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Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice

Soleman, Jehuda and Kamenova, Maria and Lutz, Katharina and Guzman, Raphael and Fandino, Javier and Mariani, Luigi. (2017) Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice. World Neurosurgery, 104. pp. 528-536.

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Official URL: https://edoc.unibas.ch/74456/

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Abstract

OBJECTIVE: To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally. METHODS: We administered a survey to neurosurgeons worldwide with questions relating to the surgical treatment of chronic subdural hematoma, with an emphasis on their practices concerning the use of a drain. RESULTS: The preferred surgical technique was burr-hole drainage (89%). Most surgeons prefer to place a drain (80%), whereas in 56% of the cases the reason for not placing a drain was brain expansion after evacuation. Subdural drains are placed by 50% and subperiosteal drains by 27% of the responders, whereas 23% place primarily a subdural drain if possible and otherwise a subperiosteal drain. Three quarters of the responders leave the drain for 48 hours and give prophylactic antibiotic treatment, mostly a single-shot dose intraoperatively (70%). Routine postoperative computed tomography is done by 59% mostly within 24-48 hours after surgery (94%). Adjunct treatment to surgery rarely is used (4%). CONCLUSIONS: The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies.
Faculties and Departments:03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Kopfbereich > Neurochirurgie (Guzman)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Kopfbereich > Neurochirurgie (Guzman)
03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Kopfbereich > Neurochirurgie (Mariani)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Kopfbereich > Neurochirurgie (Mariani)
UniBasel Contributors:Soleman, Jehuda
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Elsevier
ISSN:1878-8750
e-ISSN:1878-8769
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:30 Sep 2020 08:58
Deposited On:30 Sep 2020 08:58

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