title: Subperiosteal Drainage versus Subdural Drainage in the management of Chronic Subdural Hematoma (A Comparative Study).
abstract: BACKGROUND
  Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate.
  
  
  METHODS
  The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups.
  
  
  RESULTS
  Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, post-operative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system.
  
  
  CONCLUSIONS
  Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH.
authors.affiliation: Department of Neurosurgery, Hospital Umum Sarawak, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.
authors.forename: Adrian Ng Wei
authors.initials: AN
authors.lastname: Chih
authors.affiliation: Department of Neurosurgery, Hospital Umum Sarawak, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.
authors.forename: Albert Wong Sii
authors.initials: AW
authors.lastname: Hieng
authors.affiliation: Department of Neurosurgery, Hospital Sultanah Aminah Johor Bahru, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor, Malaysia.
authors.forename: Noor Azman A
authors.initials: NA
authors.lastname: Rahman
authors.affiliation: Center for Neuroscience Services and Research, Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia; Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, 16150 Kubang Kerian, Kelantan, Malaysia; Department of Neurosciences, Hospital Universiti Sains Malaysia, Jalan Hospital USM, 16150, Kubang Kerian, Kelantan, Malaysia.
authors.forename: Jafri Malin
authors.initials: JM
authors.lastname: Abdullah
keywords: Glasgow Outcome Scale; Markwalder grade; burr-hole drainage; chronic subdural hematoma; subdural drain; subperiosteal drain