Subperiosteal Drainage versus Subdural Drainage in the Management of Chronic
            Subdural Hematoma (A Comparative Study)

Chih, Adrian Ng Wei; Hieng, Albert Wong Sii; Rahman, Noor; Abdullah, Jafri Malin

doi:10.21315/mjms2017.24.1.3

Cited by 19 publications

(23 citation statements)

References 14 publications

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“…Parenchymal hemorrhage due to drain misplacement is a feared complication when inserting an SDD after burr hole drainage of cSDH, potentially increasing perioperative morbidity and mortality (2,7,22). All studies reporting misplacement rates showed lower rates in the SPD group (4,7,8,10,12,14). The overall misplacement rates in the included studies was 1.2% for SPD and 7.8% for SDD, while only the study by Häni et al showed a higher misplacement rate in the SPD group.…”

Section: Discussionmentioning

confidence: 93%

“…All studies, except one, reported on mortality rates (4,(7)(8)(9)(10)(11)(12)(13)(14). Overall mortality was lower in the SDD group, without showing significance (5.0% for SPD and 4.6% for SDD; RR 0.83, 95% CI 0.6-1.14, I 2 = 0%, z = −1.2, p = 0.25, Figure 5A).…”

Section: Mortalitymentioning

confidence: 98%

“…The corresponding funnel plot showed a homogenous distribution (Figure 4B). Six studies specifically analyzed drain misplacement rate or parenchymal injury rate due to drain misplacement (4,7,8,10,12,14). Overall misplacement rate and consecutive parenchymal injury rate was significantly lower in the SPD group compared to the SDD group (1.2 and 7.8%, respectively, RR 0.17, 95% CI 0.07-0.42, I 2 = 0%, z = −3.4, p = 0.0001, Figure 4C), while the funnel plot showed homogenous distribution of the studies (Figure 4D).…”

Section: Morbiditymentioning

confidence: 99%

“…Therefore, subperiosteal drains (SPD), which are inserted between the calvarium and the periosteum have been recommended by some surgeons (2,6). Several studies, amongst others a recently published RCT, were carried out comparing these two different drain types, with regard to outcome and recurrence, with somewhat controversial results (4,5,(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

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Type of Drain in Chronic Subdural Hematoma—A Systematic Review and Meta-Analysis

2020

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Background: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases, while burr-hole drainage is the most frequently used surgical treatment. Strong evidence exists that subdural drain (SDD) placement reduces recurrence rates. However, the insertion of a subperiosteal drain (SPD) was shown to lead to similar recurrence rates and less complications than SDD. The aim of this study is to provide a systematic review of the literature and conduct a meta-analysis of studies comparing SPD with SDD after burr-hole drainage of cSDH.Methods: Pubmed and Embase databases were searched using a systematic search strategy to identify studies on drain location up to December 2019. Two independent researchers assessed the studies for inclusion and quality. Primary outcome measure was recurrence, while secondary outcome measures were drain misplacement, morbidity, mortality, and clinical outcome. Besides randomized controlled trials (RCT), we included non-randomized prospective cohort studies, as well as retrospective cohort studies. A fixed effects model was used if low heterogeneity (I 2 < 50%) was present, otherwise a random effects model was used.Results: Following removal of duplicates, we screened 1109 articles of which 10 articles were included in our qualitative and quantitative analyses. One study was an RCT, three were non-randomized prospective cohort studies, and the remaining articles were retrospective cohort studies or subgroup analysis. In these 10 articles, 1,553 patients were treated with SPD and 1782 patients with SDD. Comparing the recurrence rate of cSDH a significant difference was found between SPD and SDD insertion (11.9 and 12.3%; RR 0.8, 95% CI 0.67-0.97, I 2 = 0%, z = −2.27, p = 0.02). SPD had significantly lower rates of drain misplacement and parenchymal injuries (1.2 and 7.8%; RR 0.17, 95% CI 0.07-0.42, I 2 = 0%, z = −3.4, p = 0.0001), as well as morbidity (6.4 and 8.2%; RR 0.65, 95% CI 0.5-0.84, I 2 = 44.5%, z = −3.32, p =0.0009). Mortality rates (5.0 and 4.6%; RR 0.83, 95% CI 0.6-1.14, I 2 = 0%, z = −1.2, p = 0.25) and favorable clinical outcome (89.6 and 88.9%; RR 1.1, 95% CI 0.89-1.24, I 2 = 54.2%, t = 0.98, p = 0.40) were comparable in both groups.Greuter et al. Meta-Analysis Drain Location CSDH Conclusion:The insertion of SPD after burr-hole drainage of cSDH showed lower rates of recurrence, drain misplacements and parenchymal injuries, as well as overall morbidity, while clinical outcome and mortality were comparable to SDD. Therefore, the insertion of SPD after surgical drainage of cSDH should be encouraged.

