One common intracranial emergency that is surgically treated is chronic subdural hemorrhage. In order to remove a chronic subdural hematoma, a burr hole must be created for access, the subdural region must be irrigated and a subdural drain must be inserted. Despite the subdural drain has been developed as advantageous, the curative effect of subdural irrigation has not been explored. Therefore, Rahul Raj and colleagues did this study in order to investigate the efficiency of subdural irrigation in Chronic subdural hematoma.
The FINISH experiment was conducted over 5 neurosurgery centers in Finland that included persons over 18 years of age with a persistent subdural hematoma needing burr-hole drainage. The patients were randomly allocated (1:1) by computer-generated block randomisation with block sizes of 4, 6, or 8 stratified by location, to burr-hole drainage either with or without subdural irrigation. A burr hole was drilled at the site of greatest hematoma thickness in both groups, and the subdural space was either drained or not before inserting a subdural drain that was left in place for 48 hours. The percentage of reoperations within 6 months was the main outcome measured and a non-inferiority margin of 7·5% was established. Important secondary outcomes that were also necessary to determine non-inferiority included the percentage of patients who had poor functional results and the 6-month death rate.
This study evaluated 1644 patients between January 1, 2020 and August 17, 2022, to determine their eligibility. Of these individuals, 589 (or 36%) were treated and randomly allocated to a therapy group. The 6-month duration of follow-up was prolonged till February 14, 2023. 54 (18·3%) out of 295 patients in the group allocated to receive no irrigation and 37 (12·6%) out of 294 participants in the group assigned to receive irrigation were found to require reoperation in the intention-to-treat analysis.
The mortality rate and the percentage of individuals with a modified Rankin Scale score of 4-6 did not differ significantly across the groups. The systemic infections, cerebral hemorrhage, and epileptic seizures were the most common serious adverse events. Overall, the experiment supports the use of subdural irrigation because there were no variations in functional outcome or death between the groups.
Reference:
Raj, R., Tommiska, P., Koivisto, T., Leinonen, V., Danner, N., Posti, J. P., Laukka, D., Luoto, T., Rauhala, M., Tetri, S., Korhonen, T. K., Satopää, J., Kivisaari, R., Luostarinen, T., Schwartz, C., Czuba, T., Taimela, S., Lönnrot, K., Järvinen, T. L. N., … Zeiler, F. A. (2024). Burr-hole drainage with or without irrigation for chronic subdural haematoma (FINISH): a Finnish, nationwide, parallel-group, multicentre, randomised, controlled, non-inferiority trial. In The Lancet (Vol. 403, Issue 10446, pp. 2798–2806). Elsevier BV. https://doi.org/10.1016/s0140-6736(24)00686-x
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