Download PDF
J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2418-3682
Original Article

Efficacy of Subperiosteal Drains in Chronic Subdural Hematoma: A Prospective Randomized Single-Center Study

Yavor Bozhkov
1   Department of Neurosurgery, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Germany
,
Julian Feulner
1   Department of Neurosurgery, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Germany
,
Michael Buchfelder
1   Department of Neurosurgery, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Germany
,
Max Kleiss
1   Department of Neurosurgery, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Germany
,
Sebastian Brandner
1   Department of Neurosurgery, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Germany
,
Thomas M. Kinfe 
2   Division of Functional and Stereotactic Neurosurgery, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Germany
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Chronic subdural hematomas (cSDHs) are most frequently treated by evacuation via a burr-hole craniostomy procedure. Subperiosteal drains have been introduced as alternatives to subdural ones, but only a few prospective studies have explored their efficacy. Thus, a prospective randomized trial was designed to assess their use.

Methods The study enrolled patients with newly diagnosed surgically amenable cSDH. These patients were randomized into two groups. The first group underwent cSDH evacuation via a single burr hole craniostomy procedure, followed by placement of a subperiosteal drain; the second group underwent the identical procedure without drain placement. Patient demographics, drain volumes, duration of drainage, cSDH recurrence, and postoperative outcomes were recorded.

Results Eighty-eight patients presenting with cSDH (12 with bilateral cSDHs) from a total of 100 surgical cases were enrolled. Nine patients (1 bilateral) were lost to follow-up. Of all remaining 90 procedures, 37 were carried out with drain placement and the remaining 53 without drain placement. There were five recurrent cases (13.5%) in the drain placement group and 17 (32.1%) in the group without drain placement. This resulted in a statistical significance (odds ratio [OR]: 0.33; p < 0.05) favoring the use of a drain.

Conclusion Subperiosteal drain placement can be used safely and effectively to treat cSDH in conjunction with a burr-hole craniostomy procedure, significantly reducing the rate of recurrence without any additional disadvantages.

Keywords

chronic subdural hematoma - subperiosteal - drain - recurrence - efficacy

Authors' Contributions

Y.B. and J.F. have given substantial contributions to the conception or the design of the manuscript. Y.B. and M.K. contributed to acquisition of the data. Y.B. and T.K. contributed to analysis and interpretation of the data. Y.B., T.K., M.B., and S.B. were all involved in the writing and revision of the manuscript. All the authors have read and approved the final version of the manuscript.




