Hematoma, Subdural, Chronic
Conditions
Keywords
surgery, trephining, drainage, therapeutic irrigation, subdural space, postoperative complications, mortality
Brief summary
There are numerous reported ways to treat chronic subdural hematomas (CSDH) and practice is still differing considerably between departments. Except for a recent randomized controlled trial (RCT) that found that postoperative subdural drainage was better than no drain, there is no higher level evidence. Another recent RCT did not replicate these findings, but the study was severely underpowered. Aim of this population based study is to compare clinical results (reoperation rates, complications, perioperative death, and survival) between neurosurgical departments treating CSDH with different treatment policies.
Interventions
PROCEDUREBurr hole surgery with various drainage techniques
Surgical technique 1. Continuous irrigation and drainage 2. Passive subdural drain 3. Active subgaleal drain
Sponsors
Norwegian University of Science and Technology
University Hospital of North Norway
Karolinska Institutet
St. Olavs Hospital
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients treated with evacuation of primary chronic subdural hematoma(CSDH) from 2005 through 2010 at St.Olav University Hospital * All patients treated with evacuation of primary chronic subdural hematoma(CSDH) from 2005 through 2010 at University Hospital North Norway * All patients treated with evacuation of primary CSDH from 2006 through 2010 at Karolinska University Hospital (not 2005 due to practical reasons since major changes occurred in electronic surgery protocols 2005).
Exclusion criteria
* Chronic subdural hematoma in arachnoid cyst(s) * Previous CSDH surgery * External hydrocephalus (hydrocephalus with cerebrospinal fluid (CSF) in the subdural space rather than in the ventricles) * CSDH due to previous intracranial surgery (within 6 months).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| reoperations | 1 year | Number of reoperations (X/N, %) between centers |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| continuous irrigation versus other drainage | 1 year | Number of reoperations with use of continuous irrigation (UNN) versus other drainage (St.Olav, Karolinska) |
| perioperative death | 30 days | — |
| survival | 3 years | Minimum 3 years follow up. Report 1 year mortality and use of Kaplan Meier curves (log rank test) |
| surgical complications | 30 days | As defined by the Ibanez classification where it is the treatment given for a complication that gives the score. Medical and surgical complication is both mentioned and reported seperately |
Countries
Norway, Sweden
Outcome results
None listed