Necessity of Surgical Site Closed Suction Drain for Pterional Craniotomy

Abstract

ObjectiveThe aim of this study was to assess the benefit of using a prophylactic surgical site closed suction drain in pterional craniotomy.Materials and MethodsA retrospective review was conducted on 607 consecutive patients who underwent a pterional craniotomy for treatment of intracranial anterior circulation aneurysms over a 5-year period. Between January 2000 and December 2004, 607 patients were divided into two groups, those who had a prophylactic suction drain during closure of the surgical site (drain group, DG) and those who did not (non-drain group, NDG). Head computed tomography (CT) was taken routinely on postoperative day (POD) 1, 7, and 14. Patients' demographics, incidence of surgical site complications, and courses of surgical site healing which were evaluated radiologically by the thickness of the surgical site myocutaneous layer, were analyzed between DG and NDG.ResultsPatients' demographics and characteristics did not differ significantly between the two groups. The head CT showed that the degree of changes in the postoperative surgical site thickness was 148% at POD 1, 209% at POD 7, and 198% at POD 14 in DG, and 118% at POD 1, 152% at POD 7, and 158% at POD 14 in NDG compared to the preoperative value. Postoperative surgical site hematoma was 7.9% (22/274) in DG and 2.4% (8/333) in NDG.ConclusionProphylactic use of an epidural and/or subgaleal closed suction drain does not appear to be necessary for prevention of postoperative surgical site hematoma as well as for promotion of surgical site healing in pterional craniotomy.

Advantages of using a prophylactic epidural closed drain and non-watertight dura suture in a craniotomy near the “parietal site”

“…Wound healing is promoted, the dead cavity is eliminated. In contrast, other researchers [3][4][5][6][7][8] found that inserting a drainage tube during surgery did not significantly affect the incidence of complications at the surgical site. In neurosurgery, because the dura cannot be watertight sutured near the "parietal site", subgaleal fluid collection (SFC) often occurs.…”

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

“…The placement of subgaleal drains with or without suction is often dependent on the experiences or preferences of the surgeons and/or intraoperative findings [11], the underlying hypothesis being the reduction subgaleal collection, thus avoiding wound tension, pain, and possibly (super) infection. However, previous studies suggest that the complication rate is not reduced after supratentorial craniotomies, but can include bradycardia [15,28,48], asystole [9,52], bleeding from the superior sagittal sinus [35], epidural hematomas [11,41,49], pseudohypoxic brain swelling with fatal courses [49], and The effect of drainage on recorded outcome parameters was analyzed using the binary logistic regression model. Outcome parameter at the time of discharge was decelerated as early follow-up; after 6 weeks, as late follow-up.…”

Pterional Approach

“…Finally, the fascial incision and the scalp incision are closed in the usual manner. The choice of an extradural subgaleal closed suction drain should enhance the healing and reduce fluid collections under the flap [10].…”