Enlighten-Research publications by members of the University of Glasgow http://eprints.gla.ac.uk Minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label phase 3 trial with blinded endpoint
The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/
Percutaneous bedside twist-drill drainage is a relatively safe and effective first-line management option. These findings may result in potential health cost savings and eliminate perioperative risks related to general anesthetic.
Chronic subdural hematoma (SDH) in the elderly population is a common problem encountered in neurosurgical practice. The incidence of chronic SDH has been reported as 1.7 per 100,000/year. 1 Thus, in Canada (population = 32 million), we can expect approximately 550 individuals with chronic SDHs per year. The peak incidence occurs in the sixth and seventh decades to 7.4 per 100,000 in the 70-79 age group. 1 With a greater proportion of elderly individuals in Canada over the next decade, the incidence of chronic SDH will further increase.Chronic SDH is typically defined as a hematoma with a duration greater than three weeks. 2,3 This differs from subacute SDH which is characterized by a shorter duration (three days to three weeks post initiating event). 2,3 ABSTRACT: Objective: To survey neurosurgical practices in the treatment of chronic and subacute subdural hematoma in the Canadian adult population. Methods: We developed and administered a questionnaire to Canadian Neurosurgeons with questions relating to the management of chronic and subacute subdural hematoma. Our sampling frame included all neurosurgery members of the Canadian Neurosurgical Society. Results: Of 158 questionnaires, 120 were returned (response rate = 76%). The respondents were neurosurgeons with primarily adult clinical practices (108/120). Surgeons preferred one and two burr-hole craniostomy to craniotomy or twist-drill craniostomy as the procedure of choice for initial treatment of subdural hematoma (35.5% vs 49.5% vs 4.7% vs 9.3%, respectively). Craniotomy and two burr-holes were preferred for recurrent subdural hematomas (43.3% and 35.1%, respectively). Surgeons preferred irrigation of the subdural cavity (79.6%), use of a subdural drain (80.6%), and no use of anti-convulsants or corticosteroids (82.1% and 86.6%, respectively). We identified a lack of consensus with keeping patients supine following surgery and post-operative antibiotic use. Conclusion: Our survey has identified variations in practice patterns among Canadian Neurosurgeons with respect to treatment of subacute or chronic subdural hematoma (SDH). Our findings support the need for further prospective studies and clinical trials to resolve areas of discrepancies in clinical management and hence, standardize treatment regimens.RÉSUMÉ: Prise en charge de l'hématome sous-dural chronique: enquête nationale et revue de la littérature. Objectif: Effectuer une enquête sur le traitement neurochirurgical de l'hématome sous-dural chronique et subaigu dans la population adulte canadienne. Méthodes: Nous avons développé un questionnaire comportant des questions sur la prise en charge de l'hématome sous-dural chronique et subaigu et nous l'avons soumis aux neurochirurgiens canadiens. Notre échantillon était constitué de tous les membres de la Société canadienne de neurochirurgie. Résultats: 120 des 158 questionnaires postés ont été retournés (taux de réponse de 76%). Les répondants étaient des neurochirurgiens en pratique clinique adulte surtout (108/120). Les chirurgiens préféraient la c...
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