J Cerebrovasc Endovasc Neurosurg.  2024 Sep;26(3):265-273. 10.7461/jcen.2024.E2023.08.001.

The efficacy of surgical site suction drain insertion in pterional craniotomy for intracranial cerebral aneurysm

• Kim HB
• Park JC
• Ahn JS
• Lee S
• Yang K
• Park W

• KMID: 2559436
• DOI: http://doi.org/10.7461/jcen.2024.E2023.08.001

Abstract

Objective
We evaluated the role of subgaleal closed suction drains in postoperative epidural hematoma (EDH) and wound complications following pterional craniotomy for cerebral aneurysm.
Methods
We reviewed 5,280 pterional craniotomies performed on 5,139 patients between January 2006 and December 2020. A drain was placed subgalealy and tip of drain was positioned between the bone flap and the deep temporalis. 1,637 cases (31%) had a subgaleal suction drain. We analyzed demographic and clinical variables related to EDH requiring evacuation and wound complications in patients with and without drains. Univariate and multivariate logistic regression analyses were performed to determine the associated risk factors.
Results
Fourteen cases (0.27%) of EDH requiring evacuation and 30 cases (0.57%) of wound complications were identified. Univariate analysis found that drain insertion, subarachnoid hemorrhage (SAH), and operation time were associated with EDH, while drain insertion, SAH, male gender, older age, and longer operation time were associated with wound complications. Multivariate analysis found no significant association between drain use and EDH (OR=1.62, p=0.402) or wound complications (OR=1.45, p=0.342).
Conclusions
Routine use of subgaleal closed suction drains may not be necessary after pterional craniotomy, as drain insertion was not associated with a reduced risk of EDH requiring evacuation or wound complications.

Keyword

Intracranial aneurysm; Drainage; Postoperative hemorrhage; Surgical wound infection

Figure

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  Fig. 1. Brain computed tomography (CT) of a patient with postoperative epidural hematoma (EDH) requiring evacuation.

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  Fig. 2. Magnetic resonance imaging (MRI) of a patient with postoperative epidural abscess, (A) T1-enhanced axial image, (B) T1-enhanced coronal image. Approximately 6 cm-extent fluid collection with irregular thickened peripheral enhancement is observed around the operative site.

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