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Use of subdural drain for chronic subdural haematoma? A 4-year multi-centre observational study of 302 cases
David Yuen Chung Chan1, Peter Yat Ming Woo2, Calvin Hoi Kwan Mak3
1Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Insights
Subdural drains significantly reduce chronic subdural hematoma (CSDH) recurrence after burr-hole drainage. This neurosurgical intervention showed a lower recurrence rate without increasing complications, offering a safer treatment option for aging patients.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Medical Technology
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, particularly in the aging population.
- Subdural drains are suggested to lower CSDH recurrence but face surgeon skepticism due to potential complications.
Purpose of the Study:
- To evaluate the impact of subdural drain placement on CSDH recurrence rates.
- To assess the safety and complication profile associated with subdural drain use in CSDH management.
Main Methods:
- A multicenter observational study involving 302 patients undergoing burr-hole drainage for CSDH.
- Prospective data collection and retrospective analysis from January 2008 to December 2011 across three Hong Kong hospitals.
- Primary outcome: symptomatic recurrence requiring re-operation; secondary outcomes: modified Rankin Scale (mRS), morbidity, and mortality at six months.
Main Results:
- The recurrence rate was significantly lower in the subdural drain group (8.72%) compared to the no-drain group (16.3%).
- No significant differences were observed in local wound infection, subdural empyema, acute subdural hematoma, or other complications between the groups.
- Six-month mRS, 30-day mortality, and six-month mortality were comparable across both treatment arms.
Conclusions:
- Subdural drain placement is an effective neurosurgical technique for reducing CSDH recurrence.
- The use of subdural drains in CSDH management does not significantly increase the risk of complications, offering a favorable safety profile.
Abstract:
Chronic subdural haematoma (CSDH) is a common neurosurgical condition and is more prevalent in the ageing population. Studies have suggested that placement of subdural drains after burr-hole drainage was associated with lower recurrence rates. However, a considerable proportion of surgeons remained unconvinced of the effectiveness of drain placement and concerns exist with the potential complications this additional manoeuvre entails such as infection or bleeding. The aim of the present study is to evaluate the impact of subdural drain on CSDH recurrence and its safety. This is a multicentre observational study. Data of consecutive patients with burr-hole drainage performed for CSDH in three hospitals in Hong Kong during a four-year period from January 2008 to December 2011 were prospectively collected and retrospectively analysed. The primary outcome was symptomatic recurrence requiring re-operation. Secondary outcomes included the modified Rankin scales (mRS), morbidity and mortality at six months. A total of 302 patients were identified. The recurrence rate was 8.72% (13/149) with drain placement versus 16.3% (25/153) with no drain (Odds Ratio=0.489, 95%CI 0.240-0.998; p=0.0463). Local wound infection, subdural empyema, acute subdural haematoma and other complications had no significant difference. Six-month mRS, 30-day mortality and six-month mortality were comparable in both groups. In conclusion, the use of subdural drain significantly reduced recurrence with no significant increase in complications.
