Scalp depression following surgical evacuation of chronic subdural hematomas: a retrospective study comparing between patients with and without Osteoplug polycaprolactone implants as burr-hole cover in Phramongkutklao Hospital

Abstract

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition closely associated with elderly patients. Burr hole trepanation is one of the commonly used surgical interventions for patients with cSDH. At the moment, majority of neurosurgeons do not perceive a need for burr hole covers. On the contrary, a significant population of patients have expressed concern over the lack of burr hole covers. Recently, there have been made aware of Osteoplug, biodegradable polycaprolactone implant and have properties of osteoconduction.Objective: A retrospective comparison scalp depression and tissue volume loss after burr hole trepanation between Osteoplug and No Osteoplug group in Phramongkutklao Hospital. Methodology: Through a review of patient with cSDH registry, patients’ charts, operative notes and CT or MRI findings were reviewed retrospectively between 1 January 2019 and 30 June 2021. CT or MRI scans preoperative and at least 3 months postoperatively were used as imaging tools for measure the extent of scalp depression by Brainlab between two groups. Result: A total 77 patients were enrolled, Osteoplug polycaprolactone implants 12 patients and No Osteoplug polycaprolactone implants 65 patients. No Osteoplug group, there were scalp depression 4.31 ± 1.66 mm and volume loss 1.1 ± 0.58 cm³. Osteoplug group, there were scalp depression 1.02 ± 0.4 mm and volume loss 0.18 ± 0.15 cm³. The Osteoplug group have less scalp depression and volume loss than No Osteoplug group significantly (P<0.001). Conclusions: The Osteoplug polycaprolactone implants is able to significantly minimize scalp depression and reduce tissue volume loss compared to the No Osteoplug group.