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Reducing morbidity associated with subdural drain placement after burr-hole drainage of unilateral chronic subdural hematomas: a retrospective series comparing conventional and modified Nelaton catheter techniques

  • Original Article - Neurosurgery general
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Abstract

Purpose

Placement of a subdural drain after burr-hole drainage of chronic subdural hematoma (cSDH) significantly reduces risk of its recurrence and lowers mortality at 6 months. Nonetheless, measures to reduce morbidity related to drain placement are rarely addressed in the literature. Toward reducing drain-related morbidity, we compare outcomes achieved by conventional insertion and our proposed modification.

Methods

In this retrospective series from two institutions, 362 patients underwent burr-hole drainage of unilateral cSDH with subsequent subdural drain insertion by conventional technique or modified Nelaton catheter (NC) technique. Primary endpoints were iatrogenic brain contusion or new neurological deficit. Secondary endpoints were drain misplacement, indication for computed tomography (CT) scan, re-operation for hematoma recurrence, and favorable Glasgow Outcome Scale (GOS) score (≥ 4) at final follow-up.

Results

The 362 patients (63.8% male) in our final analysis included drains inserted in 56 patients by NC and 306 patients by conventional technique. Brain contusions or new neurological deficits occurred significantly less often in the NC (1.8%) than conventional group (10.5%) (P = .041). Compared with the conventional group, the NC group had no drain misplacement (3.6% versus 0%; P = .23) and significantly fewer non-routine CT imaging related to symptoms (36.5% versus 5.4%; P < .001). Re-operation rates and favorable GOS scores were comparable between groups.

Conclusion

We propose the NC technique as an easy-to-use measure for accurate drain positioning within the subdural space that may yield meaningful benefits for patients undergoing treatment for cSDH and vulnerable to complication risks.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We would like to thank Mary Kemper for her assistance with medical editing and Nadja Baltensweiler for the illustration.

Funding

This study was supported through a scientific grant from the Research Council of the Cantonal Hospital of Aarau, Switzerland (Application number 1410.000.045).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland

    Manuel Moser, Daniel Coluccia & Edin Nevzati

  2. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, Justus-Liebig-University, Gießen, Germany

    Christoph Watermann

  3. Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Dirk Lehnick

  4. Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland

    Serge Marbacher

  5. Formerly Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland, and University of Basel, Basel, Switzerland

    Karl F. Kothbauer

Authors
  1. Manuel Moser
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Contributions

Conception and design: Moser, Coluccia, Kothbauer, Marbacher, Nevzati. Acquisition of data: Moser, Coluccia, Watermann, Nevzati. Analysis and interpretation of data: Lehnick, Moser, Nevzati. Drafting the article: Moser. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Moser. Statistical analysis: Lehnick. Funding acquisition: Nevzati. Study supervision: Moser, Nevzati.

Corresponding author

Correspondence to Manuel Moser.

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Ethical approval

Approval by the institutional review board was obtained from the Ethical Committee of Northwestern and Central Switzerland (ID number EKNZ BASEC 2014-377).

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The authors declare no competing interests.

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Co-author Karl F. Kothbauer passed away on October 23, 2020.

This article is part of the Topical Collection on Neurosurgery general

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Moser, M., Coluccia, D., Watermann, C. et al. Reducing morbidity associated with subdural drain placement after burr-hole drainage of unilateral chronic subdural hematomas: a retrospective series comparing conventional and modified Nelaton catheter techniques. Acta Neurochir 165, 3207–3215 (2023). https://doi.org/10.1007/s00701-023-05537-2

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