Comparing the Use of Subgaleal and Subdural Drain in Non-acute 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 this study 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 the capacity of draining the hematoma and complications such as pneumocephalus, recurrence and others. The effect of hematoma age on results was examined.Results:It was determined that hematoma could be evacuated more effectively in the subgaleal drain group (p=0.045). It was found that in subacute hematomas, subgaleal drain resulted in more recurrence, but prevented drain-related complications. Subgaleal drain was found to be acceptable 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 of recurrence increases

Is Placing Prophylactic Dural Tenting Sutures a Dogma?

Objective In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. Methods Results from 437 patients aged 18 to 91 years (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups, patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1), at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2), or no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. Results Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. Conclusion Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important