Optimising treatment for chronic subdural haematoma

Chronic subdural haematoma is a common neurosurgical condition, primarily observed in older people (ie, aged ≥60 years), that has an annual incidence of 1·7–20·6 cases per 100 000 individuals. 1 Feghali J Yang W Huang J Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg. 2020; 141: 339-345 Crossref PubMed Scopus (136) Google Scholar As the global population continues to age, an increasing prevalence of chronic subdural haematoma is anticipated. 2 Mehta V Harward SC Sankey EW Nayar G Codd PJ Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. J Clin Neurosci. 2018; 50: 7-15 Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar The pathophysiology of chronic subdural haematoma involves several inflammatory processes that result in leaky vascularised membranes. 1 Feghali J Yang W Huang J Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg. 2020; 141: 339-345 Crossref PubMed Scopus (136) Google Scholar , 2 Mehta V Harward SC Sankey EW Nayar G Codd PJ Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. J Clin Neurosci. 2018; 50: 7-15 Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar Although investigations into pharmacological therapies (eg, atorvastatin, tranexamic acid, and angiotensin-converting enzyme inhibitors) targeting various pathways involved in this cycle have been made, surgical intervention is still the primary treatment. 1 Feghali J Yang W Huang J Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg. 2020; 141: 339-345 Crossref PubMed Scopus (136) Google Scholar , 2 Mehta V Harward SC Sankey EW Nayar G Codd PJ Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. J Clin Neurosci. 2018; 50: 7-15 Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar , 3 Liu W Bakker NA Groen RJ Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014; 121: 665-673 Crossref PubMed Scopus (221) Google Scholar Although surgical outcomes are generally favourable, some patients have postoperative recurrence, neurological deterioration, and occasionally fatal outcomes, 1 Feghali J Yang W Huang J Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg. 2020; 141: 339-345 Crossref PubMed Scopus (136) Google Scholar thereby presenting a notable public health challenge. Burr-hole drainage with or without irrigation for chronic subdural haematoma (FINISH): a Finnish, nationwide, parallel-group, multicentre, randomised, controlled, non-inferiority trialWe could not conclude non-inferiority of burr-hole drainage without irrigation. The reoperation rate was 6·0 percentage points higher after burr-hole drainage without subdural irrigation than with subdural irrigation. Considering that there were no differences in functional outcome or mortality between the groups, the trial favours the use of subdural irrigation. Full-Text PDF