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A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma

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Abstract

Background

The usage of a drain following evacuation of a chronic subdural haematoma (CSDH) is known to reduce recurrence. In this study we aim to compare the clinical outcomes and recurrence rate of utilising two different types of drains (subperiosteal and subdural drain) following drainage of a CSDH.

Methods

Prospective randomised single-centre study analysing 50 patients who underwent CSDH treatment. Two types of drains, subperiosteal (SPD) and subdural (SDD), were utilised on consecutive alternate patients following burr-hole craniostomy, with a total of 25 patients in each group. The drains were left in for 48-h duration and then removed. The modified Rankin Scale (mRS) was used for outcome measurement at 3 and 6 months.

Results

Data analysis was performed by unpaired t test with Welch’s correction. It was observed that none of the patients in either group had haematoma recurrence during a 6-month follow-up, and a significant difference in outcome was noted at 6 months (p = 0.0118) more than at 3 months (p = 0.0493) according to the statistical analysis. Postoperative seizure and inadvertent placement of the subdural drain into the brain parenchyma were the two complications noted in this study. Anticoagulant use prior to the surgery did not affect the outcome in either group.

Conclusions

We conclude there was no recurrence of CSDH utilising the SDD and SPD following burr-hole craniostomy. The mRS measurement at the 6-month follow-up was found to be statistically significant, with better outcomes with utilisation of the SPD. The SPD may thus prove to be more beneficial than the SDD in the treatment of CSDH. A multi-centre study with a larger group of patients is recommended to reinforce the results from our study.

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References

  1. Adhiyaman V, Asghar M, Ganeshram K, Bhowmick B (2002) Chronic subdural haematoma in the elderly. Postgrad Med J 78:71–75

    Article  PubMed  CAS  Google Scholar 

  2. Baechli H, Nordmann A, Bucher H, Gratzl O (2004) Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 27:263–266

    Article  PubMed  CAS  Google Scholar 

  3. Bellut D, Woernle CM, Burkhardt JK, Kochro RA, Bertalnffy KN (2011) Subdural drainage versus subperiostal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas. World Neurosurg 77:111–118

    Article  PubMed  Google Scholar 

  4. Chen J, Levy M (2000) Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 11:399–406

    PubMed  CAS  Google Scholar 

  5. Cenic A, Bhandari M, Reddy K (2005) Management of chronic subdural hematoma: a national survey and literature review. Can J Neurol Sci 32:501–506

    PubMed  Google Scholar 

  6. Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez-Rumbo R (2005) Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 107:223–229

    Article  PubMed  Google Scholar 

  7. Gazzeri R, Galarza M, Neroni M, Canova A, Refice GM, Esposito S (2007) Continuous subgaleal suction drainage for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 149:487–493, discussion 493

    Article  CAS  Google Scholar 

  8. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: A practical scale. Lancet 305:480–484

    Article  Google Scholar 

  9. Luxon LM, Harrison M (1979) Chronic subdural haematoma. QJM 189:43–53

    Google Scholar 

  10. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374:1067–1073

    Article  PubMed  Google Scholar 

  11. Santarius T, Hutchinson PJ (2004) Chronic subdural haematoma: time to rationalize treatment? Br J Neurosurg 18:328–332

    Article  PubMed  CAS  Google Scholar 

  12. Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ (2008) The management of primary chronic subdural haematoma: a questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg 22:529–534

    Article  PubMed  CAS  Google Scholar 

  13. Weigl R, Schmiedek P, Krauss J (2003) Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:937–943

    Article  Google Scholar 

  14. Zumofen D, Regli L, Levivier M, Krayenbuhl N (2009) Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system. Neurosurgery 64:1116–1121, discussion 1121–2

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Dr ArunKumar, HS, Research Scientist, UCC, Cork, Republic of Ireland, for statistical analysis. We are indebted to all the patients who played a key role in this study. We are grateful to the general practitioners and nursing Home staff for the postoperative care along with the neurosurgical staff of Cork University Hospital, Cork.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Cork University Hospital, Cork, Republic of Ireland

    Chandrasekaran Kaliaperumal, Ayman Khalil, Eoin Fenton, Uchenna Okafo, George Kaar, Michael O’Sullivan & Charles Marks

Authors
  1. Chandrasekaran Kaliaperumal
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  2. Ayman Khalil
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  3. Eoin Fenton
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  4. Uchenna Okafo
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  5. George Kaar
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  6. Michael O’Sullivan
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  7. Charles Marks
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Corresponding author

Correspondence to Chandrasekaran Kaliaperumal.

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Comment

Even if very common in neurosurgical practice, the surgical management of chronic subdural hematomas (CSDH) is still controversial. Different neurosurgical centers use different surgical techniques, in many cases with comparable results. In many institutions the theoretical risk of cortical damage or injury of a bridging vein represents a hindrance to the extensive use of subdural drainages in CSDH. A randomized study in 2009 [Lancet. 2009 Sep 26;374(9695):1067–73] stated that the insertion of a drain is associated with reduced recurrence and mortality. Other groups, such as Gazzeri et al., Bellut et al. and Zumofen et al., advocated the efficacy and safety of subperiosteal drainage (SPD) compared to subdural drainage (SDD). However, at present there is a lack of prospective randomized comparative studies in this field.

In this single-center prospective randomized study, the authors compared both SDD and SPD and measured the clinical outcome at 3- and 6-month intervals postoperatively. Moreover, they analyzed the role of anticoagulation therapy prior to surgery. The study was well conducted and described, and is of clinical relevance. The preliminary results indicate that the use of drainage is effective and safe and that an SPD—connected with a suction system—presents better long-term results compared to a SDD, and that using an anticoagulant prior to surgery did not influence the outcome or recurrence. The greatest limitation is the small number of subjects studied. Further randomized studies with larger groups of patients are anticipated to provide more evidence of the benefit of an SPD in the surgical management of CSDH.

Alex Alfieri

Sebastian Simmermacher

Halle-Wittenberg, Halle (Saale), Germany

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Kaliaperumal, C., Khalil, A., Fenton, E. et al. A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma. Acta Neurochir 154, 2083–2089 (2012). https://doi.org/10.1007/s00701-012-1483-1

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  • DOI: https://doi.org/10.1007/s00701-012-1483-1

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