gms | German Medical Science

Objective: A subgaleal drain is commonly placed to prevent hematoma formation after craniotomy. Other postoperative complications may include CSF leakage which in turn can result in wound dehiscence and even meningitis. It is the purpose of this study to better understand the effect of subgaleal drains and type of dural closure on wound healing after craniotomy.

Method: We prospectively included 150 patients undergoing supratentorial craniotomy, recording technical variables (dural closure technique and subgaleal drains to gravity, as well as type of incision and craniotomy, skin closure, compressive dressing) and outcome (subgaleal hematoma/CSF collection, impairment of wound healing, infection, need for operative revision).

Results: Subgaleal hematoma or CSF collection was seen in 55 patients (36.7%) early after surgery (within one week), and in three patients (2.8%) at late follow-up (six weeks postoperatively, at the time of submission completed for 132 patients). Wound healing was impaired in five patients (3.3%), with two patients developing a wound related infection. A total of ten patients (6.7%) underwent either local tap for pressure relief or diagnostics, secondary stitches or operative revision.

Among other variables such as the use of dural sealants, type of skin closure and application of compressive dressing, it was also noted that the use of subgaleal drains and the type of dural closure – even absence of watertight dural closure – did not influence any of the outcome parameters documented above.

Only curved incisions and larger craniotomies were associated with a highly significant increase in early CSF or hematoma collection (p<0.001), but the significance was lost at late follow-up.

Conclusions: Subgaleal drain placement and the type of dural closure after supratentorial craniotomy are not necessarily associated with significant difference in outcome.