120; P = .46) and relative reduction 74% (IQR 50-91) vs 69% (IQR 42-94; P = .23). Among reoperated patients, volume reduction was only 15% in both groups (P = .93). Percentage volume reduction was the strongest predictor of reoperation, with an optimal threshold of 47% (area under the curve 0.88). Volumetric parameters were not associated with functional outcome at 6 months.
CONCLUSION
Irrigation did not reduce postoperative hematoma volume compared with no-irrigation, suggesting that the previously reported reoperation benefit of irrigation is not mediated through volume reduction. Volumetric parameters predicted reoperation but not functional outcome, questioning the value of radiological end points in CSDH trials.
MeSH
Drainage, Hematoma, Hematoma, Subdural, Chronic, Hematoma, Subdural, Reoperation, Neurosurgery