Publication History

Received: 05 October 2023

Accepted: 17 September 2024

Accepted Manuscript online:
19 September 2024

Article published online:
24 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Lee KS. History of chronic subdural hematoma. Korean J Neurotrauma 2015; 11 (02) 27-34
    CrossrefPubMedSearch in Google Scholar
  • 2 Trotter W. Chronic subdural haemorrhage of traumatic origin, and its relation to pachymeningitis haemorrhagica interna. Br J Surg 1914; 2 (06) 271-291
    CrossrefPubMedSearch in Google Scholar
  • 3 Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg 1981; 54 (05) 637-645
    CrossrefPubMedSearch in Google Scholar
  • 4 Holl DC, Volovici V, Dirven CMF. et al; Dutch Chronic Subdural Hematoma Research Group (DSHR). Pathophysiology and nonsurgical treatment of chronic subdural hematoma: from past to present to future. World Neurosurg 2018; 116: 402-411.e2
    CrossrefPubMedSearch in Google Scholar
  • 5 Nouri A, Gondar R, Schaller K, Meling T. Chronic subdural hematoma (cSDH): a review of the current state of the art. Brain Spine 2021; 1: 100300
    CrossrefPubMedSearch in Google Scholar
  • 6 Peng D, Zhu Y. External drains versus no drains after burr-hole evacuation for the treatment of chronic subdural haematoma in adults. Cochrane Database Syst Rev 2016; 2016 (08) CD011402
    PubMedSearch in Google Scholar
  • 7 Kamenova M, Wanderer S, Lipps P, Marbacher S, Mariani L, Soleman J. When the drain hits the brain. World Neurosurg 2020; 138: e426-e436
    CrossrefPubMedSearch in Google Scholar
  • 8 Ding H, Liu S, Quan X, Liao S, Liu L. Subperiosteal versus subdural drain after burr hole drainage for chronic subdural hematomas: a systematic review and meta-analysis. World Neurosurg 2020; 136: 90-100
    CrossrefPubMedSearch in Google Scholar
  • 9 Cenic A, Bhandari M, Reddy K. Management of chronic subdural hematoma: a national survey and literature review. Can J Neurol Sci 2005; 32 (04) 501-506
    CrossrefPubMedSearch in Google Scholar
  • 10 Laldjising ERA, Cornelissen FMG, Gadjradj PS. Practice variation in the conservative and surgical treatment of chronic subdural hematoma. Clin Neurol Neurosurg 2020; 195: 105899
    CrossrefPubMedSearch in Google Scholar
  • 11 Santarius T, Kirkpatrick PJ, Ganesan D. et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009; 374 (9695): 1067-1073
    CrossrefPubMedSearch in Google Scholar
  • 12 Erol FS, Topsakal C, Faik Ozveren M, Kaplan M, Tiftikci MT. Irrigation vs. closed drainage in the treatment of chronic subdural hematoma. J Clin Neurosci 2005; 12 (03) 261-263
    CrossrefPubMedSearch in Google Scholar
  • 13 Javadi A, Amirjamshidi A, Aran S, Hosseini SH. A randomized controlled trial comparing the outcome of burr-hole irrigation with and without drainage in the treatment of chronic subdural hematoma: a preliminary report. World Neurosurg 2011; 75 (5–6): 731-736 , discussion 620–623
    CrossrefPubMedSearch in Google Scholar
  • 14 Soleman J, Lutz K, Schaedelin S. et al. Subperiosteal vs subdural drain after burr-hole drainage of chronic subdural hematoma: a randomized clinical trial (cSDH-drain-trial). Neurosurgery 2019; 85 (05) E825-E834
    CrossrefPubMedSearch in Google Scholar
  • 15 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 (Wien) 2012; 154 (11) 2083-2088 , discussion 2088–2089
    CrossrefPubMedSearch in Google Scholar
  • 16 Taylor EB. The complex role of adipokines in obesity, inflammation, and autoimmunity. Clin Sci (Lond) 2021; 135 (06) 731-752
    CrossrefPubMedSearch in Google Scholar
  • 17 Dadej D, Szczepanek-Parulska E, Wrotkowska E, Ruchała M. Cushing's syndrome is associated with altered adipokine profile. Front Endocrinol (Lausanne) 2022; 13: 1032329
    CrossrefPubMedSearch in Google Scholar
  • 18 Gomes-Pereira L, da Silva-Santos JE. Adipokines and metabolic syndrome: pluripotent markers for a complex relationship?. Am J Hypertens 2022; 35 (04) 306-308
    CrossrefPubMedSearch in Google Scholar
  • 19 Almenawer SA, Farrokhyar F, Hong C. et al. Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 2014; 259 (03) 449-457
    CrossrefPubMedSearch in Google Scholar
  • 20 Brennan PM, Kolias AG, Joannides AJ. et al; British Neurosurgical Trainee Research Collaborative. The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg 2016; 127 (04) 732-739
    CrossrefPubMedSearch in Google Scholar
  • 21 Hwang Y, Choi S, Kim YS. et al. Comparative analysis of safety and efficacy in subperiosteal versus subdural drainage after burr-hole trephination for chronic subdural hematoma. Clin Neurol Neurosurg 2022; 212: 107068
    CrossrefPubMedSearch in Google Scholar
  • 22 Pranata R, Deka H, July J. Subperiosteal versus subdural drainage after burr hole evacuation of chronic subdural hematoma: systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162 (03) 489-498
    CrossrefPubMedSearch in Google Scholar
  • 23 Glancz LJ, Poon MTC, Coulter IC, Hutchinson PJ, Kolias AG, Brennan PM. British Neurosurgical Trainee Research Collaborative (BNTRC). Does drain position and duration influence outcomes in patients undergoing burr-hole evacuation of chronic subdural hematoma? Lessons from a UK multicenter prospective cohort study. Neurosurgery 2019; 85 (04) 486-493
    CrossrefPubMedSearch in Google Scholar
  • 24 Laumer R, Schramm J, Leykauf K. Implantation of a reservoir for recurrent subdural hematoma drainage. Neurosurgery 1989; 25 (06) 991-996
    CrossrefPubMedSearch in Google Scholar
  • 25 Tsutsumi K, Maeda K, Iijima A, Usui M, Okada Y, Kirino T. The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma. J Neurosurg 1997; 87 (06) 870-875
    CrossrefPubMedSearch in Google Scholar
  • 26 Henry J, Amoo M, Kissner M. et al. Management of chronic subdural hematoma: a systematic review and component network meta-analysis of 455 studies with 103 645 cases. Neurosurgery 2022; 91 (06) 842-855
    CrossrefPubMedSearch in Google Scholar
  • 27 Hutchinson PJ, Edlmann E, Bulters D. et al; British Neurosurgical Trainee Research Collaborative, Dex-CSDH Trial Collaborators. Trial of dexamethasone for chronic subdural hematoma. N Engl J Med 2020; 383 (27) 2616-2627
    CrossrefPubMedSearch in Google Scholar
  • 28 Kutty SA, Johny M. Chronic subdural hematoma: a comparison of recurrence rates following burr-hole craniostomy with and without drains. Turk Neurosurg 2014; 24 (04) 494-497
    PubMedSearch in Google Scholar
  • 29 Schucht P, Fischer U, Fung C. et al. Follow-up computed tomography after evacuation of chronic subdural hematoma. N Engl J Med 2019; 380 (12) 1186-1187
    CrossrefPubMedSearch in Google Scholar
  • 30 Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg 2014; 121 (03) 665-673
    CrossrefPubMedSearch in Google Scholar
  • 31 Huang YW, Yin XS, Li ZP. Burr hole craniostomy vs. minicraniotomy of chronic subdural hematoma: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26 (14) 4983-4990
    PubMedSearch in Google Scholar
  • 32 Di Cristofori A, Remida P, Patassini M. et al. Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives. Surg Neurol Int 2022; 13: 94
    CrossrefPubMedSearch in Google Scholar
  • 33 Kan P, Maragkos GA, Srivatsan A. et al. Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery 2021; 88 (02) 268-277
    CrossrefPubMedSearch in Google Scholar