Objective: The aim of this study is to evaluate the level of safety and effectiveness of a subgaleal vacuum drain in chronic subdural haematoma.
Place and Duration of Study: In the department of Neurosurgery at CMH Rawalpindi from April 2012 to April 2014,
Study Design: Descriptive prospective study.
Material and Methods: The sampling technique was non-probability consecutive sampling. A calculated sample size was 110, by taking consecutive patients with chronic subdural haematoma (CSDH), who were treated with closed drainage system. Out of 110 patients, 10 patients were excluded on the basis of exclusion criteria. 100 patients below 85 years without gender discrimination were included in the study. Among the 10 excluded patients; 5 were critically ill and were above 85 years, 1 patient was below 5 years and 4 patients had craniotomy. Two burr holes were made on the maximum width of hematoma and subgaleal and subdural drains were placed. CT Scan was done on 5th post-surgical day for radiological evaluation.
Results: There were a total of 100 patients included in the study, 90 men and 10 women, ranging in age from 19 to 85 years (mean age, 63 ±15 years). The mean GCS at admission was 14 (+ 1). Out of total 100 patients, 88 (88%) patients had unilateral CSDH and 12(12%) had bilateral CSDH. In out of 88 patients with unilateral CSDH 44 (50%) and out of 12 with bilateral CSDH 6 (50%) subgaleal vacuum drain was placed. In 44 (50%) patients out of 88 with unilateral and 6 (50%) out of 12 bilateral CSDH, subdural simple drain was placed. The recurrence in either group was noted respectively. Among 50 patients with subgaleal drain only, 1(2.2%) patient out of 44 with unilateral CSDH and 1 (16.6%) patient out of 6 with bilateral CSDH had recurrence. Among 50 patients with simple subdural drain, 2 (4.5%) out of 44 patients with unilateral and 2(33%) out of 6 patients with bilateral CSDH had recurrence. The overall postoperative recurrence was in 6(6%) out of 100 patients. The recurrence with subgaleal drain was in 2 patients (4%) out of 50 patients and with subdural drains 4 (8%) out of 50 patients respectively. Also, the recurrence rate was high in bilateral CSDH as compared to the unilateral hematoma. Out of 88, 2(2.2%) patients with unilateral and 4 (33%) out of 12 patients with bilateral CSDH had recurrence. A serious complication during this study was that 2 (4%) out of 50 patients with subdural drains had drain related cerebral cortical laceration and intra parenchymal bleed , one in male and one in female. Those patients were treated conservatively, whereas, no such complication was noted with subgaleal vacuum drain.
Conclusion: A sub galeal vacuum drain with two burr holes is sufficient to evacuate CSDH with lower recurrence rate.
Burr-hole, Subdural hematoma, Subgaleal drain.