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Background Factors determining the recurrence of chronic subdural hematomas (CSDHs) are not clear. Whether opening the so-called internal hematoma membrane is useful has not been investigated. Objective To investigate whether splitting the inner hematoma membrane influences the recurrence rate in patients undergoing burr-hole craniotomy for CSDH. Methods Fifty-two awake patients undergoing surgery for 57 CSDHs were prospectively randomized to either partial opening of the inner hematoma membrane (group A) or not (group B) after enlarged burr-hole craniotomy and hematoma evacuation. Drainage was left in situ for several days postoperatively. Groups were comparable with regard to demographic, clinical, and imaging variables. Outcome was assessed after 3–6 weeks for the combined outcome variable of reoperation or residual hematoma of one third or more of the original hematoma thickness. Results Fourteen patients underwent reoperation for clinical deterioration or residual hematoma during follow-up ( n = 6 in group A, 21%; n = 8 in group B, 28 %) ( P = 0.537). Residual hematoma of ≥ one third not requiring surgery was present in 7 patients in group A (25%) and 10 patients in group B (36%) ( P = 0.383). The overall cumulative failure rate (reoperation or hematoma thickness ≥ one third) was 13/28 (46%) in group A and 18/28 in group B ( P = 0.178; relative risk, 0.722 [95% confidence interval, 0.445–1.172]; absolute risk reduction –16% [95% confidence interval, –38% to 8%]). Conclusions Opening the internal hematoma membrane does not alter the rate of patients requiring revision surgery and the number of patients showing a marked residual hematoma 6 weeks after evacuation of a CSDH. [ABSTRACT FROM AUTHOR]

Objective To determine whether the use of a subdural drain after burr-hole evacuation of a chronic subdural hematoma is safe and effective in preventing recurrence and subsequent operations, and as such improving functional outcomes. Methods The literature search included the following databases: PubMed, the National Institutes of Health/National Library of Medicine, Clinical Trials Registry, CENTRAL (The Cochrane Library), EMBASE, and LILACS. The search was performed in June 2013, and did not have restrictions or filters with regard to language or year of publication. Methodologic quality was assessed through the Jadad's scale. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were functional outcome, mortality, and postoperative complications. Results were presented as pooled Mantel-Haenszel relative risks (RR), with 95% confidence intervals (95% CI). Results A total of 7 randomized controlled trials were analyzed. Three studies were classified as high methodologic quality and four as low quality. Pooled RR were symptomatic recurrence (RR 0.51; 95% CI 0.36–0.75), reoperation (RR 0.5; 95% CI 0.34–0.74), poor functional outcome (RR 0.61, 95% CI 0.39–0.98), mortality (RR 0.67, 95% CI 0.37–1.22), and postoperative complications (RR 1.28, 95% CI 0.78–2.11). There was no statistically significant heterogeneity within the outcomes. Conclusions The meta-analysis demonstrates that the insertion of a subdural drain was associated with a statistically significant reduction in the risk of symptomatic recurrence and the requirement for further surgical intervention of chronic subdural hematoma after surgical evacuation. Furthermore, it was associated with statistically significant improvements in both short-term and long-term functional outcome. [ABSTRACT FROM AUTHOR]