A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma.
OBJECTIVE
Chronic subdural hematoma (CSDH) recurs after surgical evacuation in 5-30% of patients. Inserting subdural drain might reduce the recurrence rate, but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains.


METHODS
A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage (BHD) of CSDH was undertaken. During the study period, 246 patients with CSDH were assessed for eligibility. Among 200 patients fulfilling the eligibility criteria, 100 each were assigned to "drain group" (drain inserted into the subdural space following BHD) and "without drain group" (subdural drain was not inserted following BHD) using random allocation software. The primary end point was recurrence needing re-drainage up to a period of 6 months from surgery.


RESULTS
Recurrence occurred in 9 of 100 patients with a drain, and 26 of 100 patients in without drain group (P = 0.002). The mortality was 5% in patients with drain and 4% in patients without drain group (P = 0.744). The medical and surgical complications were comparable between the two study groups.


CONCLUSIONS
Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications.
Amit Kumar
AK
Singh
Department of Neurosurgery, PGIMER and Dr. RML Hospital, New Delhi, India.
Bhaskar
B
Suryanarayanan
Ajay
A
Choudhary
Akhila
A
Prasad
Sachin
S
Singh
Laxmi Narayan
LN
Gupta
D004322:Drainage / Q000379:methods; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055502:Secondary Prevention; D013355:Subdural Space / Q000601:surgery*; D016896:Treatment Outcome