Analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas

Clinical article

Restricted access


The subdural evacuating port system (SEPS; Medtronic, Inc.) is a minimally invasive means of draining subacute or chronic subdural fluid collections. The purpose of this study was to examine a single institution's results with the SEPS.


A retrospective chart review was undertaken for all patients who underwent SEPS drainage of subdural collections. Demographic and radiographic characteristics were evaluated. Both pre- and post-SEPS CT studies were analyzed to determine the volume of subdural collection and midline shift. Hospital charts were reviewed for SEPS output, and periprocedural complications were noted. Results were classified as a success (S) or failure (F) based on the need for further subdural drainage procedures. Groups were then compared to identify factors predictive of success.


Eighty-five subdural collections were treated in 74 patients (unilateral collections in 63 patients and bilateral in 11). Sixty-three collections (74%) were successfully drained. In a comparison of the success and failure groups, there were no statistically significant differences (p < 0.05) in the mean age pre-SEPS, Glasgow Coma Scale score, presenting symptoms, underlying coagulopathy or use of anticoagulation/antiplatelet agents, laterality of SDH, pre-SEPS subdural volume or midline shift, or any of the measurements used to characterize SEPS placement. There were a greater number of male patients in the success group (45 [82%] of 55 patients vs 11 [58%] of 19 patients; p = 0.04). The only statistically significant (p < 0.05) factor predictive of success was the radiographic appearance of the subdural collection. More hypodense collections were successfully treated (32 [51%] of 63 collections vs 4 [18%] of 22 collections; p = 0.005), whereas mixed density collections were more likely to fail SEPS treatment (S: 11 [17%] of 63 collections vs F: 14 [64%] of 22 collections; p < 0.00001). In the success group, the percentage of the collection drained after SEPS was greater (S: 47.1 ± 32.8% vs F: 19.8 ± 28.2%; p = 0.001) and a larger output was drained (S: 190.7 ± 221.5 ml vs F: 60.2 ± 63.3 ml; p = 0.001). In the patients with available but delayed scans (≥ 30 days since SEPS placement), the residual subdural collection following successful SEPS evacuation was nearly identical to that remaining after open surgical evacuation in the failure group. In 2 cases (2.4% of total devices used), SEPS placement caused a new acute subdural component, necessitating emergency evacuation in 1 patient.


The SEPS is a safe and effective treatment option for draining subacute and chronic SDHs. The system can be used quickly with local anesthesia only, making it ideal in elderly or sick patients who might not tolerate the physiological stress of a craniotomy under general anesthesia. Computed tomography is useful in predicting which subdural collections are most amenable to SEPS drainage. Specifically, hypodense subdural collections drain more effectively through an SEPS than do mixed density collections. Although significant bleeding after SEPS insertion was uncommon, 1 patient in the series required urgent surgical hematoma evacuation due to iatrogenic injury.

Abbreviations used in this paper: F = failure; GCS = Glasgow Coma Scale; SDH = subdural hematoma; S = success; SEPS = subdural evacuating port system.

Article Information

Address correspondence to: Tyler J. Kenning, M.D., Division of Neurosurgery, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, New York 12208. email:

Please include this information when citing this paper: published online May 28, 2010; DOI: 10.3171/2010.5.JNS1083.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Axial cranial CT scans demonstrating differing density collections. A: Right hypodense SDH. B: Right isodense SDH. C: Right mixed density SDH.



Asfora WTSchwebach L: A modified technique to treat chronic and subacute subdural hematoma: technical note. Surg Neurol 59:3293322003


Benes LEggers FAlberti OBertalanffy H: A new screw catheter kit for the bedside treatment of chronic subdural hematomas. J Trauma 52:5915942002


El Solh AARamadan FH: Overview of respiratory failure in older adults. J Intensive Care Med 21:3453512006


Emonds NHassler WE: New device to treat chronic subdural hematoma—hollow screw. Neurol Res 21:77781999


Horn EMFeiz-Erfan IBristol RESpetzler RFHarrington TR: Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study. Surg Neurol 65:1501542006


Jeffree RLGordon DHSivasubramaniam RChapman A: Warfarin related intracranial haemorrhage: a case-controlled study of anticoagulation monitoring prior to spontaneous subdural or intracerebral haemorrhage. J Clin Neurosci 16:8828852009


Miele VJSadrolhefazi ABailes JE: Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma. Surg Neurol 63:4204232005


Mondorf YAbu-Owaimer MGaab MROertel JM: Chronic subdural hematoma—craniotomy versus burr hole trepanation. Br J Neurosurg 23:6126162009


Mori KMaeda M: Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41:3713812001


Rabinstein AAChung SYRudzinski LALanzino G: Seizures after evacuation of subdural hematomas: incidence, risk factors, and functional impact. Clinical article. J Neurosurg 112:4554602010


Ramnarayan RArulmurugan BWilson PMNayar R: Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method. Clin Neurol Neurosurg 110:7747782008


Rohde VGraf GHassler W: Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev 25:89942002


Rughani AILin CDumont TMPenar PLHorgan MATranmer BI: A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomas. Clinical article. J Neurosurg [epub ahead of print December 11 2009 DOI: 10.3171/2009.11.JNS091244]


Senft CSchuster TForster MTSeifert VGerlach R: Management and outcome of patients with acute traumatic subdural hematomas and pre-injury oral anticoagulation therapy. Neurol Res 31:101210182009


Stanisic MLund-Johansen MMahesparan R: Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien) 147:124912572005


Sucu HKGokmen MGelal F: The value of XYZ/2 technique compared with computer-assisted volumetric analysis to estimate the volume of chronic subdural hematoma. Stroke 36:99810002005


Weigel RSchmiedek PKrauss JK: Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:9379432003




All Time Past Year Past 30 Days
Abstract Views 128 128 40
Full Text Views 236 236 10
PDF Downloads 191 191 8
EPUB Downloads 0 0 0


Google Scholar