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This randomized controlled trial compared burr-hole surgery with and without intraoperative irrigation in patients undergoing initial surgery for chronic subdural hematoma. Postoperative subdural drainage was used in both groups. Of 242 randomized patients, 231 completed three-month follow-up. Recurrence requiring reoperation occurred in 21 of 114 patients (18.4%) in the irrigation group and 12 of 128 patients (9.4%) in the no-irrigation group. The adjusted risk difference favored the no-irrigation group (−9.4%; 95% CI, −18.5 to −0.4; P = 0.02). Functional outcomes and complication rates did not differ significantly between groups. In exploratory analyses, each 10-mL increase in postoperative pneumocephalus volume was associated with higher odds of recurrence (OR, 1.31; 95% CI, 1.10–1.56; P = 0.003). Conclusion: In this study, omitting intraoperative irrigation was associated with fewer reoperations for recurrence, while postoperative pneumocephalus was associated with recurrence risk. These findings challenge the assumption that irrigation is always beneficial, but should be interpreted in the context of the trial setting and replicated in other populations.
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This randomized controlled trial compared burr-hole surgery with and without intraoperative irrigation in patients undergoing initial surgery for chronic subdural hematoma. Postoperative subdural drainage was used in both groups. Of 242 randomized patients, 231 completed three-month follow-up. Recurrence requiring reoperation occurred in 21 of 114 patients (18.4%) in the irrigation group and 12 of 128 patients (9.4%) in the no-irrigation group. The adjusted risk difference favored the no-irrigation group (−9.4%; 95% CI, −18.5 to −0.4; P = 0.02). Functional outcomes and complication rates did not differ significantly between groups. In exploratory analyses, each 10-mL increase in postoperative pneumocephalus volume was associated with higher odds of recurrence (OR, 1.31; 95% CI, 1.10–1.56; P = 0.003). Conclusion: In this study, omitting intraoperative irrigation was associated with fewer reoperations for recurrence, while postoperative pneumocephalus was associated with recurrence risk. These findings challenge the assumption that irrigation is always beneficial, but should be interpreted in the context of the trial setting and replicated in other populations.
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