Advantages of using a prophylactic epidural closed drain and non-watertight dura suture in a craniotomy near the “parietal site”

Abstract

Background In neurosurgery, the necessity of having a drainage tube is controversial. Subgaleal fluid collection (SFC) often occurs, especially in a craniotomy near the “parietal site”. This study aimed to reassess the benefit of using a prophylactic epidural drainage (ED) and non-watertight dura suture in a craniotomy near the parietal site. Methods A retrospective review was conducted on 63 consecutive patients who underwent a craniotomy near the parietal site. The patients were divided into two groups according to different period. The deal group received ED and a non-watertight dura suture (drain group, DG), the control group that did not (non-drain group, NDG). Complications and patient recovery were evaluated and analysed. Results Three patients (11.5%, 26) in DG and 20 patients (54.1%, 37) in NDG presented with SFC (p < 0.05). One patient (3.8%) in DG and three patients (8.1%) in NDG presented with subdural tensile hydrops (STH) (p > 0.05). Six developed an infection in NDG (four intracranial infections, one abscess, one pulmonary infection), while none in DG (p > 0.05) developed infection. Three (11.5%) cases in DG and one (2.7%) case in NDG had muscle strength that improved postoperatively (p > 0.05). Fifteen (57.7%) in DG and 14 (37.8%) in NDG had epileptic seizures less frequently postoperatively (p < 0.05). The average temperature (37.4 °C vs 37.6 °C, p > 0.05), the maximum temperature (37.9 °C vs 38.1 °C, p > 0.05) on 3 PODs, the postoperative hospital stay day (7.5 days vs 8.0 days, p > 0.05), and the postoperative medicine fee (¥29762.0 vs ¥28321.0, p > 0.05) were analysed. Conclusion In patients who undergo a craniotomy near the parietal site, the prophylactic use of ED and a non-watertight dura suture helps reduce SFC, infection, and control epilepsy.

The usefulness of surgical drains on short term outcomes among patients undergoing craniotomy at the Bugando Medical Centre, Mwanza Tanzania

“…On multivariate analysis, we found that a watertight dura closure significantly reduced the occurrence of SFC 14 times (p = 0.015 14.15 [1.67–119.92]) and incomplete dura closure profoundly increased the likelihood of SFC and drainage use (p = 0.001 73 [5.64–959.80]). This was in disagreement with Li et al 28 who showed that among 63 patients who underwent craniotomy near the parietal site, there was significantly reduced SFC, infection, and control epilepsy with the prophylactic use of drainages and a non-watertight dura suture, findings contrary to Hamou et al 26 However, our findings were contrary to a study by Hamou and group in which they reported that despite watertight dural closure in patients who underwent supratentorial craniotomies there was no difference in the occurance rate of SFC.…”

Evaluation of the benefit of placing a drain in the epidural space in patients undergoing craniotomy

“…We believe that similar results could also be observed if a subgaleal drain had been used in the control group. Subgaleal drainage is also a less invasive and more practical method than epidural drainage (10).…”