ArticlePloS one2014
Risk factors in chronic subdural hematoma: comparison of irrigation with artificial cerebrospinal fluid and normal saline in a cohort analysis.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Irrigation practices in surgical evacuation of chronic subdural hematoma: systematic review and meta-analysis of technique, fluid type, and temperature.Neurosurgical review · 2025Pooled it
- Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis.Neuroradiology · 2021Pooled it
- Burr hole drainage and burr hole drainage with irrigation to treat chronic subdural hematoma: A systematic review and meta-analysis.Medicine · 2018Pooled it
- Risk Factors of Chronic Subdural Hematoma Recurrence: A Systematic Review.Medical journal of the Islamic Republic of Iran · 2025Review
- Prediction of Postoperative Recurrence of Chronic Subdural Hematoma Using Preoperative Systemic Immune Inflammation Index and Eosinophils.Asian journal of neurosurgery · 2024Article
- Article
- Artificial cerebrospinal fluid use during burr-hole surgery and reoperation rate in patients with chronic subdural hematoma: an analysis using a nationwide inpatient database.Acta neurochirurgica · 2023Article
- Chronic Subdural Hematoma-Evolution of Etiology and Surgical Treatment.Neurologia medico-chirurgica · 2023Review
- Intraoperative irrigation of artificial cerebrospinal fluid and temperature of irrigation fluid for chronic subdural hematoma: a systematic review and meta-analysis.Frontiers in neurology · 2023Review
- Half-Saline Versus Normal-Saline as Irrigation Solutions in Burr Hole Craniostomy to Treat Chronic Subdural Hematomata: A Randomized Clinical Trial.Korean journal of neurotrauma · 2022Article
- Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses.EClinicalMedicine · 2022Article
- Intraoperative hematoma volume can predict chronic subdural hematoma recurrence.Surgical neurology international · 2021Article
- Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?Neurologia medico-chirurgica · 2017Review
- The Effect of Irrigation Solutions on Recurrence of Chronic Subdural Hematoma: A Consecutive Cohort Study of 234 Patients.Neurologia medico-chirurgica · 2017Article
- A New Modified Twist Drill Craniostomy Using a Novel Device to Evacuate Chronic Subdural Hematoma.Medicine · 2016Article
- Fibrin glue injection into the hematoma cavity for refractory chronic subdural hematoma: A case report.Surgical neurology international · 2016Article
- Recurrence Rate of Chronic Subdural Hematoma after Evacuating It by Two Large Burr Holes, Irrigation, and Subgaleal Low-Pressure Suction Drainage.Asian journal of neurosurgeryArticle
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChronic subdural hematoma (CSDH) is known to have a substantial recurrence rate. Artificial cerebrospinal fluid (ACF) is an effective irrigation solution in general open craniotomy and endoneurosurgery, but no evidence of its use in burr-hole surgery exists.
objectiveTo identify the potential of ACF irrigation to prevent CSDH recurrence. More specifically, to investigate the perioperative and intraoperative prognostic factors, and to identify controllable ones.
methodsTo examine various prognostic factors, 120 consecutive patients with unilateral CSDH treated with burr-hole drainage between September 2007 and March 2013 were analyzed. Intraoperative irrigation was performed with one of two irrigation solutions: normal saline (NS; n = 60) or ACF (n = 60). All patients were followed-up for at least 6 months postoperatively. We also examined the morphological alternations of the hematoma outer membranes after incubation with different solutions.
resultsEleven patients (9.2%) had recurrence. Nine patients (15%) required additional surgery in the NS group, whereas only 2 patients (3.3%) in the ACF group required additional surgery. Among preoperative and intraoperative data, age (<80 years old, P = .044), thrombocyte (>22.0, P = .037), laterality (right, P = .03), and irrigation solution (ACF, P = .027) were related to smaller recurrence rates by log-rank tests. Only the type of irrigation solution used significantly correlated with recurrence in favor of ACF in both Cox proportional hazards (relative hazard: 0.20, 95% confidence interval (CI): 0.04-0.99; P = .049) and logistic regression models (odds ratio, 0.17, 95% CI: 0.03-0.92; P = .04) using these factors. Histological examinations of the hematoma membranes showed that the membranes incubated with NS were loose and infiltrated by inflammatory cells compared with those incubated with ACF.
conclusionIrrigation with ACF decreased the rate of CSDH recurrence.
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