• John J Y Zhang, Shilin Wang, Foo Aaron Song Chuan ASC Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore., Ming Yang, Boon Leong Quah, Ira Siyang Sun, Zhi Xu Ng, Kejia Teo, Boon Chuan Pang, Eugene Weiren Yang, Sein Lwin, Ning Chou, Shiong Wen Low, Tseng Tsai Yeo, Thomas Santarius, and Nga Vincent Diong Weng VDW Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National Univers.
• Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: zhangjohnjy@gmail.com.
• World Neurosurg. 2019 Nov 1; 131: e392-e401.

BackgroundAlthough the use of a postoperative drain after burr-hole evacuation of chronic subdural hematoma (CSDH) is known to improve surgical outcomes, the superiority of subdural over subperiosteal drains has not been firmly established. Evidence comparing these 2 drain types is largely restricted to single-center series with limited numbers. Using a multicenter cohort study, we aimed to show noninferiority of subperiosteal drains vis-à-vis subdural drains after burr-hole evacuation of CSDH.MethodsWe performed a retrospective analysis of all consecutive patients with CSDH aged 21 years and older who had undergone burr-hole craniostomy across 3 tertiary hospitals from 2010 to 2017. Primary outcome measures included CSDH recurrence and modified Rankin Scale (mRS) score at 6 months. Outcomes of patients in the subdural and subperiosteal drain groups were analyzed and confounders were adjusted for using multivariate logistic regression.ResultsOf the 570 cases analyzed, 329 (57.7%) received a subdural drain and 241 (42.3%) received a subperiosteal drain. There was no significant difference between the 2 drain groups in CSDH recurrence (13.1% in the subdural group vs. 11.2% in the subperiosteal group; P = 0.502) or 6-month mRS score (27.2% with mRS 4-6 in the subdural group vs. 20.4% in the subperiosteal group; P = 0.188). Independent predictors of CSDH recurrence identified on multivariate analysis included premorbid mRS score 0-3 (P = 0.021), separated CSDH type on preoperative computed tomography scan (P = 0.002), and postoperative pneumocephalus of ≥15 mm (P = 0.005).ConclusionsOutcomes of subdural and subperiosteal drains after burr-hole craniostomy for CSDH are largely equivalent based on our findings.Copyright © 2019 Elsevier Inc. All rights reserved.

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