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World Neurosurg. 2018 Aug;116:e983-e995. doi: 10.1016/j.wneu.2018.05.145. Epub 2018 May 29.

Treatment Standards for Chronic Subdural Hematoma: Results from a Survey in Austrian, German, and Swiss Neurosurgical Units.

Author information

1
Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland. Electronic address: dominik.baschera@ksw.ch.
2
Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland.
3
Center of Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany.
4
Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland; Brandenburg Medical School, Neuruppin, Germany.

Abstract

BACKGROUND:

Although an abundance of literature about the treatment of chronic subdural hematoma is available, it provides little evidence to clarify which treatment is most successful.

OBJECTIVE:

The aim of this study was to examine and compare current clinical standards between several hospitals.

METHODS:

Chairmen of all neurosurgical units in Austria, Germany, and Switzerland, as listed on the national neurosurgical societies' websites, were invited to participate with a personal token to access a web-based survey. A total of 159 invitations were sent and up to 5 reminder e-mails.

RESULTS:

Eighty-four invitees (53%) completed the survey. The most common surgical intervention was a single burr hole in 52 (65%) of the responding neurosurgical units, double burr holes were performed as primary procedure in 16 centers (20%), a small osteoplastic craniotomy in 4 (5%), and a twist drill craniostomy in 8 (10%). Seventy-two (90%) would place a drain in estimated 75%-100% of cases or whenever possible/safe. Sixty-five used subdural-external drains, and 7 used subgaleal-external drains. Seventeen applied suction to the drains. Thirty-six (49%) agreed with the statement that watchful waiting was an option for the treatment of chronic subdural hematomas and 19 (23.4%) disagreed. Eighteen (23%) would consider corticosteroids and 34 (45%) tranexamic acid as part of their armamentarium for the treatment of subdural hematomas.

CONCLUSIONS:

The results of this survey reflect the current evidence available in literature. Although the benefits of using of a drain are widely recognized, no consensus regarding the type of drain and surgical approach to the hematoma was reached.

KEYWORDS:

Burr hole; Chronic subdural hematoma; Standards; Survey; Treatment

PMID:
29857208
DOI:
10.1016/j.wneu.2018.05.145
[Indexed for MEDLINE]

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