Subperiosteal Drain Insertion and Anchorage after Single Burr Hole Evacuation of Chronic Subdural Hematoma

Symptomatic chronic subdural hematoma is treated by surgical evacuation followed by drain insertion for post-operative drainage. There is no international consensus on the location of the drain (subdural or subperiosteal), the type of drainage (passive or active suction), or the duration of drainage (hours or days). However, a growing body of literature highlights the risk of iatrogenic brain injury during subdural drain insertion, causing increased interest in the subperiosteal drainage technique, which has been suggested to be equally effective. There is no consensus on the optimal subperiosteal drain insertion technique, resulting in numerous technical variations in the published literature. Additionally, drain anchoring is crucial to prevent the drain from displacing away from the burr hole. To address both issues, this article presents a standardized method for subperiosteal drain insertion and a novel anchorage technique for drains. All necessary drain entry-, exit-, and anchorage points are clearly defined and marked prior to placement of local anesthesia and skin incision. The stepwise insertion and anchorage of the drain are thoroughly described and illustrated, as well as the removal of the drain after post-operative drainage is complete.