Chronic subdural hematomas: to drain or not to drain?

Area of Science:

• Neurosurgery
• Neurology

Background:

• Chronic subdural hematoma (CSH) is a common neurosurgical condition.
• Treatment typically involves surgical evacuation.

Purpose of the Study:

• To compare the efficacy of burr hole evacuation with and without subdural drainage for CSH.
• To assess postoperative resolution of collections and clinical improvement.

Main Methods:

• A consecutive series of 21 adult patients with CSH underwent burr hole evacuation without drainage.
• This group was compared to a historical series treated with drainage.
• Identical treatment and follow-up protocols were used.

Main Results:

• Both groups showed similar time-related neurological improvement and resolution of subdural collections.
• The drained group universally showed progressive clinical improvement within 24 hours postoperatively, unlike the undrained group.
• Early postoperative clinical deterioration was not observed in all undrained cases.

Conclusions:

• Burr hole craniostomy with closed system drainage is advisable to prevent early postoperative clinical deterioration.
• Subdural drainage may not be necessary if technically difficult, such as with significant perioperative cortical expansion.