J Neurosurg. 2025 Aug 15:1-7. doi: 10.3171/2025.4.JNS242409. Online ahead of print.
ABSTRACT
OBJECTIVE: Chronic subdural hematoma (CSDH) is a common cause of morbidity in the older population and the incidence of CSDH is likely to increase in upcoming years due to the increasing age of the population. Surgical intervention is the cornerstone of treatment, but trials have shown conflicting results regarding the optimal type of surgical drainage. The aim of this study was to compare outcomes between patients with CSDH who were surgically treated with active subgaleal drainage versus passive subdural drainage.
METHODS: This retrospective single-center cohort study included patients who underwent surgery for CSDH from 2020 to 2022. In a neurosurgical department in Lund, Sweden, the clinical routine changed from use of a passive subdural drain to an active subgaleal drain during this period. Data were collected from patient medical records and analyzed using univariable analysis followed by multivariable logistic regression analysis. The primary outcome was reoperation for recurrent hematoma within 3 months. Secondary outcomes were postoperative morbidity and mortality.
RESULTS: Of 452 patients (331 male, median age 78 years) included in the analysis, 3 were lost to follow-up, leaving 230 patients who received passive subdural drainage and 219 patients who received active subgaleal drainage for outcomes assessment. The risk of recurrent surgery for CSDH within 3 months was significantly lower in the active subgaleal drain group (12.7%) compared with the passive subdural drain group (20.1%) (p = 0.022). Regarding secondary outcomes, no statistically significant differences were found.
CONCLUSIONS: Risk of recurrent CSDH requiring surgery was lower in patients who received active subgaleal drainage compared with those who received passive subdural drainage, with no increased risk of postoperative complications. These findings support use of the active subgaleal drain system for CSDH surgery.
PMID:40815860 | DOI:10.3171/2025.4.JNS242409
