Abstract
ObjectiveChronic subdural hematoma (CSDH) is a condition that is frequently seen in the neurological and neurosurgical practice. Surgical treatment is overall preferred; however, conservative treatment is also an option. Both surgical and conservative treatment of CSDH vary across neurosurgeons. The aim of the present study was to evaluate different treatment strategies for CSDH among neurosurgeons in different countries. Material and MethodsWe designed a survey that was sent to neurosurgeons affiliated with the Congress of Neurological Surgeons.The questions were related to the conservative and surgical treatment methods of CSDH. Furthermore, we also included questions related to post-operative care. Results443 neurosurgeons completed the survey. 46.2 % of the respondents sometimes use dexamethasone as monotherapy. Overall, 26.2 % estimated dexamethasone to have a high efficacy on CSDH.A Glasgow Coma Score lower than 12 was considered to be the most important indication for surgery by 57.8 %. Double burr hole is the preferred surgical technique by 48.1 % of the respondents. One day after surgery, 69.3 % routinely orders a CT-scan. ConclusionsThe majority of the neurosurgeons worldwide remains reluctant in the use of conservative treatment methods in the management of CSDH. Further research is needed to assess the effectivity and side-effects of these conservative methods.
Highlights
Chronic subdural hematoma (CSDH) is a condition that is frequently seen in the neurological and neurosurgical practice
Among 443 neurosurgeons of which the majority treated more than five patients with CSDH yearly, conservative treatment methods such as atorvastatin, ACE-inhibitors and tranexamic acid were almost never used in practice
Neurosurgeons remain reluctant in the use of conservative therapy in the treatment of CSDH
Summary
Chronic subdural hematoma (CSDH) is a condition that is frequently seen in the neurological and neurosurgical practice. CSDH is most commonly seen in the elderly population [2,6]. With the ageing population there is an expected increase of CSDH worldwide, with an incidence of 58 per 10,000 among people older than 65 [2]. It is noted that a minor part of the neurosurgeons prescribe medical therapy, instead of or in addition to surgery, for the treatment of CSDH [1]. Conservative treatment may consist of prescription of ACE-inhibitors, corticosteroids, atorvastatin or tranexamic acid. The effectiveness of these medications is expected due to their anti-angiogenic, anti-inflammatory, or antifibrinolytic characteristics, respectively [7,10,11,12,13,22]
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