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Updated: May 29, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Optimal drain position after evacuation of chronic subdural hematomas: a systematic review and network meta-analysis
Ningyu Wei1, Hongyu Lu2, Yuan Cheng1
1Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, Chongqing, China.
Insights
Subgaleal drain placement (SGD) significantly reduces chronic subdural hematoma (CSDH) recurrence. Subgaleal active drainage (SGD_a) and subdural irrigation drainage (SDD_irr) show promise for recurrence and mortality, respectively, in CSDH management.
Area of Science:
- Neurosurgery
- Medical Technology
- Evidence-Based Medicine
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition.
- Burr-hole hematoma drainage is the standard treatment for CSDH.
- The study evaluates drain placement in subdural (SDD), subperiosteal (SPD), and subgaleal (SGD) locations.
Purpose of the Study:
- To assess the impact of drain placement in different anatomical locations on CSDH treatment outcomes.
- To compare the efficacy of subdural drain (SDD), subperiosteal drain (SPD), and subgaleal drain (SGD) in managing CSDH.
- To identify optimal drain placement strategies for reducing CSDH recurrence and mortality.
Main Methods:
- Systematic review and network meta-analysis (NMA) of 14 studies with 4,161 patients.
- Searched PubMed, Embase, Cochrane Library, and Web of Science.
- Analyzed outcomes using two classification systems: anatomical location and anatomical location + technique.
Main Results:
- Subgaleal drain (SGD) placement was associated with a significantly lower recurrence rate compared to no drain (RR=0.43).
- Subgaleal active drainage (SGD_a) showed the highest ranking for reducing recurrence (SUCRA=79.83%).
- Subdural irrigation drainage (SDD_irr) demonstrated the best efficacy in reducing mortality (SUCRA=63.85%).
Conclusions:
- Subgaleal active drainage (SGD_a) and subdural irrigation drainage (SDD_irr) show potential for reducing recurrence and mortality in CSDH.
- Careful patient selection is crucial due to physiological conditions and disease features.
- Further research is needed to clarify the efficacy of these treatment modalities.
Background:
Chronic subdural hematoma (CSDH) is one of the most prevalent diseases encountered in neurosurgery. At present, burr-hole hematoma drainage has been established as the standard surgical intervention for CSDH, effectively reducing the risk of postoperative recurrence. The current study employed systematic review and network meta-analysis (NMA) to assess the impact of drain placement in three different anatomical locations-subdural drain (SDD), subperiosteal drain (SPD), and subgaleal drain (SGD)-on treatment outcomes.
Methods:
A search was conducted across PubMed, Embase, Cochrane Library, and Web of Science up to February 14, 2026. The Newcastle-Ottawa Scale was used to assess the risk of bias. R (v4.4.0) and Stata18 were used for the NMA.
Results:
This NMA included 14 articles comprising 4,161 patients. The drainage locations evaluated were SDD, SPD, and SGD. Pooled results were analyzed based on two classification systems: Classification I (anatomical location) and Classification II (anatomical location + technique). (1) Recurrence rate: Classification I: According to the league table, SGD was associated with a significantly lower recurrence rate versus No_drain [risk ratio (RR) = 0.43, 95% credible interval (CrI): 0.20-0.96]. Based on the surface under the cumulative ranking curve (SUCRA), SGD (78.25%) ranked as the best intervention. Classification II: According to the league table, subgaleal active drainage (SGD_a) was significantly associated with recurrence versus No_drain (RR = 0.26, 95% CrI: 0.10-0.75), and also ranked highest in SUCRA (79.83%). (2) Mortality: Classification I: SGD was associated with reduced mortality (SUCRA = 72.64%). Classification II: subdural irrigation drainage (SDD_irr) showed the best efficacy in reducing mortality (SUCRA = 63.85%).
Conclusion:
SGD_a and SDD_irr exhibit significant potential in reducing recurrence rates and mortality, respectively, in the management of CSDH. However, due to the physiological conditions and disease features of old and high-risk populations, careful assessment is necessary when selecting treatment approaches in clinical practice. Further studies should be conducted to clarify the actual efficacy of these two treatment modalities.
Systematic Review Registration:
This study is a systematic review and network meta-analysis and has been registered in the PROSPERO database. Registration ID: CRD42024587692. Official URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=587692.