Turkish Neurosurgery
A Comparison of Subgaleal Active Drainage and Subdural Passive Drainage and an Analysis of Factors Affecting Chronic Subdural Hematoma Outcomes
Utku Özgen1, İlyas Dolaş3, Tuğrul Cem Ünal3, Pulat Akın Sabancı3, Aydın Aydoseli3, Yavuz Aras3, Achmed Ali2, Emrah Keskin4, Kemal Tanju Hepgül3
1Zonguldak Ataturk State Hospital, Department of Neurosurgery, Zonguldak,
2Istanbul University Istanbul Medical Faculty, Department of Anesthesiology and Reanimation, Istanbul,
3Istanbul University Istanbul Medical Faculty, Department of Neurosurgery, Istanbul,
4Bulent Ecevit University, Department of Neurosurgery, Zonguldak,
DOI: 10.5137/1019-5149.JTN.37703-22.2

Abstract Aim: Chronic subdural hematoma (CSDH) is one of the most common forms of intracranial bleeding encountered in neurosurgical practice. Recurrence of CSDH is a significant problem, and recurrence rates can be as high as 33%. In the last 20 years, the insertion of postoperative drains into the cavity has become a common strategy owing to its reduction of the risk of recurrence. This study aimed to analyze and compare the factors that influence the recurrence of CSDH among patients treated with subdural non-suction-assisted passive drainage, subgaleal suction-assisted active drainage, and without drainage. Material and Methods: We retrospectively evaluated 87 surgical patients with a diagnosis of CSDH treated between 2007 and 2018 using patient records from the neurosurgery archive of our faculty. The patients were divided into three groups: drain-free group (group A), subdural passive drainage group (group B), and subgaleal active drainage group (group C). Recurrence was defined as an increase in hematoma volume on imaging and persistence of the patient’s symptoms. Results: Patients with double-membrane CSDH exhibited higher recurrence rates (p = 0.043) and those with low-density CSDH exhibited lower recurrence rates (p = 0.015) compared to the other patients. No relationship was found between the number of burr holes made and CSDH recurrence (p = 0.177). Group C showed the lowest recurrence rate (13.3%), but the differences between groups were not statistically significant. Conclusion: Hematoma density, membrane type, postoperative Glasgow Outcome Scale scores, and postoperative drainage time were found to be statistically significant predictors of recurrence. Burr-hole craniotomy with subgaleal active drainage is a safe and effective method for preventing CSDH recurrence and carries a reduced risk of parenchymal injury.

Corresponding author : Utku Özgen