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

Text 1-s2.0-S1878875017306423-main.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (7MB)

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.

Interest & Impact

Downloads

1 since deposited on 05 Mar 2018
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item