title: Subdural drainage versus subperiosteal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas.
abstract: BACKGROUND
  Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial.
  
  
  OBJECTIVE
  The aim of this retrospective single-center study is to compare for the first time two surgical methods in the treatment of subdural hematoma that have been proven to be efficient in previous studies in a direct comparison.
  
  
  METHODS
  We analyzed the data of 143 scSDHs in 113 patients undergoing surgery for subdural hematoma with placement of subperiosteal or subdural drainage after double burr-hole trepanation for hematoma evacuation.
  
  
  RESULTS
  Overall, there were no statistically significant differences regarding general patient characteristics, preoperative and postoperative symptoms, postoperative hematoma remnant, rates of recurrences, mortality, complications, and outcome at discharge and at 3-month follow up between the groups. There was a close to significant tendency of lower mortality after placement of subperiosteal drainage system and a tendency towards lower rate of recurrent hematoma after placement of subdural drainage system.
  
  
  CONCLUSIONS
  Our study shows for the first time a direct comparison of two mainly used surgical techniques in the treatment of scSDH. Both methods proved to be highly effective, and general patient data, complications, outcome and mortality of both groups are equal or superior compared with previously published series. Because there is a clear tendency to less mortality and fewer serious complications, treatment with double burr-hole trepanation, irrigation, and placement of subperiosteal drainage is our treatment of choice in patients with predictable high risk of complications.
authors.affiliation: Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland. dbellut@gmail.com
authors.forename: David
authors.initials: D
authors.lastname: Bellut
authors.forename: Christoph Michael
authors.initials: CM
authors.lastname: Woernle
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.forename: Ralf Alfons
authors.initials: RA
authors.lastname: Kockro
authors.forename: Helmut
authors.initials: H
authors.lastname: Bertalanffy
authors.forename: Niklaus
authors.initials: N
authors.lastname: Krayenbühl
mesh_terms: D000368:Aged; D003399:Craniotomy / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology; D019990:Perioperative Care; D010521:Periosteum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013355:Subdural Space / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome