Optimal drain position after evacuation of chronic subdural hematomas: a systematic review and network meta-analysis
Abstract
Background: Chronic subdural hematoma (CSDH) is one of the most prevalent diseases encountered in neurosurgery. At present, burr-hole hematoma drainage has been established as the standard surgical intervention for CSDH, effectively reducing the risk of postoperative recurrence. The current study employed systematic review and network meta-analysis (NMA) to assess the impact of drain placement in three different anatomical locations-subdural drain (SDD), subperiosteal drain (SPD), and subgaleal drain (SGD)-on treatment outcomes.
Methods: A search was conducted across PubMed, Embase, Cochrane Library, and Web of Science up to February 14, 2026. The Newcastle-Ottawa Scale was used to assess the risk of bias. R (v4.4.0) and Stata18 were used for the NMA.
Results: This NMA included 14 articles comprising 4,161 patients. The drainage locations evaluated were SDD, SPD, and SGD. Pooled results were analyzed based on two classification systems: Classification I (anatomical location) and Classification II (anatomical location + technique). (1) Recurrence rate: Classification I: According to the league table, SGD was associated with a significantly lower recurrence rate versus No_drain [risk ratio (RR) = 0.43, 95% credible interval (CrI): 0.20-0.96]. Based on the surface under the cumulative ranking curve (SUCRA), SGD (78.25%) ranked as the best intervention. Classification II: According to the league table, subgaleal active drainage (SGD_a) was significantly associated with…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,161 participants or records.
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