Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice.

Soleman, Jehuda; Kamenova, Maria; Lutz, Katharina Sarah Jennifer; Guzman, Raphael; Fandino, Javier; Mariani, Luigi (2017). Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice. World neurosurgery, 104, pp. 528-536. Elsevier 10.1016/j.wneu.2017.04.134

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OBJECTIVE To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally. METHODS We administered a survey to neurosurgeons worldwide with questions relating to the surgical treatment of chronic subdural hematoma, with an emphasis on their practices concerning the use of a drain. RESULTS The preferred surgical technique was burr-hole drainage (89%). Most surgeons prefer to place a drain (80%), whereas in 56% of the cases the reason for not placing a drain was brain expansion after evacuation. Subdural drains are placed by 50% and subperiosteal drains by 27% of the responders, whereas 23% place primarily a subdural drain if possible and otherwise a subperiosteal drain. Three quarters of the responders leave the drain for 48 hours and give prophylactic antibiotic treatment, mostly a single-shot dose intraoperatively (70%). Routine postoperative computed tomography is done by 59% mostly within 24-48 hours after surgery (94%). Adjunct treatment to surgery rarely is used (4%). CONCLUSIONS The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Lutz, Katharina Sarah Jennifer


600 Technology > 610 Medicine & health








Nicole Söll

Date Deposited:

05 Mar 2018 09:36

Last Modified:

29 Oct 2019 08:03

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Burr-hole drainage Chronic subdural hematoma Subdural drain Subgaleal drain Subperiosteal drain Survey





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