A Comparison of Subperiosteal or Subgaleal Drainage with Subdural Drainage on The Outcome of Chronic Subdural Hematoma Surgery
Ibraheem Alkhawaldeh1, Ibrahim Serag2, Mohamed Abouzid3, Aboalmagd Hamdallah4, Mohammad Al-Jafari5, Mariam Abdelhady6, Ahmed Aljabali7, Abdelrahman Ayman Khattab8, Ahmed Negida9
1Faculty of Medicine, Mutah University, 2Faculty of medicine mansoura University, 3Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, 4Faculty of Medicine, Al-Azhar University, Damietta, Egypt., 5Faculty of Medicine, Mutah University, Al-Karak, Jordan, 6Faculty of Medicine, October 6 University, 7Faculty of Medicine, Jordan University of Science and Technology, 8Faculty of Medicine Al Azhar University, Cairo, Egypt., 9Virginia Commonwealth University
Objective:
This study aimed to compare the outcome of SPGD versus SDD in surgically treated patients of CSDH.
Background:
Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially in the elderly. There are various means to treat CSDH with controversies in operative management. One of the options is whether the placement of subperiosteal /subgaleal position drain (SPGD) or subdural drain (SDD) affects the outcome or not.
Design/Methods:
We searched PubMed, Cochrane, Scopus, and Web of Science (WOS) till January 2023. We included observational and controlled trials comparing drain positions following the evacuation of CSDH.
Results:
Our analysis included 15 studies involving 4070 patients, 1863 (45.8%) underwent SPGD, and 2207 (54.2%) underwent SDD. The pooled overall recurrence rates demonstrated that the use of an SPGD was associated with a lower recurrence rate compared with the use of an SDD (OR= 0.81; 95% CI [0.66, 1], P-value= 0.05), Pooled results were homogenous (P-value= 0.25, I2= 18%). The pooled overall analysis estimated that the use of an SPGD was associated with a lower brain injury rate compared with the use of an SDD (OR= 0.53; 95% CI [0.30, 0.93], P-value= 0.03), Pooled results were homogenous (P-value= 0.67, I2= 0) No significant differences were identified between the SPD and SDD groups in terms of surgical infection rate (P-value= 0.97), mortality rate (P-value= 0.19), favorable outcome rates (mRS score 0 to 3) (P-value= 0.83), pneumocephalus rate (P-value= 0.98), and seizure rate (P-value= 0.85).
Conclusions:
Craniotomy with SPGD can be recommended as an effective and safe surgical procedure for CSDH patients. It has a lower recurrence rate and reduced incidence of postoperative brain injuries. It is also, technically easy, and has no direct contact with brain parenchyma.