Subperiosteal drain versus subdural drain in chronic and subacute subdural hematoma burr-hole evacuation

Background: Chronic subdural hematoma (cSDH) is one of the most prevalent neurosurgical conditions, with burr-hole drainage being the standard surgical procedure. While subdural drain (SDD) insertion reduces recurrence rates, subperiosteal drain (SPD) placement has shown comparable recurrence rates with fewer complications. Objective: To compare the outcomes of SPD and SDD in chronic and subacute subdural hematoma burr-hole evacuation. Methods: A prospective, randomised study was conducted on 200 patients admitted to the Neurosurgery Department at Mansoura University Hospitals. Patients were allocated into two equal groups: SPD (n=100) and SDD (n=100). Outcomes measured included recurrence rate, infection, seizures, mortality, parenchymal injury, and new neurological deficits. Results: The recurrence rate was significantly higher in the SDD group (14%) compared to the SPD group (4%). Infection rates were 6% (SDD) and 4% (SPD), seizures occurred in 10% (SDD) and 4% (SPD), mortality was 4% (SDD) and 2% (SPD), and parenchymal injury was observed only in the SDD group (4%). New neurological deficits were noted in 10% (SDD) and 6% (SPD) of cases. Conclusion: SPD is superior to SDD in terms of recurrence rate, incidence of seizures, parenchymal injury, and new neurological deficits. Although infection and mortality rates were lower with SPD, the difference was not statistically significant.