How do you decide when to place a drain after a subdural hematoma evacuation?

Drain use following chronic subdural hematoma drainage has long been controversial. The risk of brain injury while placing subdural drains has been well described and should be carefully considered when making the decision to do so. On the other hand, studies have demonstrated that subdural drains reduce the risk of hematoma recurrence.

My personal approach to the use of drains after burr hole drainage of a chronic subdural hematoma is the following:

1. If the brain visibly “bounces back” after drainage of the subdural hematoma, I tend to avoid the placement of a drain.
2. If, following evacuation of the subdural hematoma, the brain does not return near its normal location under the burr hole, I will leave a small drain. That said, I do not plac...