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Background Cerebrospinal fluid (CSF) leak following endoscopic third ventriculostomy (ETV), or other neuroendoscopic surgeries, is a common complication (1.8-4.4%), carrying meningitis risk.1,4 Post-ETV subdural collection can also occur (<1%).1 The contributing factors include the short iatrogenic tract connecting the subarachnoid space and ventricle, sustained post-operative raised intracranial pressure and non-watertight dural closure.2 Many surgeons plug the tract with a haemostatic agent. [...]this does not address the incomplete dural closure and risk of plug migration into the ventricle, obstructing the newly-formed ventriculostomy.3 We describe a technique currently used at Birmingham Children’s Hospital, UK, which is a modification of a technique used at Hospital for Sick Children, Toronto, on over 100 cases. Figure 1 a) A gelatin sponge (eg SPONGOSTAN™, Johnson & Johnson™, Soeborg, Denmark) is cut into a ‘T’ shape, with the top horizontal bar cut into a semi-circular shape. b) The vertical component is compressed into a ‘stalk’. c) The top part is cut in the middle of its thickness, turning the sponge into a ‘mushroom’. d) The ‘mushroom stalk’ is inserted into the tract immediately after the removal of the endoscope.

BackgroundChronic subdural hematoma (CSDH) is a common neurological condition; surgical evacuation is the mainstay of treatment for symptomatic patients. No clear evidence exists regarding the impact of timing of surgery on outcomes. We investigated factors influencing time to surgery and its impact on outcomes of interest.MethodsPatients with CSDH who underwent burr-hole craniostomy were included. This is a subset of data from a prospective observational study conducted in the UK. Logistic mixed modelling was performed to examine the factors influencing time to surgery. The impact of time to surgery on discharge modified Rankin Scale (mRS), complications, recurrence, length of stay and survival was investigated with multivariable logistic regression analysis.Results656 patients were included. Time to surgery ranged from 0 to 44 days (median 1, IQR 1–3). Older age, more favorable mRS on admission, high preoperative Glasgow Coma Scale score, use of antiplatelet medications, comorbidities and bilateral hematomas were associated with increased time to surgery. Time to surgery showed a significant positive association with length of stay; it was not associated with outcome, complication rate, reoperation rate, or survival on multivariable analysis. There was a trend for patients with time to surgery of ≥7 days to have lower odds of favorable outcome at discharge (p=0.061).ConclusionsThis study provides evidence that time to surgery does not substantially impact on outcomes following CSDH. However, increasing time to surgery is associated with increasing length of stay. These results should not encourage delaying operations for patients when they are clinically indicated.