Soleman, JehudaJehudaSolemanKamenova, MariaMariaKamenovaLutz, Katharina Sarah JenniferKatharina Sarah JenniferLutzGuzman, RaphaelRaphaelGuzmanFandino, JavierJavierFandinoMariani, LuigiLuigiMariani2024-10-252024-10-252017-08https://boris-portal.unibe.ch/handle/20.500.12422/156686OBJECTIVE To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally. METHODS We administered a survey to neurosurgeons worldwide with questions relating to the surgical treatment of chronic subdural hematoma, with an emphasis on their practices concerning the use of a drain. RESULTS The preferred surgical technique was burr-hole drainage (89%). Most surgeons prefer to place a drain (80%), whereas in 56% of the cases the reason for not placing a drain was brain expansion after evacuation. Subdural drains are placed by 50% and subperiosteal drains by 27% of the responders, whereas 23% place primarily a subdural drain if possible and otherwise a subperiosteal drain. Three quarters of the responders leave the drain for 48 hours and give prophylactic antibiotic treatment, mostly a single-shot dose intraoperatively (70%). Routine postoperative computed tomography is done by 59% mostly within 24-48 hours after surgery (94%). Adjunct treatment to surgery rarely is used (4%). CONCLUSIONS The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies.enBurr-hole drainage Chronic subdural hematoma Subdural drain Subgaleal drain Subperiosteal drain Survey600 - Technology::610 - Medicine & healtharticle10.7892/boris.1087222846127710.1016/j.wneu.2017.04.134