{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T06:39:03Z","timestamp":1793860743484,"version":"4.6.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2014subdural drain (SDD), subperiosteal drain (SPD), and subgaleal drain (SGD)\u2014on treatment outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A search was conducted across PubMed, Embase, Cochrane Library, and Web of Science up to February 14, 2026. The Newcastle\u2013Ottawa Scale was used to assess the risk of bias. R (v4.4.0) and Stata18 were used for the NMA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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)\u202f=\u202f0.43, 95% credible interval (CrI): 0.20\u20130.96]. 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 recurrence versus No_drain (RR\u202f=\u202f0.26, 95% CrI: 0.10\u20130.75), and also ranked highest in SUCRA (79.83%). (2) Mortality: Classification I: SGD was associated with reduced mortality (SUCRA\u202f=\u202f72.64%). Classification II: subdural irrigation drainage (SDD_irr) showed the best efficacy in reducing mortality (SUCRA\u202f=\u202f63.85%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SGD_a and SDD_irr exhibit significant potential in reducing recurrence rates and mortality, respectively, in the management of CSDH. However, due to the physiological conditions and disease features of old and high-risk populations, careful assessment is necessary when selecting treatment approaches in clinical practice. Further studies should be conducted to clarify the actual efficacy of these two treatment modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      This study is a systematic review and network meta-analysis and has been registered in the PROSPERO database. Registration ID: CRD42024587692. Official URL:\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=587692<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1706424","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T04:29:53Z","timestamp":1778560193000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimal drain position after evacuation of chronic subdural hematomas: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Ningyu","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyu","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Chongqing Medical University Affiliated First Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"402","DOI":"10.2176\/nmc.ra.2016-0337","article-title":"Chronic subdural hematoma in elderly patients: is this disease benign?","volume":"57","author":"Uno","year":"2017","journal-title":"Neurol Med Chir 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