Abstract
Strengths and limitations of subdural versus subperiosteal drain location after burr hole evacuation of chronic subdural hematoma (CSDH) are currently debated. The safety of subdural placement of a drain has been questioned in a recent study by Soleman et al. from 2019, showing a misplacement rate of 17%, and these results have been further highlighted by the same authors, with a slightly lower misplacement rate of 15.8%, in the recent paper “When the drain hits the brain.” The safety of subdural drainage for CSDH depends to a high degree on type of drain and surgical technique. In this technical note, we describe drain type and technique for drain placement which is standardized in Denmark.
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References
Andersen-Ranberg NC, Debrabant B, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K (2019) The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma. Acta Neurochir 161(5):885–894. https://doi.org/10.1007/s00701-019-03858-9
Kamenova M, Wanderer S, Lipps P, Marbacher S, Mariani L, Soleman J (2020) When the drain hits the brain. World Neurosurg. https://doi.org/10.1016/j.wneu.2020.02.166
Ronn Jensen TS, Andersen-Ranberg N, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K (2018) National guidelines for treatment of chronic subdural haematoma. Ugeskr Laeger 180(42):V03180160
Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P et al (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374(9695):1067–1073. https://doi.org/10.1016/s0140-6736(09)61115-6
Sjavik K, Bartek J Jr, Sagberg LM, Henriksen ML, Gulati S, Stahl FL et al (2017) Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study. J Neurosurg:1–7. https://doi.org/10.3171/2016.12.Jns161713
Soleman J, Lutz K, Schaedelin S, Kamenova M, Guzman R, Mariani L, Fandino J (2019) Subperiosteal vs subdural drain after Burr-hole drainage of chronic subdural hematoma: a randomized clinical trial (cSDH-drain-trial). Neurosurgery 85(5):E825–e834. https://doi.org/10.1093/neuros/nyz095
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Chronic Subdural Hematoma (CSDH) is one of the most frequent neurosurgical diagnoses. Nevertheless, no uniform surgical approach has so far been adopted, and while the importance of drainage has been validated in a randomized setting, other questions as to the type of drainage, drain duration- and placement are still unanswered. In this technical note, the authors challenge previous reports on subdural drain placement as being dangerous, arguing that subdural drain placement can be performed safely, if only the correct drainage type and technique is used - as is the case in their nation-wide setting.
This technical note adds to the discussion on CSDH drainage type and technique, while illustrating the need of further studies to identify the optimal surgical management of CSDH in the future.
Jiri Bartek
Stockholm, Sweden
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Jensen, T.S.R., Poulsen, F.R., Bergholt, B. et al. Drain type and technique for subdural insertion after burr hole evacuation of chronic subdural hematoma. Acta Neurochir 162, 2015–2017 (2020). https://doi.org/10.1007/s00701-020-04473-9
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DOI: https://doi.org/10.1007/s00701-020-04473-9