Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice.
OBJECTIVE
To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally.


METHODS
We administered a survey to neurosurgeons worldwide with questions relating to the surgical treatment of chronic subdural hematoma, with an emphasis on their practices concerning the use of a drain.


RESULTS
The preferred surgical technique was burr-hole drainage (89%). Most surgeons prefer to place a drain (80%), whereas in 56% of the cases the reason for not placing a drain was brain expansion after evacuation. Subdural drains are placed by 50% and subperiosteal drains by 27% of the responders, whereas 23% place primarily a subdural drain if possible and otherwise a subperiosteal drain. Three quarters of the responders leave the drain for 48 hours and give prophylactic antibiotic treatment, mostly a single-shot dose intraoperatively (70%). Routine postoperative computed tomography is done by 59% mostly within 24-48 hours after surgery (94%). Adjunct treatment to surgery rarely is used (4%).


CONCLUSIONS
The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies.
['Soleman|Jehuda|J|', 'Kamenova|Maria|M|', 'Lutz|Katharina|K|', 'Guzman|Raphael|R|', 'Fandino|Javier|J|', 'Mariani|Luigi|L|']
D003399:Craniotomy D003431:Cross-Cultural Comparison D004322:Drainage D005260:Female D019538:Health Care Surveys D020200:Hematoma, Subdural, Chronic D006801:Humans D008297:Male D011183:Postoperative Complications D010818:Practice Patterns, Physicians' D055502:Secondary Prevention D011795:Surveys and Questionnaires D014600:Utilization Review
Chronic subdural hematoma Survey Burr-hole drainage Subdural drain Subperiosteal drain Subgaleal drain