Subdural irrigation and burr-hole drainage may reduce complications in hematoma patients, finds research

A new study published in the journal of The Lancet found that the patients who had burr-hole drainage with subdural irrigation had lower reoperation rates and similar functional results when compared to patients without subdural irrigation.

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.