Page 152 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Subdural catheter guidance for CSDH

drilling. Simultaneously, the guidance device underwent findings, a decision was made regarding the removal of the
thorough pre-insertion preparation. A visual inspection drainage tube, which was retained for no more than 3 days.
was conducted to check for any physical damage, such All patients received prophylactic antibiotic therapy post-
as cracks or bends. If the device contained mechanical operatively to prevent the risk of infection.
components, they were carefully examined for proper For the control group, the only difference in the
functionality. For guidance devices with adjustable angles, surgical procedure was the absence of the guidance
the locking mechanisms were tested to confirm they could device during catheter insertion and irrigation. Instead,
securely maintain the required position. Furthermore, the the catheter was inserted into the hematoma cavity using
tip of the device was lubricated with a sterile, biocompatible a blind approach, advancing slowly while determining
lubricant to facilitate smooth insertion into the subdural the insertion direction and depth based on preoperative
space while minimizing tissue irritation and the risk of imaging assessment. Particular attention was given to any
trauma during the procedure.
sensation of resistance during the insertion process. Once
During insertion, the first step involved carefully the catheter was positioned appropriately, normal saline
opening and cauterizing the dura mater and the outer irrigation was performed to achieve decompression.
membrane of the subdural hematoma using a bipolar
cautery device. The device settings were precisely adjusted 2.3. Statistical analysis
based on tissue characteristics and membrane thickness. In this study, Statistical Package for the Social Sciences
Initially, a low-power setting was used to create a small 26.0 (IBM Corp., Armonk, NY, USA) was employed for
opening, with gradual increases in power to ensure complete comprehensive data analysis. Measurement data were
hemostasis and effective cauterization. Subsequently, with summarized as the mean and standard deviation (SD).
gentle, slow, and highly precise movements, the guidance Group comparisons were conducted using an independent-
device was inserted into the subdural space through the sample t-test (two-tailed). The decision to apply a two-
burr hole (Figure 1A and B). The hematoma cavity in tailed test was based on extensive evidence from preclinical
CSDH is typically large enough to accommodate the research, preliminary clinical observations, and prior
device. In addition, the structural characteristics and studies on similar devices. These findings consistently
adjustable angle of the guidance device help reduce the risk suggest that the combination of the subdural catheter
of direct brain injury during insertion. Nonetheless, careful guidance device and burr hole drainage is effective in
observation was maintained throughout the procedure to mitigating and preventing intraoperative cerebral cortex
prevent significant damage due to unnoticed septations or damage. The analysis focused on evaluating this beneficial
adhesions on preoperative imaging. The device’s trajectory effect. Count data were presented as the number of cases or
was carefully monitored to ensure proper alignment with as a percentage (%), and comparisons between groups were
the preplanned path. If necessary, insertion was halted to performed using Fisher’s exact test. Statistical significance
reevaluate the device’s position and direction. Every effort was defined as a p<0.05.
was made to avoid accidental injury to adjacent brain
parenchyma, blood vessels, or other critical structures. In addition, the demographic information of the
experimental and control groups, including age and gender
With the aid of the guidance device, a soft, graduated distribution, demonstrates good data quality (Figure A1
catheter was carefully inserted into the hematoma cavity and Table A1). Data visualization was performed using the
to an appropriate depth. The guidance device ensured that free platform Wei Sheng Xin (https://www.bioinformatics.
the catheter advanced in the correct direction, minimizing com.cn/). 12
the risk of unintended damage. Through the catheter, slow
irrigation with normal saline was performed to remove 3. Results
liquefied or partially liquefied old blood clots. The total 3.1. Cortical injury complications
volume of irrigation fluid exceeded 2000 mL, and the
process continued until clear fluid was observed, indicating A total of 274 patients diagnosed with CSDH were
successful decompression. Following this, a drainage tube allocated to the control group. Among them, 6 patients
was placed, and its patency was confirmed before suturing experienced post-operative cortical injury complications,
the incision. The drainage tube was then connected to a resulting in an incidence rate of 2.19% (6/274). In contrast,
collection bag and secured, with the incision site covered the experimental group consisted of 244 CSDH patients
using sterile gauze. A follow-up CT scan was performed and none of them developed cortical injury complications
on the first post-operative day to evaluate the catheter post-operatively, leading to an incidence of 0% (0/244)
position and hematoma drainage. Based on the imaging (Figure 2A).

Volume 9 Issue 2 (2025) 144 doi: 10.36922/ejmo.8532