2025 American Academy of Neurology Abstract Website

Muhammad Fawad Tahir¹, Hassan Waseem², Jamir Pitton Rissardo³, Zain abideen⁴, Sania Aimen⁵, Ana Leticia Fornari Caprara³, Vishnu Byroju³, Khadija Ahmed⁶, Maimoona Khan⁶, Sami Ullah Khan⁷, Muhammad Ahmed Ayaz⁸
¹H.B.S Medical and Dental College, Islamabad, Pakistan, ²Allama Iqbal Medical College, Lahore, Pakistan, ³Cooper University Hospital, New Jersey, United State, ⁴King Edward Medical University, Lahore, Pakistan, ⁵Quetta Institute of Medical Sciences, Pakistan, ⁶Dow university of health sciences, Karachi, Pakistan, ⁷MTI Lady Reading Hospital, ⁸University of Mississippi Medical Center

Objective:

To assess the efficacy and safety of irrigation during burr hole drainage for chronic subdural hematoma.

Background:

The commonly used method for treatment of chronic subdural hematoma is burr hole craniotomy. However, the therapeutic effects of irrigation used during this method are still not well understood.

Design/Methods:

PubMed, Cochrane Central, and ScienceDirect were searched till September 2024. The primary and secondary outcomes of interest were the recurrence rate of subdural hematoma, mortality, post-operative infections, hemorrhagic complications, and pneumocephalus. Risk ratios (RR) along with 95% CIs were calculated for categorical outcomes using the Review Manager Software 5.4.1 and employing a random effects model. The quality of the included studies was evaluated using the Newcastle Ottawa scale and Cochrane RoB 2.0 tool. A leave-one-out sensitivity analysis was performed to investigate the source of heterogeneity. The risk of publication bias was assessed through funnel plots and Eggers’s regression test.

Results:

Fourteen studies were included in the final analysis with a total of 2,251 patients. There was no significant difference in the recurrence rate of subdural hematoma (RR=1.01;95%CI: [0.64, 1.61]; p =0.95; I²=54%) and mortality (RR=1.13; 95%CI: [0.69, 1.84]; p =0.63; I²=0%) between the two groups. Similarly, no statistically significant difference was observed in the risk of postoperative infections (RR=0.87; 95%CI;[0.51, 1.47]; p=0.60; I²=0%), hemorrhagic complications (RR=1.35; 95%CI:[0.30, 6.05]; p=0.69; I²=63%) and pneumocephalus (RR=2.56; 95%CI:[0.95, 6.89]; p=0.06; I²=82%) between the irrigation and no irrigation groups.

Conclusions:

In conclusion, burr hole craniotomy with or without irrigation shows comparable safety and efficacy outcomes. Further high-quality multicenter randomized clinical trials are required to confirm if irrigation has effects in improving the efficacy outcomes or reducing complications for better applicability in clinical practice.