Postoperative Safety and Functional Recovery After Subdural and Subgaleal Drainage in Traumatic Chronic Subdural Hematoma in North-Western Nigeria: A Prospective Randomized Study

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly among the elderly. Burr-hole craniostomy with closed drainage remains standard; however, the optimal drain location—subdural (SD) or subgaleal (SG)—is disputed. This study aimed to compare postoperative complications and functional outcomes between SD and SG closed drainage systems after burr-hole evacuation of traumatic CSDH. Methods: In this prospective randomized study, 48 adult patients with traumatic CSDH were assigned to SD (n = 24) or SG (n = 24) drainage. Postoperative seizures, pneumocephalus, and surgical site infections (SSIs) were assessed clinically, radiologically, and using Centers for Disease Control and Prevention criteria. Functional outcomes were measured with the Glasgow Outcome Score (GOS) at discharge, 6 weeks, and 12 weeks. Results: Mean age was 61.8 ± 13.8 years (SD) and 56.8 ± 15.3 years (SG; P = 0.237). At discharge, good recovery (GOS 5) occurred in 54.2% (SD) versus 41.7% (SG), moderate disability (GOS 4) in 41.7% versus 54.2%, and severe disability (GOS 3) in 4.2% in each group. At 6 weeks, good recovery increased to 75.0% (SD) and 62.5% (SG). At 12 weeks, all patients achieved good recovery. Complications were infrequent: seizures in 8.3% (SD) versus 4.2% (SG), pneumocephalus in 12.5% versus 8.3%, and SSI in 4.2% versus 0%. Differences were not statistically significant. Conclusions: SD and SG drainage systems provide comparable safety and functional outcomes. Both systems led to progressive GOS improvement, with all patients achieving good recovery by 12 weeks. Further multicenter studies with longer follow-up are justified.