OPTIMIZING NEUROSURGICAL INTERVENTIONS FOR TRAUMATIC CHRONIC SUBDURAL HEMATOMA: A ONE HEALTH APPROACH TO EVALUATING SUBGALEAL VERSUS SUBDURAL DRAINAGE TECHNIQUES

Chronic subdural haematoma (CSDH) is a common neurosurgical condition, especially in older adults, and recurrence after surgery remains a major concern. This study compared two drainage techniques—subdural and subgaleal—following burr-hole evacuation of traumatic CSDH. A prospective randomized controlled trial was conducted on 48 patients over 12 months, with participants assigned to either drainage method. Outcomes assessed included recurrence within 12 weeks and functional recovery using the Glasgow Outcome Score (GOS) at discharge, 6 weeks, and 12 weeks. Recurrence was uncommon and similar in both groups, occurring in 8.3% of patients in the subdural group and 12.5% in the subgaleal group, with no statistically significant difference (p = 1.000). All recurrence episodes happened early after surgery and were managed successfully with repeat burr-hole evacuation. Functional outcomes improved steadily over time in both groups, with most patients achieving good recovery by 12 weeks, and no meaningful differences were observed between the two techniques at any follow-up point. Logistic regression did not identify any clear predictors of recurrence, although the small number of events limited the strength of this analysis. Overall, both drainage methods appeared similarly effective in terms of recurrence prevention and recovery. However, the study was underpowered due to the low event rate, so these findings should be interpreted cautiously. Larger studies are needed to draw firmer conclusions.