Drains vs. no drains following burr-hole evacuation of chronic subdural hematoma

Abstract

Objectives: The purpose of this study was to examine the recurrence of chronic subdural hematomas after burr hole evacuation with and without the use of a subdural drain. The study was designed as a randomised control study. Setting: UPUMS SAIFAI Department of Neurosurgery.  Duration: The research lasted from August 2022 to December 2023. Inclusion Criteria Male and female 18-80 years old with persistent subdural hematoma with a midline displacement of more than 5mm on CT scan.

Exclusion Criteria: Bilateral chronic subdural haemorrhage on CT scan, recurrent CSDH, patients with  shunt in-situ, patients with bleeding-related conditions (INR > 2.5, BT > 7 min, count of platelets < 60000) or on anticoagulant drugs, patients with severe systemic ailment such as renal failure (Serum Creatinine > 2.5), chronic liver disease (ultrasound shows liver cirrhosis and splenomegaly) and known ischemic heart disease were excluded from this study

Materials and Methods: In this study, 100 participants were randomly assigned to two equal groups. Persons who met the inclusion criteria were enrolled in the trial through the emergency room and OPD. All patients were prepared for surgery, and their informed permission was obtained. All patients were treated identically as per usual ward regular practice, with the exception that the treatment choice (whether to use the drain or not) was determined by randomization; Group A with drain and Group B without drain. All patients were discharged on the third postoperative day and were observed for 6 months.

Results: Recurrence occurred in just 19 (19%) of the individuals. Four of these 19 patients are in the drain group, whereas the remaining 15 are no drain. While no recurrence was detected in 81 (81%) of the patients [group A: 46 (92%) vs. group B: 35 (70%)]. The difference between the two groups was statistically insignificant.

Conclusion: Based on the findings of this study, it was concluded that there is no significant difference between the two groups and that recurrence will occur whether a drain is placed or not; however, it was also discovered that the rate of recurrence was lower with a subdural drain than without a drain after burr hole evacuation of chronic subdural hematoma. Some additional component may be involved in recurrence, necessitating a lengthy investigation to make a solid judgement.