Page 151 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Subdural catheter guidance for CSDH

1. Introduction brain parenchyma or damage blood vessels on the brain
surface, potentially leading to neurological deficits. 9
Chronic subdural hematoma (CSDH) is a significant
medical condition that arises from the accumulation of Nevertheless, combining a subdural catheter guidance
blood between the arachnoid mater and the dura mater. device with burr hole drainage in the treatment of
This chronic hemorrhagic lesion has been extensively CSDH offers a potential solution to mitigate and prevent
studied in neurosurgery. The incidence of CSDH in intraoperative cerebral cortex damage. By providing a more
the general population is relatively low, ranging from controlled and directed approach to catheter insertion,
1-4
approximately 1 – 13/100,000 individuals. However, the guidance device helps surgeons avoid inadvertent
the incidence increases significantly with age, reaching trauma to brain tissue. This study collected cases of CSDH
127.1/100,000 individuals in those aged 80 years or older. treated with burr hole drainage at the hospital between
5
This age-related trend highlights the vulnerability of the January 2015 and December 2019. By comparing post-
elderly population to this condition. operative outcomes between patients treated with and
The vast majority (over 80%) of CSDH patients have a without the subdural catheter guidance device (Patent
history of traumatic brain injury. The pathophysiological Owner: Lepu Medical Shenyang Shenda Endoscope Co.,
mechanism underlying CSDH involves the tearing of Ltd.), the experimental group demonstrated satisfactory
the bridging veins on the brain’s surface, which leads to efficacy. This research aims to further evaluate the device’s
bleeding into the subdural space. This initial hemorrhage effectiveness in reducing cortical injury and provide
triggers a nonspecific inflammatory response within the evidence for its potential widespread application in CSDH
inner dural layer. The inflammatory process triggers a series management.
of cellular and molecular changes, activating fibroblasts 2. Methods
and promoting the release of cytokines. These factors
contribute to hematoma formation and the subsequent 2.1. Eligibility criteria
6
development of a fibrous membrane around it. As the The inclusion criteria for this study were as follows: Patients
hematoma grows, it exerts a mass effect on the surrounding aged between 10 and 95 years presenting with clinical
brain tissue, resulting in increased intracranial pressure. symptoms of CSDH, such as headache, dizziness, and limb
The primary symptoms of CSDH are diverse and can weakness, with symptoms that are persistent and consistent
significantly impact a patient’s quality of life. Increased with the characteristics of CSDH ; a definitive diagnosis of
10
intracranial pressure often leads to headaches, ranging CSDH; and patients who had provided complete informed
from mild-to-severe, and may be accompanied by consent. The exclusion criteria included: The presence of
nausea and vomiting. Altered consciousness is another an acute subdural hematoma, including recurrent cases,
common symptom, with patients experiencing confusion, as acute subdural hematoma mostly forms within 72 h
drowsiness, or, in severe cases, coma. In addition, CSDH can after head trauma and presents as a hyperdense shadow on
lead to cognitive impairments, such as dementia, apathy, computed tomography (CT) ; prior treatment of the target
11
and unresponsiveness, which often develop insidiously and subdural hematoma; a Glasgow Coma Scale score below 9;
progress over time, highlighting the importance of early and a life expectancy of <1 year. 1
diagnosis. In a smaller subset of patients, focal neurological
deficits such as hemiplegia, aphasia, and focal epilepsy may 2.2. Surgical procedure
arise, depending on the location of the hematoma and the The surgery was performed under local anesthesia, with
extent of brain tissue compression. 7 lidocaine administered at the surgical site. A small arcuate

Surgical intervention is the primary treatment for or straight incision, typically 3 – 5 cm in length, was made
CSDH. However, for patients with contraindications to at the thickest part of the hematoma within the hairline,
surgery, such as those with severe comorbidities or poor usually at the highest point of the head. A burr hole was
overall health, symptomatic and supportive treatment drilled above the superior temporal line, generally at
8
may be considered. Currently, the most used surgical the parietal eminence. Before inserting the subdural
technique for CSDH is burr hole craniotomy, which catheter guidance device, the burr hole area underwent
involves making a small opening in the skull to access a thorough examination to ensure the complete absence
the subdural space. However, this procedure employs a of bone fragments, soft tissue residues, or other potential
blind technique, limiting the surgeon’s direct visualization debris that could obstruct the insertion procedure. High-
of the surgical field. Consequently, the cerebral cortex is magnification surgical loupes were frequently used for
highly susceptible to injury. During catheter insertion for meticulous inspection, and sterile saline irrigation was
drainage, the catheter tip may inadvertently penetrate the performed to remove any loose particles remaining after

Volume 9 Issue 2 (2025) 143 doi: 10.36922/ejmo.8532