gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Treatment concept of chronic subdural hematoma according to an optimized algorithm based on evidence-based-medicine derived key factors: a prospective controlled study

Meeting Abstract

  • L. Schlickum - Radiologische Klinik, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg
  • R. Weigel - Neurochirurgische Universitätsklinik, Medizinische Hochschule Hannover
  • G. Weisser - Radiologische Klinik, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg
  • J.K. Krauss - Neurochirurgische Universitätsklinik, Medizinische Hochschule Hannover

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.06.04

DOI: 10.3205/12dgnc206, URN: urn:nbn:de:0183-12dgnc2064

Published: June 4, 2012

© 2012 Schlickum et al.
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Outline

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Objective: In the past we analyzed the literature on chronic subdural hematoma for the efficiency of different operative treatment options. We then implemented our findings in an optimized treatment algorithm (OA-EBM group) and compared the results to a control group treated by the standard departmental surgical technique (SDST group) in a prospective design.

Methods: Symptomatic patients with chronic subdural hematoma who fulfilled the inclusion criteria were randomly assigned to one of two treatment arms according to the duty roster of the clinic. For the OA-EBM-algorithm only one burr hole, intraoperative rinsing and a closed system drainage was mandatory. A two-catheter-technique was used to reduce intracavital air. Final endpoints were recurrence and the amount of intracranial air on postoperative ct-scan.

Results: A total of 93 out of 117 patients joined the study accounting for 113 cases because of 20 patients with bilateral hematomas. Demographic data of 68 cases treated by the standard protocol did not differ from 45 cases treated by the EBM-algorithm. Recurrence rate was 18% (12 cases) in the SDST group versus 2% (1 case) in the EBM group (p < 0,05). The amount of intracranial air was significantly lower in the OA-EBM group (3 ± 0.7 cm3 vs 5 ± 0.9 cm3) with p = 0.04. In the standard group ct-scanning was performed slightly earlier (3 ± 0.2 days vs 3.6 ± 0.2 days, p = 0.015). Comparing only non-recurrent cases of both groups no significant difference was apparent.

Conclusions: Implementation of EBM key factors into a treatment algorithm for chronic subdural hematoma can improve outcome in a typical neurosurgical department by means of recurrence and the amount of postoperative air within the hematoma cavity.