Abstract
Background Chronic subdural hematomas (cSDHs) are most frequently treated by evacuation via
a burr-hole craniostomy procedure. Subperiosteal drains have been introduced as alternatives
to subdural ones, but only a few prospective studies have explored their efficacy.
Thus, a prospective randomized trial was designed to assess their use.
Methods The study enrolled patients with newly diagnosed surgically amenable cSDH. These
patients were randomized into two groups. The first group underwent cSDH evacuation
via a single burr hole craniostomy procedure, followed by placement of a subperiosteal
drain; the second group underwent the identical procedure without drain placement.
Patient demographics, drain volumes, duration of drainage, cSDH recurrence, and postoperative
outcomes were recorded.
Results Eighty-eight patients presenting with cSDH (12 with bilateral cSDHs) from a total
of 100 surgical cases were enrolled. Nine patients (1 bilateral) were lost to follow-up.
Of all remaining 90 procedures, 37 were carried out with drain placement and the remaining
53 without drain placement. There were five recurrent cases (13.5%) in the drain placement
group and 17 (32.1%) in the group without drain placement. This resulted in a statistical
significance (odds ratio [OR]: 0.33; p < 0.05) favoring the use of a drain.
Conclusion Subperiosteal drain placement can be used safely and effectively to treat cSDH in
conjunction with a burr-hole craniostomy procedure, significantly reducing the rate
of recurrence without any additional disadvantages.
Keywords
chronic subdural hematoma - subperiosteal - drain - recurrence - efficacy
