Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial

@article{Santarius2009UseOD,
  title={Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial},
  author={Thomas Santarius and Peter J. Kirkpatrick and Dharmendra Ganesan and Hui-Ling Chia and Ibrahim Jalloh and Peter Smielewski and Hugh K. Richards and Hani Marcus and Richard A. Parker and Stephen J. Price and Ramez Wadie Kirollos and John D. Pickard and Peter John Hutchinson},
  journal={The Lancet},
  year={2009},
  volume={374},
  pages={1067-1073}
}
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Transition of a clinical practice to use of subdural drains after burr-hole evacuation of chronic subdural haematomas: The Helsinki experience.
Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma
TLDR
Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex.
External drains versus no drains after burr-hole evacuation for the treatment of chronic subdural haematoma in adults.
TLDR
There is some evidence that postoperative drainage is effective in reducing the symptomatic recurrence of CSDH with external subdural drains and the effect of drainage on the occurrence of surgical complications, mortality and poor functional outcome is uncertain.
Use of subdural drain for chronic subdural haematoma? A 4-year multi-centre observational study of 302 cases
Finnish study of intraoperative irrigation versus drain alone after evacuation of chronic subdural haematoma (FINISH): a study protocol for a multicentre randomised controlled trial
TLDR
If there is no difference in recurrence rates between intraoperative irrigation and no irrigation, CSDH surgery could be carried out faster and more safely by omitting the step of irrigation, according to the aim of this multicentre randomised controlled trial.
[Postoperative bed header position after burr-hole drainage of chronic subdural haematoma: systematic review and meta-analysis of randomised controlled trials].
Efficacy and safety of subdural drains after burr-hole evacuation of chronic subdural hematomas: systematic review and meta-analysis of randomized controlled trials.
Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma
TLDR
The use of subdural drains results in significantly improved postoperative imaging in burr hole evacuation of CSDH, thus providing radiological corroboration for their recommended use.
Post-operative day two versus day seven mobilization after burr-hole drainage of subacute and chronic subdural haematoma in Nigerians
TLDR
It appears that both EM and LM are equally beneficial in the post-operative care of patients following burr-hole drainage of S/CSDH, and the authors advocate EM of patients to reduce the length of hospital stay.
In Reply: Subperiosteal vs Subdural Drain After Burr-Hole Drainage of Chronic Subdural Hematoma: A Randomized Clinical Trial (cSDH-Drain-Trial).
TLDR
Although the noninferiority criteria were not met, SPD insertion led to lower recurrence rates, fewer surgical infections, and lower drain misplacement rates, which suggest that SPD may be warranted in routine clinical practice.
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References

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TLDR
Results suggested that postoperative residual intracapsular air is a factor contributing to recurrence, and a simple, less invasive procedure with which to treat chronic subdural haematoma and the outcome is excellent.
Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains.
TLDR
Patients have lower rates of repeated surgeries if subdural drains are placed following evacuation of an SDH via a burr hole, regardless of whether there was visible evidence of brain reexpansion during surgery.
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TLDR
A modified technique: permanent subdural drain with subcutaneous reservoir is compared to a modified technique, practicable at the bedside as well as in the outpatient department, thus making it possible to reduce the number of additional operations.
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TLDR
This study suggests that, to avoid the possibility of early postoperative clinical deterioration, burr hole craniostomy and closed system drainage is advisable and subdural drainage is not necessary when the installation of the drainage system seems to be technically difficult.
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TLDR
It is concluded that closed-system drainage after burr-hole irrigation reduces the recurrence rate of chronic subdural hematoma.
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The survey has identified variations in practice patterns among Canadian Neurosurgeons with respect to treatment of subacute or chronic subdural hematoma (SDH) and the need for further prospective studies and clinical trials to resolve areas of discrepancies in clinical management and hence, standardize treatment regimens.
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TLDR
It is suggested that well developed subdural neomembranes are the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10 to 20 days, however, blood vessel dysfunction and impairment of cerebral blood flow may participate in delay of brain reexp expansion.
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TLDR
It is suggested that burr hole evacuation has the best cure/complication ratio and that postoperative closed system drainage reduces postoperativeclosed system drainage.
Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate.
TLDR
Old age, pre-existing cerebral infarction, and persistence of subdural air after surgery were significantly correlated with poor brain re-expansion (p < 0.001), which will further improve the surgical outcome for patients with CSDH.
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