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Management of Chronic Subdural Hematoma: A National Survey and Literature Review

Published online by Cambridge University Press:  02 December 2014

Aleksa Cenic
Affiliation:
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
Mohit Bhandari
Affiliation:
Division of Orthopedics, McMaster University, Hamilton, Ontario, Canada
Kesava Reddy
Affiliation:
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
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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:

RÉSUMÉ: 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 craniostomie à un et à deux trous de trépan plutôt que la craniotomie ou la craniostomie par foret hélicoïdal pour le traitement initial de l’hématome sous-dural (35,5% ; 49,5% ; 4,7% ; 9,3% respectivement). La craniotomie et la craniostomie à deux trous de fraise étaient les techniques privilégiées pour traiter les récidives d’hématomes sous-duraux (43,3% et 35,1% respectivement). Les chirurgiens préféraient l’irrigation de la cavité sous-durale (79,6%), la mise en place d’un drain sous-dural (80,6%) sans administration d’anti-convulsivants ou de corticostéroïdes (82,1% et 86,6% respectivement). Nous avons constaté une absence de consensus en ce qui concerne la position du patient en décubitus dorsal après la chirurgie et l’utilisation d’antibiotiques dans les suites postopératoires.

Conclusion:

Notre enquête a identifié des différences dans le traitement de l’hématome sous-dural sub-aigu ou chronique par les neurochirurgiens canadiens. Ces constatations soulignent le besoin d’études prospectives et d’essais thérapeutiques pour résoudre ces différences dans la prise en charge et donc pour standardiser la prise en charge de ces affections.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2005

References

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