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Ambivalence among neurologists and neurosurgeons on the treatment of chronic subdural hematoma: a national survey

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Abstract

No class I evidence exists about the optimal treatment of chronic subdural hematoma (CSDH). The aim of this study was to evaluate current practice of CSDH patients with different neurological grades, and probable ambivalence towards various treatment paradigms, especially primary treatment with high-dose corticosteroids, among vascular neurologists and neurosurgeons. A questionnaire survey containing 4 questions, 1 consisting of cases, was sent to every vascular neurologist (n = 83) and neurosurgical centre (n = 15) in the Netherlands. The various treatment options were related to the treating physician, geographical distribution, both in general and for individual case. Sixty-two percent of surveys were returned. The proportion of patients primarily treated with corticosteroids was 17.5 % in 2009 and 20.5 % in 2010. Surgery by either burr holes or craniotomy was favoured by 61.1 % as primary treatment, and conservative treatment with corticosteroids by 22.4 %. Case studies revealed that surgery was preferred in case of severe neurological symptoms, whereas wait-and-see policy was preferred in case of mild symptoms without midline shift, of which 28 % would administer corticosteroids. Variety in answers was obtained in less pronounced cases. In the Netherlands, neurologists and neurosurgeons appear to favour surgery in CSDH patients as primary treatment, especially in severe cases. An ambivalent approach towards treatment protocols was shown, especially in patients with mild symptoms, regardless of hematoma size. A regimen of high-dose corticosteroids only, is preferred by about a quarter and predominantly in milder cases, and might depend on geographical distribution. These results suggest the need for a well-designed randomized trial.

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References

  1. Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK (2002) Chronic subdural haematoma in the elderly. Postgrad Med J 78:71–75

    Article  PubMed  CAS  Google Scholar 

  2. Sambasivan M (1997) An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol 47:418–422

    Article  PubMed  CAS  Google Scholar 

  3. Stroobandt G, Fransen P, Thauvoy C, Menard E (1995) Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. Acta Neurochir (Wien) 137:6–14

    Article  CAS  Google Scholar 

  4. Mori K, Maeda M (2001) Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41:371–381

    Article  CAS  Google Scholar 

  5. Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ (2008) The management of primary chronic subdural haematoma: a questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg 22:529–534

    Article  PubMed  CAS  Google Scholar 

  6. Bender MB, Christoff N (1974) Nonsurgical treatment of subdural hematomas. Arch Neurol 31:73–79

    Article  PubMed  CAS  Google Scholar 

  7. Cenic A, Bhandari M, Reddy K (2005) Management of chronic subdural hematoma: a national survey and literature review. Can J Neurol Sci 32:501–506

    PubMed  Google Scholar 

  8. Dran G, Berthier F, Fontaine D, Rasenrarijao D, Paquis P (2007) Effectiveness of adjuvant corticosteroid therapy for chronic subdural hematoma: a retrospective study of 198 cases. Neurochirurgie 53:477–482

    Article  PubMed  CAS  Google Scholar 

  9. Drapkin AJ (1991) Chronic subdural hematoma: pathophysiological basis for treatment. Br J Neurosurg 5:467–473

    Article  PubMed  CAS  Google Scholar 

  10. Guenot M (2001) Chronic subdural hematoma. Introduction and results of a survey by the French Society of Neurosurgery. Neurochirurgie 47:459–460

    PubMed  CAS  Google Scholar 

  11. Sun TF, Boet R, Poon WS (2005) Non-surgical primary treatment of chronic subdural haematoma: Preliminary results of using dexamethasone. Br J Neurosurg 19:327–333

    Article  PubMed  CAS  Google Scholar 

  12. Zarkou S, Aguilar MI, Patel NP, Wellik KE, Wingerchuk DM, Demaerschalk BM (2009) The role of corticosteroids in the management of chronic subdural hematomas: a critically appraised topic. Neurologist 15:299–302

    Article  PubMed  Google Scholar 

  13. Hong HJ, Kim YJ, Yi HJ, Ko Y, Oh SJ, Kim JM (2009) Role of angiogenic growth factors and inflammatory cytokine on recurrence of chronic subdural hematoma. Surg Neurol 71:161–165

    Article  PubMed  Google Scholar 

  14. Frati A, Salvati M, Mainiero F, Ippoliti F, Rocchi G, Raco A, Caroli E, Cantore G, Delfini R (2004) Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: a prospective study. J Neurosurg 100:24–32

    Article  PubMed  Google Scholar 

  15. Glover D, Labadie EL (1976) Physiopathogenesis of subdural hematomas. Part 2: inhibition of growth of experimental hematomas with dexamethasone. J Neurosurg 45:393–397

