Use of Active Low Suction Pressure (Subgaleal) Drains in Chronic Subdural Hematoma Surgery

Background: Subdural drains are used to reduce recurrence after surgical evacuation of chronic subdural hematoma. There is a small risk of parenchymal injury. We hypothesize that using subgaleal drains with low active suction (-50 mm Hg to -100 mm Hg) may be a safer alternative and still maintain efficacy in preventing recurrence.

Methods: A retrospective review of adult patients who underwent surgical drainage of chronic subdural hematoma at our institution was performed. They were classified into 2 groups: a subdural group and a subgaleal group. We collected data on patient demographics, preoperative use of antiplatelets or anticoagulants, the type of drains used, laterality of burr-hole surgery performed and postoperative complications, and recurrence. Descriptive statistics and regression analyses were used to analyze the data.

Results: 322 patients recruited, 172 received subgaleal drains with low active suction and 150 received passive subdural drains. There was no significant difference in the rate of recurrence; there was 11. % recurrence in the subgaleal drain group and 9.3% recurrence in the subdural drain group (P = 0.660). Patients who underwent active subgaleal drain insertion had significantly fewer complications, at 2.3% compared with 8.0% in patients who had passive subdural drains (P = 0.037).

Conclusions: The use of subgaleal drains with low active suction led to significantly lower complication rates compared with the use of subdural drains and maintained its efficacy in preventing recurrence.