Comparing the Use of Subgaleal and Subdural Drain in Nonacute Subdural Hematomas: Does the Hematoma Age Affect the Results?

Aim: Surgical treatment of non-acute subdural hematomas is to place a closed drainage system in the subdural area following burr-hole trepanation,but it has tendency to drain related complications. Subgaleal drain is also suggested as an alternative, but there is no consensus yet. The aim of thisstudy is to examine the effect of hematoma age and drain insertion style on surgical outcomes.Materials and Methods: The data of 79 patients were retrospectively analyzed. The patients were divided into two groups as “subdural drain”and “subgaleal drain”. Each group was further subgrouped as “chronic hematoma” and “subacute hematoma”. They were compared in terms of thecapacity of draining the hematoma and complications such as pneumocephalus, recurrence and others. The effect of hematoma age on results wasexamined.Results: It was determined that hematoma could be evacuated more effectively in the subgaleal drain group (p=0.045). It was found that insubacute hematomas, subgaleal drain resulted in more recurrence, but prevented drain-related complications. Subgaleal drain was found to beacceptable for chronic subdural hematomas.Conclusion: The use of subgaleal drain may be an option to avoid drain-related complications. However, if the hematoma is subacute, the rate ofrecurrence increases.

Akut Olmayan Subdural Hematomlarda Subgaleal ve Subdural Diren Kullanımının Karşılaştırılması: Kanama Yaşı Sonuçları Etkiler mi?

Amaç: Kronik ve subakut subdural hematomların kabul görmüş cerrahi tedavisi burr-hole trepanasyonu takiben subdural alana kapalı diren sistemi yerleştirmektir. Direne bağlı komplikasyonlara açık olan bu yönteme alternatif olarak direnin subgaleal alana yerleştirilebileceği de önerilmektedir, ancak henüz bu konuda görüş birliği sağlanamamıştır. Bu çalışmada amaç, kronik veya subakut subdural hematomun cerrahi tedavisinde kanamanın yaşının ve direnin subgaleal alana veya subdural alana yerleştirilmesinin cerrahi başarı üzerindeki etkisini incelemektir. Gereç ve Yöntem: Kriterlere uyan ve takiplerine eksiksiz ulaşılabilen 79 hastanın verileri geriye dönük incelendi. Hastalar, kullanılan cerrahi yönteme göre “subdural diren grubu” ve subgaleal diren grubu” olarak iki gruba ayrıldı. Her bir grup ayrıca kendi içinde “kronik kanaması olanlar” ve “subakut kanaması olanlar” olarak iki alt gruba daha ayrıldı. Gruplar, uygulanan yöntemin kanamayı boşaltabilme kapasitesi, pnömosefali, rekürrens ve diğer komplikasyonlar açısından kıyaslandı. Kanamanın yaşının sonuçlara etkisi incelendi. Bulgular: Subgaleal diren grubunda kanamanın daha etkili şekilde boşaltılabildiği belirlendi (p=0,045). Subakut kanamada subgaleal direnin daha fazla rekürrens ile sonuçlandığı ancak direne bağlı komplikasyonları önlediği fark edildi. Kronik kanaması olan hastalarda ise subgaleal diren yerleştirilmesinin kabul edilebilir olduğu saptandı. Sonuç: Direne bağlı komplikasyonlardan kaçınabilmek için subgaleal diren kullanılması seçenek olabilir. Ancak subakut hematom varlığında rekürrens oranı artmaktadır.

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