The effect of long-term subgaleal drain retention (for 14 days) in preventing Cerebro-Spinal Fluid (CSF) fistula development in cases with an insufficiently closed dural defect after craniotomy or craniectomy

Abstract

Purpose: Our aim was to determine the effectiveness of long-term subgaleal drain retention in preventing CSF fistula development that may occur in the wound site when the dura cannot be completely closed after craniotomy or craniectomy.
 Material and method: This study was planned to include the cases of craniotomy and craniectomy performed at Bak?rcay University Cigli Training and Research Hospital during 2017-2021. The study has been made in a retrospective manner to include a subgaleal drain group and a control group. Both groups were selected from Bak?rcay University Cigli Training and Research Hospital. A subgaleal drain was placed in 18 cases with a large or multiple defect after craniotomy or craniectomy where the defect could not be completely closed with grafts. It was planned to be kept in place for 14days with free drainage. Patients were administered antibiotics for three days after the surgery. Patients were monitored for CSF fistula and infection development. On the other hand, 12 patients having large dural defect were included in the control group. Patients in the control group were determined by a random selection method. Patients were followed for 2 days under subgaleal drainage. The Control group was also monitored for CSF fistula and infection development. Both groups statistically were compared with each other in terms of CSF fistula and infection development.
 Results: There were 18 cases where the dura was closed insufficiently, long-term subgaleal drainage was performed. The mean age was 66.6 (34-82) years. The surgery performed was craniotomy/craniectomy for cerebellar hematoma drainage in 3 cases, acute subdural hematoma drainage in 5 cases, supratentorial tumour resection in 5 cases, large depression fracture in 4 cases and debridement of cerebral tissue damaged by firearm injury in 1 case. The drain was withdrawn at the end of the 14th day in all patients. A CSF fistula did not occur in any of 18 patients (%0) included in the study. In all patients (%100), the wounds were healed without any problems and no signs of local or systemic infection were found. In the control group, the mean age is 62.2 (48-88) years. CSF fistula developed in 4 (%33.3) of 12 patients in the control group. We had to apply lumbal external drainage in 2(%50) of 4 patients with CSF fistula. Central nervous system infection developed in one (% 8.33) patient.
 Conclusion: Long-term subgaleal drainage can be used as an alternative to lumbar external drainage.