Introduction: The usage of drain following evacuation of chronic subdural hematoma (CSDH) is well known to reduce the recurrence of hematoma. In this study we aim to compare the clinical outcomes and recurrence rate of utilizing two different types of drains (sub periosteal and subdural drain) following drainage of CSDH.
Methods: Prospective randomized single center study analyzing 50 patients who underwent treatment of CSDH. Two types of drain, sub periosteal and subdural, was utilized on consecutive alternate patients following burr-hole craniostomy, with a total of 25 patients in each group. The drains were left in for duration of 48 hours and then removed. Modified Rankin Scale (mRS) was used for outcome measurement at 3 months and 6 months were analyzed with recurrence of the CSDH.
Results: Data analysis was performed by unpaired t test with Welch’s correction. It was observed that none of the patient in either group had recurrence of hematoma on a 6-month follow-up and no significant difference was noted in the p values on statistical analysis. Postoperative seizure and inadvertent placement of the subdural drain into brain parenchyma were the two complications noted in this study. Anticoagulation prior to the surgery did not affect the outcome in both the groups.
Conclusions: We conclude there was no recurrence of the CSDH in the utility of subdural and subperiosteal drains following burr hole craniostomy. The mRS measurement at 3 and 6 months were found to be the same in each group. Subperiosteal drain may prove to be beneficial in comparison to subdural drain in reducing the operative morbidity.
Patient Care: By utilizing the different type of drain for 48 hours following drainage of CSDH it appears that the morbidity and associated mortality associated with recurrence of hematoma is reduced
Learning Objectives: By the conclusion of this session, the participants will be able to understand the importance and option of utility of two types of drains following evacuation of CSDH along with their clinical outcome.
References: Santarius T, Kirkpatrick PJ, Ganesan D, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009; 374: 1067-1073.