Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study
BackgroundPrevious studies on the management of chronic subdural hematoma (cSDH) mainly focused on the risk of postoperative recurrence and measures to prevent it. In this study, we propose the use of a non-invasive postoperative treatment method, the modified Valsalva maneuver (MVM), as a means of...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.1069708/full |
| _version_ | 1828049559076470784 |
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| author | Lang Zeng Jiasheng Yu Rudong Chen Hongkuan Yang Hua Li Lingcheng Zeng Junhong Wang Weidong Xu Shengqi Hu Kun Chen |
| author_facet | Lang Zeng Jiasheng Yu Rudong Chen Hongkuan Yang Hua Li Lingcheng Zeng Junhong Wang Weidong Xu Shengqi Hu Kun Chen |
| author_sort | Lang Zeng |
| collection | DOAJ |
| description | BackgroundPrevious studies on the management of chronic subdural hematoma (cSDH) mainly focused on the risk of postoperative recurrence and measures to prevent it. In this study, we propose the use of a non-invasive postoperative treatment method, the modified Valsalva maneuver (MVM), as a means of reducing the recurrence of cSDH. This study aims to clarify the effects of MVM on functional outcomes and recurrence rates.MethodsA prospective study was conducted at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2016 to December 2020. The study included 285 adult patients who underwent burr-hole drainage for the treatment of cSDH and received subdural drains. These patients were divided into two groups: the MVM group (n = 117) and the control group (n = 98). In the MVM group, patients received treatment with a customized MVM device for at least 10 times per hour, 12 h per day. The study's primary endpoint was the recurrence rate of SDH, while functional outcomes and morbidity 3 months after surgery were the secondary outcomes.ResultsIn the current study, 9 out of 117 patients (7.7%) in the MVM group experienced a recurrence of SDH, while 19 out of 98 patients (19.4%, p < 0.05) in the HC group experienced a recurrence of SDH. Additionally, the infection rate of diseases such as pneumonia (1.7%) was significantly lower in the MVM group compared to the HC group (9.2%, p < 0.001, odds ratio (OR = 0.1). After 3 months of the surgery, 109 out of 117 patients (93.2%) in the MVM group achieved a favorable prognosis, compared to 80 out of 98 patients (81.6%) in the HC group (p = 0.008, with an OR of 2.9). Additionally, infection rate (with an OR of 0.2) and age (with an OR of 0.9) are independent predictors of a favorable prognosis at the follow-up stage.ConclusionsThe use of MVM in the postoperative management of cSDHs has been shown to be safe and effective, resulting in reduced rates of cSDH recurrence and infection following burr-hole drainage. These findings suggest that MVM treatment may lead to a more favorable prognosis at the follow-up stage. |
| first_indexed | 2024-04-10T19:11:31Z |
| format | Article |
| id | doaj.art-c7f7a32b0dde49aaada591b1a93ae8ab |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-10T19:11:31Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-c7f7a32b0dde49aaada591b1a93ae8ab2023-01-30T13:48:53ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-01-011310.3389/fneur.2022.10697081069708Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort studyLang ZengJiasheng YuRudong ChenHongkuan YangHua LiLingcheng ZengJunhong WangWeidong XuShengqi HuKun ChenBackgroundPrevious studies on the management of chronic subdural hematoma (cSDH) mainly focused on the risk of postoperative recurrence and measures to prevent it. In this study, we propose the use of a non-invasive postoperative treatment method, the modified Valsalva maneuver (MVM), as a means of reducing the recurrence of cSDH. This study aims to clarify the effects of MVM on functional outcomes and recurrence rates.MethodsA prospective study was conducted at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2016 to December 2020. The study included 285 adult patients who underwent burr-hole drainage for the treatment of cSDH and received subdural drains. These patients were divided into two groups: the MVM group (n = 117) and the control group (n = 98). In the MVM group, patients received treatment with a customized MVM device for at least 10 times per hour, 12 h per day. The study's primary endpoint was the recurrence rate of SDH, while functional outcomes and morbidity 3 months after surgery were the secondary outcomes.ResultsIn the current study, 9 out of 117 patients (7.7%) in the MVM group experienced a recurrence of SDH, while 19 out of 98 patients (19.4%, p < 0.05) in the HC group experienced a recurrence of SDH. Additionally, the infection rate of diseases such as pneumonia (1.7%) was significantly lower in the MVM group compared to the HC group (9.2%, p < 0.001, odds ratio (OR = 0.1). After 3 months of the surgery, 109 out of 117 patients (93.2%) in the MVM group achieved a favorable prognosis, compared to 80 out of 98 patients (81.6%) in the HC group (p = 0.008, with an OR of 2.9). Additionally, infection rate (with an OR of 0.2) and age (with an OR of 0.9) are independent predictors of a favorable prognosis at the follow-up stage.ConclusionsThe use of MVM in the postoperative management of cSDHs has been shown to be safe and effective, resulting in reduced rates of cSDH recurrence and infection following burr-hole drainage. These findings suggest that MVM treatment may lead to a more favorable prognosis at the follow-up stage.https://www.frontiersin.org/articles/10.3389/fneur.2022.1069708/fullchronic subdural hematoma (cSDH)modified Valsalva maneuver (MVM)recurrencepredictorsfavorable prognosis |
| spellingShingle | Lang Zeng Jiasheng Yu Rudong Chen Hongkuan Yang Hua Li Lingcheng Zeng Junhong Wang Weidong Xu Shengqi Hu Kun Chen Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study Frontiers in Neurology chronic subdural hematoma (cSDH) modified Valsalva maneuver (MVM) recurrence predictors favorable prognosis |
| title | Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study |
| title_full | Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study |
| title_fullStr | Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study |
| title_full_unstemmed | Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study |
| title_short | Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study |
| title_sort | modified valsalva maneuver after burr hole drainage of chronic subdural hematomas a single center cohort study |
| topic | chronic subdural hematoma (cSDH) modified Valsalva maneuver (MVM) recurrence predictors favorable prognosis |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.1069708/full |
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