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Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial

Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ.

Lancet. 2009 Sep 26;374(9695):1067-73.

BACKGROUND: Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5-30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes.

METHODS: We did a randomised controlled trial at one UK centre between November, 2004, and November, 2007. 269 patients aged 18 years and older with a chronic subdural haematoma for burr-hole drainage were assessed for eligibility. 108 were randomly assigned by block randomisation to receive a drain inserted into the subdural space and 107 to no drain after evacuation. The primary endpoint was recurrence needing redrainage. The trial was stopped early because of a significant benefit in reduction of recurrence. Analyses were done on an intention-to-treat basis. This study is registered with the International Standard Randomised Controlled Trial Register (ISRCTN 97314294).

FINDINGS: Recurrence occurred in ten of 108 (9.3%) people with a drain, and 26 of 107 (24%) without (p=0.003; 95% CI 0.14-0.70). At 6 months mortality was nine of 105 (8.6%) and 19 of 105 (18.1%), respectively (p=0.042; 95% CI 0.1-0.99). Medical and surgical complications were much the same between the study groups.

INTERPRETATION: Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months.

FUNDING: Academy of Medical Sciences, Health Foundation, and NIHR Biomedical Research Centre (Neurosciences Theme).

Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.

Comments (9)Add Comment

Drain better than non-drain
written by Thomas S, October 01, 2009
In this randomised study Santorius et al. have studied the recurrence rate using subdural drains versus no drains after evacuation of chronic subdural haematoma.

Recurrence rate:
Subdural drain: 9.3%
Non-drain: 24%

No differences in complications were observed between the groups.
Dear Dr.
written by drghazwan, May 04, 2010
How many burrholes used for each case and how long you will keep the drain ?
I usually use drain
written by ramfermelo, August 15, 2010
I routinely use drain, but only if the brain is complete reexpanded i avoid to used, and most frequently 2 burr hole, with excellent result
What is the best drain type for Chronic subdural hematomas
written by Norman, June 07, 2011
What kind of drain do you usually use for chronic subdural hematomas? is penrose (by cutting surgical gloves) drain is used more often than closed-system drain such as with small-bored nasogastric tube?
written by sharmakchand, June 07, 2011
I use 10 or 12 no Foley's catheter as drainage tube, through tangential drill hole made in dependent part of chronic subdural haematoma. The catheter is pliable and does not damage the brain. Morever it has a small baloon whic can be inflated with 2cc saline. This helps it to sit snugly against drill hole and helps in having haemostasis at drill hole site. The Foley's catheter can be easily attached to sterile bag. The catheter is preloaded with saline to prevent airlock. Moment drill hole is made the subdural is not allowed to come out by pressure of thumb,and quickly catheter without stellate is inserted into subdural cavity, balloon inflated with 2cc saline and catheter is pulled back gently to ensure that balloon sits tightly against the drill hole from inside. The dura is cut with drill tip only and if it still seems intact ,sterile hypodermic needle can be used to cut dura. Out of 50 cases there was only one mortality, rest all were discharged, after postoperative NCCT head done 48 to 72 hours after surgery. See my other blogs on the same site, about my method of drainage of liquid subdural haematomas.
written by zcy153, February 24, 2012
a very good method
Drain for a chrinic subdural hematoma
written by bmcasis, February 25, 2012
This is an interesting topic, Dr. I always use a drain through a single burr hole for a chronic subdural hematoma. Before inserting a drain, copious washing with sterile nss is done to washout most of the blood. I use a Jackson-Pratt drain, 100 ml with a regular flat drain. The JP drain is compressed with just a finger pressure. I use this because you can control the amount of negative pressure and the 1-way value prevents the collected blood from going back into the cranium if the reservoir is inadvertently compressed.
Chronic subdural haemorrage drainaging
written by neurosurgeon80, June 20, 2012
I think that the active drainage system cannot be used,especially in elderly patients,because the risk of rebleeding,so the using Foley catheter in this cases more preferable.
written by neurosurgeon80, June 20, 2012
I remember the patient that was reoperated due to CSH 4 times,and everytime the active drainage system was used.

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