Page 154 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Subdural catheter guidance for CSDH

median of 0.32 cm, and an IQR of 0.15 cm. An independent abilities, and overall quality of life. Moreover, 3.9% of
samples t-test was conducted to compare the post- the patients developed seizure symptoms. Seizures not
operative hematoma thickness between the two groups. only pose an immediate threat to the patients’ well-being
The null hypothesis assumed no difference between the during the post-operative recovery period but also require
control and experimental groups. Before the test, the data additional medical interventions and close monitoring.
were assessed to ensure compliance with the necessary These results highlight the importance of exploring more
assumptions for an independent samples t-test, such as accurate and safer methods for drainage tube placement
normality of distribution and homogeneity of variances. to minimize such risks and improve patient outcomes.
A two-tailed test was selected, as no prior hypothesis During catheterization, the drainage catheter is usually
was made regarding the direction of the difference. The blindly inserted into the subdural space. Thus, the catheter
t-test results showed a t-statistic of 0.871 and a two-tailed tip may be placed into the brain parenchyma or injure
p=0.384. This result implies that the data do not provide the vessels on the cerebral surface. In some adverse cases
strong evidence of a significant difference in post-operative reported in the study, it was observed that during the
hematoma thickness between the two groups. surgical procedure, the drainage catheter was erroneously
To further understand the relationship, additional inserted into the brain parenchyma instead of the
measures, such as the CI95 of the difference in means, hematoma cavity (Figure 1C and D). Due to the presence of
could be considered. However, this information is not pressure within the CSDH cavity, as well as potential blood
available in the current context. It is important to note clots, neurosurgeons might not immediately recognize
that the conclusion drawn from the statistical analysis is the mistake during the initial stages of catheter insertion,
based on the existing sample and data, and other factors posing a significant risk. In addition, the catheter direction
or further research may be necessary for a comprehensive is not controlled during insertion, which can lead to
evaluation (Figure 2B). This finding suggests that the two drainage mispositioning. 28
treatment methods may be comparable in terms of their This study focused on the impact of a subdural
overall average hematoma clearance effect post-operatively. catheter guidance device on post-operative cortical injury
However, further evaluation considering other relevant complications in patients with CSDH. A total of 274 CSDH
indicators is warranted. patients were assigned to the control group, among whom
4. Discussion 6 patients experienced post-operative cortical injury
complications, resulting in an incidence rate of 2.19%
CSDH is one of the most common diseases in (6/274). In contrast, the experimental group, consisting
neurosurgery, and it is more common in the elderly. of 244 CSDH patients, showed a remarkable outcome,
Surgical intervention is required for patients with with none developing cortical injury complications post-
significant mass effects of hematoma. CSDH is mainly operatively, resulting in an incidence of 0% (0/244).
13
treated with surgery, with skull drilling and drainage Fisher’s exact test was performed to statistically analyze the
being the preferred method. 14-21 Studies have shown that difference in the incidence of cortical injury complications
burr hole drainage offers advantages such as minimal between the two groups, resulting in a p-value of 0.0427.
risk of injury, simple operation, fewer complications, and The results indicate that the incidence of cortical injury
safety. 1,5,13,14,22-27 However, cranial drilling and drainage complications in the experimental group was significantly
present several disadvantages, including the small burr lower than in the control group. In addition, the CMLE
hole and the unintended penetration of the catheter tip OR was 0, with a CI95 of (0.0, 0.9447), confirming the
into the brain parenchyma or damage to blood vessels on association between the presence of a guidance device
the brain surface caused by catheter irrigation under non- during the procedure and reduced cortical injury.
direct vision, potentially causing neurological injury. 24,26
28
Levin et al. conducted a comprehensive and in-depth Notably, in this in-depth research, neither the
study, which meticulously analyzed a substantial number experimental group nor the control group had any
of patients undergoing surgical procedures involving the reported cases of post-operative seizures or infections.
placement of drainage tubes. A rather concerning finding This outstanding result not only indicates the high-
emerged: when the placement of these drainage tubes was quality of surgical procedures but also strongly supports
carried out under indirect vision, it led to various post- the effectiveness of the subdural catheter guidance device
operative complications. Specifically, 2.8% of the patients in reducing cortical injury complications during CSDH
suffered from brain tissue damage. This brain tissue drainage surgery. Although the guidance device-assisted
damage could have far-reaching consequences, potentially catheter is not inserted under direct visualization, its
affecting the patient’s neurological functions, cognitive unique advantage in minimizing cortical injury is evident.

Volume 9 Issue 2 (2025) 146 doi: 10.36922/ejmo.8532