• Jo Ee Sam, Regunath Kandasamy, WongAlbert Sii HiengASHDepartment of Neurosurgery, Hospital Umum Sarawak, Jalan Hospital, Sarawak, Malaysia., GhaniAbdul Rahman IzainiARIDepartment of Neurosciences, School of Medical Sciences, Jalan Hospital USM, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia., Song Yee Ang, Zamzuri Idris, and Jafri Malin Abdullah.
• Department of Neurosciences, School of Medical Sciences, Jalan Hospital USM, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia; Department of Neurosurgery, Hospital Umum Sarawak, Jalan Hospital, Sarawak, Malaysia. Electronic address: joeesam@gmail.com.
• World Neurosurg. 2021 Dec 1; 156: e381-e391.

ObjectiveSubgaleal drains are generally deemed necessary for cranial surgeries including decompressive craniectomies (DCs) to avoid excessive postoperative subgaleal hematoma (SGH) formation. Many surgeries have moved away from routine prophylactic drainage but the role of subgaleal drainage in cranial surgeries has not been addressed.MethodsThis was a randomized controlled trial at 2 centers. A total of 78 patients requiring DC were randomized in a 1:1:1 ratio into 3 groups: vacuum drains (VD), passive drains (PD), and no drains (ND). Complications studied were need for surgical revision, SGH amount, new remote hematomas, postcraniectomy hydrocephalus (PCH), functional outcomes, and mortality.ResultsOnly 1 VD patient required surgical revision to evacuate SGH. There was no difference in SGH thickness and volume among the 3 drain types (P = 0.171 and P = 0.320, respectively). Rate of new remote hematoma and PCH was not significantly different (P = 0.647 and P = 0.083, respectively), but the ND group did not have any patient with PCH. In the subgroup analysis of 49 patients with traumatic brain injury, the SGH amount of the PD and ND group was significantly higher than that of the VD group. However, these higher amounts did not translate as a significant risk factor for poor functional outcome or mortality. VD may have better functional outcome and mortality.ConclusionsIn terms of complication rates, VD, PD, and ND may be used safely in DC. A higher amount of SGH was not associated with poorer outcomes. Further studies are needed to clarify the advantage of VD regarding functional outcome and mortality, and if ND reduces PCH rates.Copyright © 2021 Elsevier Inc. All rights reserved.

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