    Article  PubMed  CAS  Google Scholar 

  16. Delgado-Lopez PD, Martin-Velasco V, Castilla-Diez JM, Rodriguez-Salazar A, Galacho-Harriero AM, Fernandez-Arconada O (2009) Dexamethasone treatment in chronic subdural haematoma. Neurocirugia (Astur) 20:346–359

    CAS  Google Scholar 

  17. Pichert G, Henn V (1987) Conservative therapy of chronic subdural hematomas. Schweiz Med Wochenschr 117:1856–1862

    PubMed  CAS  Google Scholar 

  18. Goodglass H, Kaplan E (1983) The assessment of aphasia and related disorders. Lea Febiger, Philadelphia

    Google Scholar 

  19. Weigel R, Schmiedek P, Krauss JK (2003) Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:937–943

    Article  PubMed  CAS  Google Scholar 

  20. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374:1067–1073

    Article  PubMed  Google Scholar 

  21. Parlato C, Guarracino A, Moraci A (2000) Spontaneous resolution of chronic subdural hematoma. Surg Neurol 53:312–315

    Article  PubMed  CAS  Google Scholar 

  22. Naganuma H, Fukamachi A, Kawakami M, Misumi S, Nakajima H, Wakao T (1986) Spontaneous resolution of chronic subdural hematomas. Neurosurgery 19:794–798

    Article  PubMed  CAS  Google Scholar 

  23. Maurice-Williams RS (1999) Chronic subdural haematoma: an everyday problem for the neurosurgeon. Br J Neurosurg 13:547–549

    Article  PubMed  CAS  Google Scholar 

  24. Suzuki M, Endo S, Inada K, Kudo A, Kitakami A, Kuroda K, Ogawa A (1998) Inflammatory cytokines locally elevated in chronic subdural haematoma. Acta Neurochir (Wien) 140:51–55

    Article  CAS  Google Scholar 

  25. Suzuki M, Kudo A, Kitakami A, Doi M, Kubo N, Kuroda K, Ogawa A (1998) Local hypercoagulative activity precedes hyperfibrinolytic activity in the subdural space during development of chronic subdural haematoma from subdural effusion. Acta Neurochir (Wien) 140:261–265

    Article  CAS  Google Scholar 

  26. Wada T, Kuroda K, Yoshida Y, Ogasawara K, Ogawa A, Endo S (2006) Local elevation of the anti-inflammatory interleukin-10 in the pathogenesis of chronic subdural hematoma. Neurosurg Rev 29:242–245

    Article  PubMed  Google Scholar 

  27. Weigel R, Schilling L, Schmiedek P (2001) Specific pattern of growth factor distribution in chronic subdural hematoma (CSH): evidence for an angiogenic disease. Acta Neurochir (Wien) 143:811–818

    Article  CAS  Google Scholar 

  28. Berghauser Pont LM, Dammers R, Schouten JW, Lingsma HF, Dirven CM (2012) Clinical factors associated with outcome in chronic subdural hematoma: a retrospective cohort study of patients on pre-operative corticosteroid therapy. Neurosurgery 70:873–880

    Article  PubMed  Google Scholar 

  29. Berghauser Pont LME, Dirven CMF, Dippel DW, Verweij BH, Dammers R (2012) The role of corticosteroids in the management of chronic subdural hematoma, a systematic review. Eur J Neurol. doi: 10.1111/j.1468-1331.2012.03768.x. [Epub ahead of print]

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Authors and Affiliations

  1. Department of Neurosurgery, Erasmus MC, ‘s Gravendijkwal 230, Office Hs-114, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    L. M. E. Berghauser Pont, C. M. F. Dirven & R. Dammers

  2. Department of Neurology, Erasmus MC, Rotterdam, The Netherlands

    D. W. J. Dippel

  3. Rudolf Magnus Institute of Neuroscience, University MC Utrecht, Utrecht, The Netherlands

    B. H. Verweij

Authors
  1. L. M. E. Berghauser Pont
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  2. D. W. J. Dippel
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  3. B. H. Verweij
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  4. C. M. F. Dirven
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  5. R. Dammers
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Correspondence to R. Dammers.

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Berghauser Pont, L.M.E., Dippel, D.W.J., Verweij, B.H. et al. Ambivalence among neurologists and neurosurgeons on the treatment of chronic subdural hematoma: a national survey. Acta Neurol Belg 113, 55–59 (2013). https://doi.org/10.1007/s13760-012-0130-1

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  • DOI: https://doi.org/10.1007/s13760-012-0130-1

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