Fatih ÇALIŞ, Mohammed ALADDAM, Mehmet Ali KAHRAMAN, Said ABUMARASA, Tahsin SAYGI, Semih Naci BALAK
Comprehensive Medicine - 2026;18(2):212-218
Objective: To compare radiological evolution and clinical outcomes after burr-hole evacuation of chronic subdural hematoma (CSDH) using subdural versus subgaleal/subperiosteal drains. Materials and Methods: We retrospectively reviewed 127 consecutive adults who underwent burr-hole surgery for CSDH (2018-2025) at a single tertiary center. Patients were grouped by drain type: subdural (n=113) or subgaleal/subperiosteal (n=14). Subdural space thickness (sum of both sides in bilateral cases) was measured on CT preoperatively, on postoperative day 1, and at ~2 weeks. The primary outcome was residual subdural thickness at follow-up imaging. Subdural thicknesses were compared between the groups using ANCOVA, with drain type as the main factor and age, baseline thickness, preoperative midline shift, sex, and anticoagulant use as covariates. Clinical outcomes included recurrence requiring reoperation, postoperative Glasgow Coma Scale (GCS), ICU admission, and length of stay. Results: Groups were similar in age and sex, but the subgaleal/subperiosteal group more frequently used anticoagulants and had greater preoperative midline shift. On postoperative day 1, subgaleal/subperiosteal drainage was associated with greater subdural thickness than subdural drainage (18.1 vs 14.7 mm, p=0.005). At 2 weeks, residual thickness did not differ significantly (10.3 vs 13.2 mm; p=0.161). Recurrence requiring reoperation occurred in 3.1% (4/127), all in the subdural group. Postoperative GCS, ICU admission, and hospital length of stay were comparable. Conclusion: Subgaleal/subperiosteal drains were associated with greater early residual subdural hematoma but similar 2-week radiological resolution compared with subdural drains, with low recurrence and comparable clinical outcomes. Subgaleal/subperiosteal drainage appears to be a safe alternative in CSDH surgery.