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Section: Discussionmentioning

confidence: 93%

Section: Mortalitymentioning

confidence: 98%

Section: Morbiditymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Type of Drain in Chronic Subdural Hematoma—A Systematic Review and Meta-Analysis

2020

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“…In 8 studies [7,10,11,14–18] including 1782 participants, the postoperative bleeding rate was statistically significant in the non-RCT group and overall effect, with RR of 4.50 (95% CI = 1.76–11.54; P = .002) and 2.39 (95% CI = 1.31–4.36; P = .004), respectively. Meanwhile, there was no significant difference in the RCT group, with RR = 1.20 (95% CI = 0.52–2.77; P = .67).…”

Section: Resultsmentioning

confidence: 99%

Comparison of subperiosteal or subgaleal drainage and subdural drainage in patients with chronic subdural hematoma: A systematic review and meta-analysis

Song,

Zhou,

Wang

et al. 2023

Medicine

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Background: Chronic subdural hematoma (CSDH) is a relatively common disease, especially in the elderly, for which there is no clear standard of treatment available. The authors systematically evaluated the efficacy of various surgical procedures for the treatment of chronic subdural hematoma. Methods: Electronic databases of PubMed, EmBase, Web of Science, Medicine, and the Cochrane Library were searched systematically. Based on the PRISMA template, we finally selected and analyzed 13 eligible papers to evaluate the effect of different drainage methods on CSDH. The primary outcomes were recurrence and clinical outcomes. Secondary outcomes were mortality and postoperative complications and other parameters. Results: The meta-analysis included 3 randomized controlled trials and 10 retrospective studies (non-randomized controlled trials) involving 3619 patients. The pooled results showed no statistically significant difference between non-subdural drainage (NSD) and subdural drainage (SD) in mortality and complication rates (P > 0.05). Additionally, overall pooled results showed that the use of NSD (10.9%) has a lower recurrence rate than the use of SD (11.7%), but the results were not statistically significant (relative risk ratio [RR] = 0.98; 95% confidence interval [CI] = 0.70–1.45; I 2 = 47%; P = .92). However, the difference between NSD and SD in postoperative bleeding rate reached statistical significance (RR = 2.39; 95% CI = 1.31–4.36; I 2 = 0 %; P = .004). Subgroup analysis showed that SD was associated with similar recurrent CSDH (RR = 0.75; 95% CI = 0.52–1.09; I 2 = 0%; P = .14), good recovery (RR = 0.98; 95% CI = 0.93–1.04; I 2 = 0%; P = .50), and mortality (RR = 0.98; 95% CI = 0.37–2.57; I 2 = 0%; P = .96), compared to NSD. Conclusions: These results suggest that NSD and SD are equally effective in the treatment of patients with CSDH, with no difference in final clinical characteristics and radiologic outcomes. However, in patients with limited subdural space after evacuation of a hematoma, NSD may be the preferred strategy to avoid iatrogenic brain injury.

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Passive or active drainage system for chronic subdural haematoma—a single-center retrospective follow-up study

Majewska,

Madsbu,

Sagberg

et al. 2024

Acta Neurochir

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Background Postoperative drainage systems have become a standard treatment for chronic subdural hematoma (CSDH). We previously compared treatment results from three Scandinavian centers using three different postoperative drainage systems and concluded that the active subgaleal drainage was associated with lower recurrence and complication rates than the passive subdural drainage. We consequently changed clinical practice from using the passive subdural drainage to the active subgaleal drainage. Objective The aim of the present study was to assess a potential change in reoperation rates for CSDH after conversion to the active subgaleal drainage. Methods This single-center cohort study compared the reoperation rates for recurrent same-sided CSDH and postoperative complication rates between patients treated during two study periods (passive subdural drainage cohort versus active subgaleal drainage cohort). Results In total, 594 patients were included in the study. We found no significant difference in reoperation rates between the passive subdural drain group and the active subgaleal drain group (21.6%, 95% CI 17.5–26.4% vs. 18.0%, 95% CI 13.8–23.2%; p = 0.275). There was no statistical difference in the rate of serious complications between the groups. The operating time was significantly shorter for patients operated with the active subgaleal drain than patients with the passive subdural drain (32.8 min, 95% CI 31.2–34.5 min vs. 47.6 min, 95% CI 44.7–50.4 min; p < 0.001). Conclusions Conversion from the passive subdural to the active subgaleal drainage did not result in a clear reduction of reoperation rates for CSDH in our center.

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Subperiosteal Drainage versus Subdural Drainage in the Management of Chronic Subdural Hematoma (A Comparative Study)

Cited by 19 publications

References 14 publications

Type of Drain in Chronic Subdural Hematoma—A Systematic Review and Meta-Analysis

Type of Drain in Chronic Subdural Hematoma—A Systematic Review and Meta-Analysis

Comparison of subperiosteal or subgaleal drainage and subdural drainage in patients with chronic subdural hematoma: A systematic review and meta-analysis

Passive or active drainage system for chronic subdural haematoma—a single-center retrospective follow-up study

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