Reduction of cortical injury using a subdural catheter guidance device: A comparative study on burr hole drainage for chronic subdural hematoma

Chronic subdural hematoma (CSDH) is a chronic hemorrhagic lesion caused by the accumulation of blood between the arachnoid mater and the dura mater. Currently, the most commonly used surgical approach for CSDH is burr hole craniotomy. However, this procedure employs a blind technique, making the cerebral cortex susceptible to injury. The use of a subdural catheter guidance device combined with burr hole drainage in the treatment of CSDH can prevent intraoperative cerebral cortex damage and reduce its potential impact. This study retrospectively analyzed a total of 518 patients with CSDH who underwent surgical treatment at the hospital. Of these, 361 were male (69.69%) and 157 were female (30.31%), with a median age of 59.5 years (range: 12 – 92 years). All patients underwent preoperative head computed tomography and/or magnetic resonance imaging scans, which revealed crescent-shaped mixed-density or iso-dense shadows beneath the inner table of the skull. Informed consent for the burr hole decompression procedure was obtained from all patients. Subsequently, the 518 patients were randomly divided into two groups: The control group (undergoing the procedure without a “guidance device”) and the experimental group (undergoing the procedure with a “guidance device”). All patients provided consent for the publication of their clinical details and related images. In the control group, 274 patients with CSDH were treated, among whom 6 cases had post-operative cortical injury complications, with an incidence rate of 2.19%. In the experimental group, 244 patients with CSDH were treated, and no cortical injury complications occurred post-operatively, with an incidence rate of 0. Fisher’s exact test (two-tailed) showed p=0.0427, indicating a significant reduction in cortical injury complications with the use of the guidance device. In addition, the conditional maximum-likelihood estimate (CMLE) odds ratio for Fisher’s exact test was 0, with a 95% confidence interval ranging from 0.0 to 0.9447, further reflecting the relationship between the relevant factors. This indicates that incorporating a subdural catheter guidance device during burr hole drainage for CSDH can assist surgeons in avoiding damage to the cerebral cortex.