The evacuation of a chronic subdural hematoma (cSDH) is one of the most common procedures in neurosurgery. The aim of this study was to assess the influence of drainage suction in the surgical treatment of cSDH on the recurrence rate. Post hoc analysis was conducted on two randomized controlled trials (cSDH-Drain-Trial and TOSCAN trial) stratifying a total of 581 patients into active or passive drain type. Of the 581 patients, 359 (61.8%) and 220 (37.9%) were stratified into the active and passive drainage groups, respectively. The reoperation rate following postoperative recurrence was 23.1% and 14.1% in the active and passive drainage groups, respectively (p < 0.011). After propensity score matching, the differences in recurrence rate remained significant (26.6% versus 15.6%, p = 0.012). However, the functional outcome (mRS) at 6–12 months did not differ significantly (median [IQR]) between the 2 groups (passive drainage group 0.00 [0.00, 2.00], active drainage group 1.00 [0.00, 2.00], p = 0.431). Mortality was comparable between the groups (passive drainage group 12 (5.5%), active drainage group 20 (5.6%), p = 0.968). In the univariate analysis, active drainage, short (<48 h) duration of drainage, and early (<48 h) postoperative mobilization were significantly associated with a higher recurrence rate. However, the multivariate logistic regression model could not confirm that any of these parameters were significantly associated with recurrence. Our post hoc analysis proposes that using a passive instead of an active drain might be associated with a reduced recurrence rate after evacuation of a cSDH. We suggest gathering further evidence by means of a randomized controlled trial.

Objective: During surgery on low-grade gliomas (LGG), reliable data relevant to the primary motor cortex (M1) for the face area are lacking. We analyzed the impact of tumor removal within the M1 face area on neurological deficits. Methods: We included LGG patients with resection within the M1 face area between May 2012 and November 2019. The primary endpoint was postoperative facial motor function. Secondary endpoints were postoperative aphasia, dysarthria, and dysphagia. Surgery was performed either with the awake protocol or under anesthesia with continuous dynamic mapping. The alarm criteria were speech arrest or a mapping threshold of 3 mA or less. Resection was completed in five patients. The resection was stopped due to the alarm criteria in three patients and for other reasons (vascular supply, patient performance) in four patients. A total of 66.7% (n = 8) presented with new-onset facial paresis (62.5% left LGG) and 41.7% (n = 5) with aphasia (all left LGG) postoperatively. After one year, all eight patients had recovered from the facial paresis. Tumor removal within the M1 face area was not associated with permanent facial motor deficits.

BACKGROUND AND OBJECTIVES: Patients with symptomatic Chiari malformation type 1 (CM-1) usually undergo either bone-only posterior fossa decompression (PFD) or a more invasive procedure involving dural expansion with or without tonsillar resection (PFD+). PFD+ may be more effective but it carries a higher risk of complications. Intraoperative ultrasound (iUS) may help determine whether PFD alone is sufficient, although specific criteria and its role in surgical decision making are not yet defined. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, using search terms related to iUS, intraoperative sonography, and CM-1. Extracted data included demographics, surgical methods, iUS criteria, and outcomes. Conversion rates and the positive predictive values (PPVs) were calculated to quantify iUS effectiveness. Conversion rate was defined as the proportion of cases requiring secondary PFD+ after initial PFD. PPV was based on the number of successful PFDs relative to all initial PFDs. Risk of bias was evaluated using the Newcastle-Ottawa scale. RESULTS: From 202 initial articles, 1 prospective and 8 retrospective studies were included, covering 844 pediatric and adult patients. According to the Newcastle-Ottawa scale, 1 study had a low, 3 moderate, and 5 high risk of bias. To assess decompression sufficiency, 8 studies used qualitative iUS criteria, whereas 1 used quantitative thresholds. Follow-up time ranged from 1 to 48 months, with varied outcome measures. Conversion rates ranged from 0% to 16% and PPV from 0.857 to 1.000, depending on the study. Conversion surgery rates were comparable with reoperation rates reported from studies without iUS. CONCLUSION: The available evidence does not yet support iUS as a robust testing method to inform intraoperative decision making regarding the extent of decompression, due to the heterogeneity of its application, and the absence of standardized assessment criteria. We propose a reporting framework incorporating all currently reported criteria to induce standardization and guide further research.