Browse by author
Lookup NU author(s): Dr Paul Brennan
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2018 The Author(s) 2018. Published by Oxford University Press on behalf of Congress of Neurological Surgeons.Background: Drain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes. Objective: To examine whether this is influenced by variation in drain location, positioning or duration of placement. Methods: We performed a subgroup analysis of a previously reported multicenter, prospective cohort study of CSDH patients performed between May 2013 and January 2014. Data were analyzed relating drain location (subdural or subgaleal), position (through a frontal or parietal burr hole), and duration of insertion, to outcomes in patients aged >16 yr undergoing burr-hole drainage of primary CSDH. Primary outcomes comprised modified Rankin scale (MRS) at discharge and symptomatic recurrence requiring redrainage within 60 d. Results: A total of 577 patients were analyzed. The recurrence rate of 6.7% (12/160) in the frontal subdural drain group was comparable to 8.8% (30/343) in the parietal subdural drain group. Only 44/577 (7.6%) patients underwent subgaleal drain insertion. Recurrence rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups (P =. 95). We found no significant differences in discharge MRS between these groups. Recurrence rates were comparable between patients with postoperative drainage for 1 or 2 d, 6.4% and 8.4%, respectively (P =. 44). There was no significant difference in MRS scores between these 2 groups (P =. 56). CONCLUSION: Drain insertion after CSDH drainage is important, but position (subgaleal or subdural) and duration did not appear to influence recurrence rate or clinical outcomes. Similarly, drain location did not influence recurrence rate nor outcomes where both parietal and frontal burr holes were made. Further prospective cohort studies or randomized controlled trials could provide further clarification.
Author(s): Glancz LJ, Poon MTC, Coulter IC, Hutchinson PJ, Kolias AG, Brennan PM
Publication type: Article
Publication status: Published
Journal: Clinical Neurosurgery
Year: 2019
Volume: 85
Issue: 4
Pages: 486-493
Print publication date: 01/10/2019
Online publication date: 29/08/2018
Acceptance date: 14/07/2018
Date deposited: 28/10/2019
ISSN (print): 0148-396X
ISSN (electronic): 1524-4040
Publisher: Oxford University Press
URL: https://doi.org/10.1093/neuros/nyy366
DOI: 10.1093/neuros/nyy366
PubMed id: 30169738
Altmetrics provided by Altmetric
