The Effect of Irrigation Solutions on Recurrence of Chronic Subdural Hematoma: A Consecutive Cohort Study of 234 Patients

Chronic subdural hematomas (CSDHs) occur often in elderly persons and can occur with mild head trauma. With burr-hole irrigation as standard treatment, symptoms usually improve and can be cured, and outcomes are good, but postoperative recurrences are a common problem. This study investigated the effectiveness and recurrence rates when using artificial cerebrospinal fluid (ACF) instead of normal saline (NS) as an irrigation solution for burr-hole irrigation in patients with CSDH. This prospective study included 234 consecutive patients who underwent initial surgical treatment by burr-hole irrigation for a CSDH between April 2008 and June 2015. The irrigation solution used was changed from NS to ACF in June 2011. Factors examined with regard to recurrence included age, sex, unilateral or bilateral surgery, computed tomography (CT) findings, antiplatelet or anticoagulant drug use, past history, and irrigation solution (NS or ACF). These were analyzed by univariate and multivariate analyses. Univariate analyses (chi-square test) with a significance level <5% showed that recurrence rates were significantly lower in the ACF group than in the NS group (P = 0.003). Multivariate analysis (multiple logistic regression analysis) showed that the risk of recurrence was reduced 3.14-fold in the ACF group compared to the NS group (odds ratio, 3.143; 95% confidence interval, 0.1504-0.6733; P = 0.0028). None of the other factors were significantly different. In burr-hole irrigation for CSDH, the use of ACF instead of NS as an irrigation solution significantly reduces recurrence rates.