Related Experiment Video
Updated: Mar 5, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma
Mathew R Guilfoyle1, Peter J A Hutchinson2, Thomas Santarius2
1Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. mathew.guilfoyle@addenbrookes.nhs.uk.
Insights
Subdural drains after chronic subdural hematoma surgery improve long-term survival compared to no drain, matching general population survival rates. This suggests drains should be standard practice for CSDH evacuation.
Area of Science:
- Neurosurgery
- Clinical Trials
- Patient Outcomes
Background:
- Chronic subdural hematoma (CSDH) is common and often treated with burrhole drainage.
- While effective, CSDH burrhole drainage has a significant reoperation rate.
- The Cambridge Chronic Subdural Haematoma Trial (CCSHT) previously showed benefits of subdural drains at 6 months.
Purpose of the Study:
- To examine the long-term survival of patients from the CCSHT.
- To compare the survival of CSDH patients treated with and without subdural drains.
- To assess if drain use impacts survival compared to the general population.
Main Methods:
- A randomized controlled trial comparing subdural drains versus no drains after burrhole evacuation for CSDH.
- Patient survival was tracked for a minimum of 8 years post-enrollment using the UK NHS tracing service.
- Survival data were compared between trial groups and against age- and sex-matched UK general population survival rates.
Main Results:
- At 5 years, the drain group had significantly better survival than the no-drain group (p=0.027).
- This difference was not significant at 10 years.
- Patients receiving drains had survival rates similar to the general population, while the no-drain group had significantly lower survival (p=0.0006).
Conclusions:
- Subdural drains following CSDH evacuation are associated with improved long-term survival.
- The survival benefit appears to align with general population expectations.
- Routine use of subdural drains for CSDH evacuation is recommended unless contraindicated.
Background:
Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial.
Methods:
In the original trial patients at a single neurosurgical centre from 2004-2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016-a minimum of 8 years following enrollment-via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex.
Results:
At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006).
Conclusion:
Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated.
Related Concept Videos
01:19Veins of Head and Neck
On the other hand, the vertebral veins, unlike their arterial counterparts, are not primarily responsible for brain drainage. Instead, they drain the cervical vertebrae, spinal cord, and some small...
01:22Aneurysm IV: Nursing Management
01:29Venous Thrombosis III: Interprofessional Care