Treatment Standards for Chronic Subdural Hematoma: Results from a Survey in Austrian, German, and Swiss Neurosurgical Units

Abstract

Background: Although an abundance of literature about the treatment of chronic subdural hematoma is available, it provides little evidence to clarify which treatment is most successful.

Objective: The aim of this study was to examine and compare current clinical standards between several hospitals.

Methods: Chairmen of all neurosurgical units in Austria, Germany, and Switzerland, as listed on the national neurosurgical societies' websites, were invited to participate with a personal token to access a web-based survey. A total of 159 invitations were sent and up to 5 reminder e-mails.

Results: Eighty-four invitees (53%) completed the survey. The most common surgical intervention was a single burr hole in 52 (65%) of the responding neurosurgical units, double burr holes were performed as primary procedure in 16 centers (20%), a small osteoplastic craniotomy in 4 (5%), and a twist drill craniostomy in 8 (10%). Seventy-two (90%) would place a drain in estimated 75%-100% of cases or whenever possible/safe. Sixty-five used subdural-external drains, and 7 used subgaleal-external drains. Seventeen applied suction to the drains. Thirty-six (49%) agreed with the statement that watchful waiting was an option for the treatment of chronic subdural hematomas and 19 (23.4%) disagreed. Eighteen (23%) would consider corticosteroids and 34 (45%) tranexamic acid as part of their armamentarium for the treatment of subdural hematomas.

Conclusions: The results of this survey reflect the current evidence available in literature. Although the benefits of using of a drain are widely recognized, no consensus regarding the type of drain and surgical approach to the hematoma was reached.

Keywords: Burr hole; Chronic subdural hematoma; Standards; Survey; Treatment.