Volume 83, Issue 10 (January 2025)
Tehran Univ Med J. 2025, 83(10): 714-720 |
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Kamalifar S, Jafari S. Comparison of the outcomes of acute cerebral subdural hematoma drainage using multidural stabs versus dural flap: a double-blind randomized clinical trial. Tehran Univ Med J. 2025; 83 (10) :714-720
URL: http://tumj.tums.ac.ir/article-1-13882-en.html
URL: http://tumj.tums.ac.ir/article-1-13882-en.html
1- Department of Neurosurgery, Clinical Research Development Unit, Valiasr Hospital, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.
Abstract: (21 Views)
Background: Traumatic brain injury is one of the most important causes of acute subdural hematoma that requires immediate surgical intervention. The choice of surgical technique can affect the clinical outcomes of patients. The aim of the present study was to compare the clinical outcomes and complications of the multidural slit and dural flap methods in the evacuation of acute subdural hematoma.
Methods: This study was a randomized, double-blind clinical trial conducted on 94 patients with acute subdural hematoma in Valiasr Hospital, Arak (from April to August 2024). Patients were divided into two equal groups: dural flap (n=47) and multidural slit (n=47) by block randomization. The primary outcome was the Glasgow Outcome Scale at three to six months after surgery. Secondary outcomes included intraoperative bleeding, surgical duration, incidence of complications (fungal hernia and CSF leak), and the Glasgow Coma Scale 24 hours after surgery. Data analysis was performed using SPSS statistical software, version 26. The comparison of qualitative variables was done using the chi-square test, and quantitative variables with heterogeneous distribution were compared using the Mann-Whitney U test and the Wilcoxon rank-sum test. The significance level in all tests was considered to be 0.05.
Results: The mean age of patients in the dural flap group was 33.97±5.71 years and in the multidural slit group was 33.78±35.14 years (P=0.411). Fungal herniation occurred in 15 patients (31.9%) in the dural flap group, while none was observed in the multidural slit group (P<0.001). CSF leak occurred in 12 patients (25.5%) in the dural flap group and three patients (6.4%) in the multidural slit group (P=0.022).
Conclusion: Both multidural slit and dural flap techniques can be used in the drainage of acute subdural hematoma. The multidural slit technique was associated with a significant reduction in intraoperative bleeding, complete prevention of fungal hernia, and greater improvement in GCS and GOS.
Methods: This study was a randomized, double-blind clinical trial conducted on 94 patients with acute subdural hematoma in Valiasr Hospital, Arak (from April to August 2024). Patients were divided into two equal groups: dural flap (n=47) and multidural slit (n=47) by block randomization. The primary outcome was the Glasgow Outcome Scale at three to six months after surgery. Secondary outcomes included intraoperative bleeding, surgical duration, incidence of complications (fungal hernia and CSF leak), and the Glasgow Coma Scale 24 hours after surgery. Data analysis was performed using SPSS statistical software, version 26. The comparison of qualitative variables was done using the chi-square test, and quantitative variables with heterogeneous distribution were compared using the Mann-Whitney U test and the Wilcoxon rank-sum test. The significance level in all tests was considered to be 0.05.
Results: The mean age of patients in the dural flap group was 33.97±5.71 years and in the multidural slit group was 33.78±35.14 years (P=0.411). Fungal herniation occurred in 15 patients (31.9%) in the dural flap group, while none was observed in the multidural slit group (P<0.001). CSF leak occurred in 12 patients (25.5%) in the dural flap group and three patients (6.4%) in the multidural slit group (P=0.022).
Conclusion: Both multidural slit and dural flap techniques can be used in the drainage of acute subdural hematoma. The multidural slit technique was associated with a significant reduction in intraoperative bleeding, complete prevention of fungal hernia, and greater improvement in GCS and GOS.
Type of Study: Original Article |
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