Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence

Abstract

Background/Objectives Chronic Subdural Hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH. Materials and Methods We retrospectively analyzed the charts of 180 CSDH patients treated with bedside twist drill craniostomy (TDC) and subdural drain insertion. Patients were divided into two groups: Group A (n=123) received our traditional drain (pediatric size nasogastric tube (NGT), while group B (n=49) had the external ventricular drain (EVD). Various demographic and radiological data were collected. Our main outcome was recurrence, defined as symptomatic re-accumulation of hematoma on the previously operated side within 3 months. Results 212 cases of subdural hematoma were treated in 172 patients. Majority of patients were male (78%) and had a history of previous head trauma (73%). 17 cases had recurrence, 11 in the NGT group drain and 6 in the EVD group. The use of antiplatelet or anticoagulation agents was associated with recurrence (P= 0.038 and 0.05, respectively). There was no difference between both groups in terms of recurrence [OR=1.42, 95% CI:0.49 to 4.08, P=0.573]. Conclusion Chronic subdural hematoma is a common disease with a high rate of recurrence. Although using a drain postoperatively has shown to improve the incidence of recurrence, little remains known about the best type of drain to use. Our analysis showed no difference in the recurrent rate between using the pediatric size NGT and the EVD catheter post TDC.

Chronic subdural hematoma drainage using anti-thrombotic catheter technique

“…Different types of drains can be used in the subdural space, with no consensus. 15 The rate of proximal catheter obstruction is difficult to be established and may be underreported. In our study, the proximal drain obstruction on cSDH drainage was 40% using conventional drains.…”