gms | German Medical Science

Objective: Chronic subdural hematoma (cSDH) is common and burr hole trepanation with subsequent inlay of a subdural drainage remains a safe surgical measure. Since performance of scheduled postoperative CT-scans before or after drainage removal is still controversial, we retrospectively analyzed the value of CT imaging with subdural drains in situ.

Methods: 74 patients (20 females, 27% and 54 males, 73%) with primary cSDH were included. Routine CT-scans were performed after burr hole trepanation and placement of a subdural drain. Patients' sex, age, symptoms, anticoagulation therapy, side and thickness of initial hematoma were recorded. The influence of routine postoperative CT-scanning with or without indwelling subdural drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow-up by single factor analyses. Subgroup analyses were performed for 29 patients (39%) receiving anticoagulant drugs at the time of admission.

Results: Median age was 75 years (32–92 years). Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent surgery (p = 0.721; burr hole trepanation p = 1.000 or craniotomy p = 0.576), duration of hospitalization (p = 0.808), outcome at discharge (p = 0.543) or numbers of subsequent CT-scans (p = 0.469). Middle-term follow-up was available for 35 patients. Among those, beneficial effects of CT-scanning with inlaying drainage could not be shown. Subgroup analyses revealed CT-scanning with inlaying drainage to be associated with marginally better short-term outcome (p = 0.056) in patients receiving anticoagulant drugs.

Conclusions: Performance of scheduled postoperative cranial imaging with indwelling drains was not shown to reduce subsequent CT-scans or to be beneficial and may miss information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal.