Introduction: Chronic Sub dural Hematoma (SDH) is a common problem encountered in neurosurgical practice. Surgical intervention has remained the gold standard. Even though, there is no clear consensus regarding different mode of surgical interventions. Published practice parameters are highly controversial till date. We have tried to address one of such controversies in this present article.

Material and Methods: This is a retrospective review of 216 hemispheres drained through double burr holes craniostomy. The decisions to place subdural drain were on surgeon’s preference and beliefs. Radiological and symptomatic recurrences were noted in both drain and no drain group.

Results: Cohort was divided into two groups, drain versus no drain. Subdural drain was placed in 94/216 (43.51%) hemispheres. No drain was placed in 122/216 (56.48%) hemispheres. In drain group, there were 23 (24.46%) radiological recurrence of which only 5 (5.31% of drain group) were symptomatic. In no drain group, there were 39 (31.96%) radiological recurrences and 11 (9.01% of no drain group) symptomatic recurrences. The difference was not statistically significant.

Conclusions: The use of subdural drain was associated with lower radiological and symptomatic recurrences without any statistical significance. Only one fourth of radiological recurrences became symptomatic requiring re–intervention. More randomised control trials are required to formulate guidelines.