Burr hole evacuation of chronic subdural haematomas followed by continuousinflow and outflow irrigation

Chronic subdural haematomas are prone to recollect, increasing the risk of further complications and death. Burr hole evacuation followed by continuou s irrigation of a Ringer solution into the remaining subdural cavity, allow s remaining blood to be washed out and the brain to re-expand. This technique was compared with burr hole evacuation either without or wit h a passive drainage and craniotomy, respectively, Reformation of haematomas after continuous irrigation occurred in 2,6% (2/7 7); more than a twelve (32,6%; 15/46) and a nine (23,8%; 5/21) times rate r eduction compared to burr hole evacuation without and with passive drainage , respectively. Compared to the craniotomy results, the rate dropped sevent een times (44,4%; 4/9). Expect from the two rebleedings in 77 haematomas operated on through burr h oles followed by irrigation, all patients recovered including nine recurren t haematomas re-operated on by this method. Recurrent haematomas operated on through burr hole evacuation alone or with insertion of a passive drainage, recollected in 50% (2/4) and 33,3% (2/6). Similar rate after craniotomies was 11,1%(1/9). Neither infections nor deaths followed burr hole evacuation combined with c ontinuous irrigation, whereas 5,3% (2/38) and 5,9% (1/17) suffered from emp yema after burr hole evacuation alone or combined with a passive drainage, respectively. Five (9,1%) of these 55 patients died either from empyemas (t hree) or rebleedings (two). Recurrent haematomas evacuated through a craniotomy had no complications fr om infections. Compared to other methods, continuous irrigation reduces the need for re-op eration significantly by preventing haematoma recurrence and empyema format ion. Contrary to other surgical techniques, haematoma recurrence after seco nd time surgery did not occur.