Clinical outcomes of chronic subdural hematoma treated with Foley catheter drainage: a retrospective cohort study.

Abstract

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly among the elderly, that often requires surgical drainage. Due to economic and logistical constraints, traditional closed-system drains are often impractical in low- and middle-income countries (LMICs). Foley catheter drainage has also been proposed as a cost-effective alternative, yet few studies have evaluated its safety and efficacy. This study investigates the clinical outcomes of patients with CSDH who underwent Foley catheter drainage, focusing on its effectiveness and safety.

Materials and methods: This retrospective analysis examined the case records of 134 patients who underwent burr-hole craniotomy with Foley catheter drainage for chronic subdural hematoma (CSDH) at our hospital from January 2022 to December 2024. Patient demographics, presenting symptoms, postoperative recovery, recurrence rates, and complications were assessed. Statistical analysis, including Chi-square tests and Pearson correlation, was conducted using SPSS 28, with a significance threshold set at P < 0.05.

Results: One hundred thirty-four patients were studied, with a mean age of 61.8 years and male predominance (80.6%). The most frequent presenting symptoms were headache (77.6%) and motor deficits (55.97%). Postoperative recovery was satisfactory, with 85% of patients making a complete recovery. The rate of recurrence was 3.7%, and the most common complications were pneumocephalus (7.5%) and infections (5.2%). There was a positive correlation (r = 0.48, P < 0.0001) between preoperative Glasgow Coma Scale (GCS) scores and functional recovery. However, it was not strong enough to serve as a stand-alone predictor, and clinical correlation, which considers other variables, needs to be taken into consideration while interpreting. The mortality rate was 3%.

Conclusion: Foley catheter drainage of cerebrospinal fluid (CSF) hygroma (CSDH) can be considered a reliable and safe alternative in low- and middle-income countries (LMICs), with recovery rates of 85% and a low risk of recurrence. However, further prospective studies are required to prove these findings, as this is a single-arm retrospective study. Though complications were tolerable, attention to surgical technique and vigilant postoperative observation continues to be vital. Further studies and refinement of management are warranted to confirm these results.