“DA-Fix” Drain: An Innovative Noncontact Chronic Subdural Hematoma Drainage System

Abstract Recurrent chronic subdural hematoma (CSDH) is a major global problem with high morbidity and mortality. Despite being a treatable entity with a simple procedure such as burr hole and evacuation, it has a high recurrence rate. The placement of a subgaleal drain, which is the current standard of care, is a suboptimal method for preventing recurrences. The senior author devised a new type of burr hole cap (DA-Fix, GPS Precisions, Ghaziabad, India; patent pending) made of medical grade titanium with an integrated subdural evacuation system, with a suction port in the center, designed in such a way as to be completely atraumatic to the underlying brain and vessels. Once fixed, a no. 12 suction drain is connected to the nozzle arising from the center of the DA-Fix and tunneled out away from the primary incision site. This drain was then connected to the suction drain system under half negative suction. We present our initial clinical experience with this novel DA-Fix drain in patients with CSDH. Three patients with CSDH underwent burr hole drainage and placement of the DA-Fix drain. All three patients had the suction drain placed for 4 to 6 days (mean: 5 days) and had good radiological outcomes. Two patients could be discharged, and one patient died in the hospital on the 11th day due to sudden myocardial infarction. We describe a novel noncontact, controlled suction integrated into a burr hole cap with a detachable suction attachment. This invention has the potential to dramatically reduce the recurrence and complication rates of subdural hematoma(s).