Introduction: Burr-hole drainage(BHD) of CSDH remains one of the commonest neurosurgical procedures performed worldwide. The recurrence rates range from 5%-34%. Many recent studies have concluded that use of subdural drain reduces the recurrence rates. Various types of drains have been used-closed system subdural drains, subdural evacuating port systems and others. All of these incur an extra cost apart from the operative costs that might be significant in developing countries like ours. We report our results utilizing subdural surgical glove drain after BHD for CSDH in terms of recurrence rates and outcome.

Methods: A 2-year retrospective analysis of patients operated for CSDH. After BHD and hematoma evacuation, saline irrigation was given and subdural surgical glove drain was placed and exited 5cm from incision. Drain was removed after 24 hours and patients were mobilized from POD2. The functional outcome and recurrence rates were analysed.

Results: A total of 130 cases were operated during study period. The mean age was 67.2 years(range 35-86 years). There were 66 elderly(>65yrs) cases. Twenty six(18%) had coagulation abnormalities. There were 103 unilateral and 27 bilateral lesions. Morphology of the hematoma was as follows: subacute(n-69), chronic(n-61). Seven cases had recurrences. Of these, 4 were of bilateral and 3 were unilateral (with inhomogeneous hematomas and internal septations). Re-do BHD was done in 4 cases, while 1 case underwent craniotomy and membranectomy. Thus, recurrence rate was 5.3%. The foreign-body infection rate was 0% and there was 1 death. The mean follow-up was 9.2 months(range 2-24 months). Good to excellent outcomes were noted in 95% cases.

Conclusions: This novel technique, with its recurrence rates comparable to or lower than the world literature, at no extra cost might reduce the overall health costs to a significant extent, given the frequency of such operations performed worldwide. We recommend this technique, atleast in developing countries like ours

Patient Care: As per the results, the recurrence rates were only 5.3% which is lower than most series reporting on CSDH and the foreign-body infection rate was 0%. Also, it is now known that use of a drain reduce the recurrence rates. None of the reports have mention of a glove drain for this purpose. With the frequency and number of CSDH drainage being performed every year across the globe, the application of this simple technique may reduce the costs of this procedure which might prove significant, at least in developing countries.

Learning Objectives: By the conclusion of this session, participants would be able to 1) Describe the importance of a surgical glove drain in BHD after CSDH in terms of recurrence rates and outcome 2) Discuss the recurrence factors for CSDH

References: 1) Alcala-Cerra G, Young AM, Moscote-Salazar LR, Paternina-Caicedo A. Efficacy and safety of subdural drains after burr-hole evacuation of chronic subdural hematomas: systematic review and meta-analysis of randomized controlled trials. World Neurosurgery 2014; 82(6): 1148-1157. 2) Rughani AI, Lin C, Dumont TM, Penar PL, Horgan MA, Tranmer BI. A case comparison study of the subdural evacuating port system in treating chronic subdural hematomas. J Neurosurg 2010;113:609-14 3) Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systemic review and meta-analysis of surgical procedure. J Neurosurg 2014;121:665-73