Use of Active Low Suction Pressure (Subgaleal) Drains in Chronic Subdural Hematoma Surgery

Subdural drains are used to reduce recurrence after surgical evacuation of chronic subdural hematoma. There is a small risk of parenchymal injury. We hypothesize that using subgaleal drains with low active suction (-50 mm Hg to -100 mm Hg) may be a safer alternative and still maintain efficacy in preventing recurrence.

A retrospective review of adult patients who underwent surgical drainage of chronic subdural hematoma at our institution was performed. They were classified into 2 groups: a subdural group and a subgaleal group. We collected data on patient demographics, preoperative use of antiplatelets or anticoagulants, the type of drains used, laterality of burr-hole surgery performed and postoperative complications, and recurrence. Descriptive statistics and regression analyses were used to analyze the data.

322 patients recruited, 172 received subgaleal drains with low active suction and 150 received passive subdural drains. There was no significant difference in the rate of recurrence; there was 11. % recurrence in the subgaleal drain group and 9.3% recurrence in the subdural drain group (P = 0.660). Patients who underwent active subgaleal drain insertion had significantly fewer complications, at 2.3% compared with 8.0% in patients who had passive subdural drains (P = 0.037).

The use of subgaleal drains with low active suction led to significantly lower complication rates compared with the use of subdural drains and maintained its efficacy in preventing recurrence.