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Butterfly needle tap and suction (BTS) technique: a treatment for recurrent chronic subdural hematoma after burr hole craniostomy

Yamamoto, Shun Nagashima, Yoshitaka Maki, Hideki Nishimura, Yusuke Araki, Yoshio Nishihori, Masahiro Noda, Tomoyuki Imai, Tasuku Kawabata, Teppei Ueno, Masahiro Nishida, Yasumasa Saito, Ryuta 名古屋大学

2023.04

概要

Chronic subdural hematoma (CSDH) is a common neurological condition particularly
in elderly patients. The incidence of CSDH has been increasing with an aging population
worldwide [1]. CSDH is a public health problem with an estimated 1-year incidence of
5−58/100,000 cases [2]. The treatment methods were determined according to the patient’s
neurological symptoms and clinical conditions. Although surgery continues to play an
important role in treatment, the surgical procedure and management of CSDH remain
controversial. Several surgical techniques are available for CSDH, including burr hole
craniostomy (BHC), twist drill craniostomy (TDC), and craniotomy. Previous studies have
established BHC with closed-system drainage or irrigation as the most common standard
treatment [3-6].
Regardless of the selection of these surgical procedures, CSDH has a considerable
recurrence rate ranging from approximately 10% to 20% [7-12]. This considerably high rate is
particularly problematic in an aging society with greater comorbidities, where less-invasive
procedures are expected to be of greater importance because of these comorbid medical
conditions [1, 10]. Nevertheless, the available literature concerning the management of
recurrent CSDH is relatively scarce compared with its of first-time onset.
Some patients may exhibit the resolution of residual hematoma after the initial
surgery, yet for those with severe neurological symptoms, reoperation and readmission may
be indicated. For the patients with mild neurological symptoms, we performed a percutaneous
puncture technique, called the butterfly needle tap and suction (BTS) technique, which
involves a percutaneous puncture through the burr hole created during the previous operation,
and subsequently draining the hematoma with a butterfly needle. This procedure can be
performed in an outpatient clinic without admission and it is much less invasive than
reoperation. The aim of this study was to establish a less invasive treatment for recurrent
chronic subdural hematoma by providing a comprehensive description of the BTS technique
and examining its safety and efficacy. ...

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参考文献

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