Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach

Edlmann, Ellie; Holl, Dana C; Lingsma, Hester F.; Bártek, Jiří; Bartley, Andreas; Duerinck, Johnny; Jensen, T. S.; Soleman, Jehuda; Shanbhag, Nagesh C; Devi, Bhagavatula Indira; Laeke, Tsegazeab; Rubiano, Andrés M.; Fugleholm, Kåre; Veken, Jorn Van Der; Tisell, Magnus; Hutchinson, Peter J.; Dammers, Rúben; Kolias, Angelos G.; Iorio-Morin, Christian; Marshman, Laurence A.G.; Poon, Wai Sang; Vimala, Smita; Sousa, Sarah Vitória Gomes de; Stienen, Martin N.; Tian, Ye; Gaag, Niels A. van der; Verbaan, Dagmar

doi:10.1007/s00701-020-04218-8

Cited by 61 publications

(70 citation statements)

References 41 publications

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“…An Indian prospective randomized trial showed similar complications and mortality, but fewer recurrences with drain placement (26 vs. 9%) (26). Other study groups and metaanalyses reached the same conclusions (27)(28)(29)(30)(31)). An Indian RCT reported a lower rate of recurrence with a single burr-hole with drain placement vs. two burr-holes (1.4 vs. 15.7%) (20).…”

Section: Discussionmentioning

confidence: 77%

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

et al. 2020

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Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear.Objective: To identify factors associated with increased risk of recurrence.Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes.Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013).Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs.

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Section: Discussionmentioning

confidence: 77%

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

et al. 2020

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“…The dosage and treatment duration in this trial were selected on the basis of previous studies 8 and are similar to the dosage and treatment duration used in other ongoing trials of glucocorticoids, although longer treatment durations of 3 and 8 weeks are also being evaluated. 25 The median time to recurrence of chronic subdural hematoma after surgical evacuation has been 12 to 15 days in several studies, and this was the rationale for designing the trial with a 2-week treatment period with dexamethasone. 5,12 More adverse events, such as hyperglycemia, new-onset diabetes, new-onset psychosis, and infections, were reported in the dexamethasone group than in the placebo group in our trial.…”

Section: Discussionmentioning

confidence: 99%

Trial of Dexamethasone for Chronic Subdural Hematoma

Hutchinson¹,

et al. 2020

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document.When citing, please reference the published version. Take down policyWhile the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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“…9 However, ongoing RCTs are investigating the value of corticosteroids as stand-alone and adjacent treatment to surgery for CSDH. 13,14 A recent placebo-controlled RCT showed that atorvastatin significantly lowers hematoma volume and neurological symptoms as a stand-alone treatment of cSDH. 15 Hence, atorvastatin could be considered a pharmacological treatment, especially for geriatric patients who are often highrisk surgical candidates.…”

Section: Discussionmentioning

confidence: 99%

“…However, to date, surgery (BHD) remains the gold standard treatment for geriatric patients, while we eagerly anticipate results from various prospective studies on pharmacological and other interventional treatment options. 14 In general, recurrence rates for surgically evacuated cSDH are estimated to be around 10%. 21 The main study and many other publications comparing SPD to SDD in regard to recurrence did not detect a statistically significant difference, except for a trend for a lower recurrence rate in the SPD group.…”

Section: Discussionmentioning

confidence: 99%

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Greuter¹,

Lutz

Fandiño

et al. 2020

Neurosurgical Focus

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OBJECTIVEChronic subdural hematoma (cSDH) occurs more frequently in elderly patients, while older patient age is associated with worse postoperative outcome following burr-hole drainage (BHD) of cSDH. The cSDH-Drain trial showed comparable recurrence rates after BHD and placement of either a subperiosteal drain (SPD) or subdural drain (SDD). Additionally, an SPD showed a significantly lower rate of infections as well as iatrogenic parenchymal injuries through drain misplacement. This post hoc analysis aims to compare recurrence rates and clinical outcomes following BHD of cSDH and the placement of SPDs or SDDs in elderly patients.METHODSThe study included 104 patients (47.3%) 80 years of age and older from the 220 patients recruited in the preceding cSDH-Drain trial. SPDs and SDDs were compared with regard to recurrence rate, morbidity, mortality, and clinical outcome. A post hoc analysis using logistic regression, comparing the outcome measurements for patients < 80 and ≥ 80 years old in a univariate analysis and stratified for drain type, was further completed.RESULTSPatients ≥ 80 years of age treated with an SDD showed higher recurrence rates (12.8%) compared with those treated with an SPD (8.2%), without a significant difference (p = 0.46). Significantly higher drain misplacement rates were observed for patients older than 80 years and treated with an SDD compared with an SPD (0% vs 20%, p = 0.01). Comparing patients older than 80 years to younger patients, significantly higher overall mortality (15.4% vs 5.2%, p = 0.012), 30-day mortality (3.8% vs 0%, p = 0.033), and surgical mortality (2.9% vs 1.7%, p = 0.034) rates were observed. Clinical outcome at the 12-month follow-up was significantly worse for patients ≥ 80 years old, and logistic regression showed a significant association of age with outcome, while drain type had no association with outcome.CONCLUSIONSThe initial findings of the cSDH-Drain trial and the findings of this subanalysis suggest that SPD may be warranted in elderly patients. As opposed to drain type, patient age (> 80 years) was significantly associated with worse outcome, as well as higher morbidity and mortality rates.

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Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach

Cited by 61 publications

References 41 publications

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

Trial of Dexamethasone for Chronic Subdural Hematoma

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

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