PUBLICATIONS

Dexamethasone versus surgery for chronic subdural hematoma.

CONCLUSIONS: More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.

IP Miah*, DC Holl*, J Blaauw, HF Lingsma, HM den Hertog, B Jacobs, ND Kruyt, J van der Naalt, S Polinder, RJM Groen, KH Kho, F van Kooten, CMF Dirven, WC Peul, K Jellema, R Dammers, NA van der Gaag, DECSA Collaborators

New England Journal of Medicine (2022)

Natural History and Management Options of Chronic Subdural Hematoma. 

CONCLUSIONS:

• The importance of CSDH should not be underestimated. The complication and recurrence rates are relatively high and can significantly affect the quality of life and outcome of elderly patients. Similarly, costs associated with the increasing incidence are high. 

• Treatment is warranted when there are significant and progressive clinical symptoms and corresponding radiological finding of substantial subdural collection exerting mass effect on the underlying brain

• Surgery is the mainstay of treatment for CSDH. Both BHC and TDC are considered effective treatment options and in some cases, craniotomy may be required. However, there is no level I evidence comparing these 3 techniques.

• There is level I evidence that placement of a subdural drain during burr hole craniostomy is associated with reduced recurrence and mortality. 

• Good outcomes and a return to previous functional baseline can be achieved in many patients but not all.

• Complications rates are also relatively high and need to be anticipated, diagnosed and treated in a timely manner.

• Since the incidence of CSDH is expected to double over the next 30 years, class I evidence on the clinical- and cost- effectiveness of surgical and non-surgical treatments is highly important. High quality randomized controlled trials are needed to provide reliable data to refine clinical decision-making.

DC Holl, AG Kolias, R Dammers, I Timofeev

Chapter 15 in Neurosurgical Diseases: An Evidence-based Approach to Guide Practice. ISBN: 1684200512. Thieme (2022)

Surgery after primary dexamethasone treatment for patients with Chronic Subdural Hematoma - A retrospective study.

CONCLUSIONS: More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.

DC Holl, R Fakhry, CMF Dirven, FAL te Braake, OK Begashaw, W Moudrous, SM Droger, N Asahaad, C de Brabander, GJJ Plas, B Jacobs, J van der Naalt, HM den Hertog, NA van der Gaag, K Jellema, R Dammers, HF Lingsma

World Neurosurgery (2022)

External validation of prognostic models predicting outcome after chronic subdural hematoma.

CONCLUSIONS: None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confrms the difculty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unifed predictors and relevant outcome measures and appropriate modeling strategies is warranted.

DC Holl, A Mikolic, J Blaauw, R Lodewijkx, M Foppen, K Jellema, NA van der Gaag, HM den Hertog, B Jacobs, J van der Naalt, D Verbaan, KH Kho, CMF Dirven, R Dammers, HF Lingsma, D van Klaveren

Acta Neurochirurgica (2022)

National survey on the current practice and attitudes toward the management of chronic subdural hematoma.

CONCLUSIONS: Variation was found regarding preferential CSDH-treatment. However, this is considered not to be insurmountable when implementing evidence-based treatments. This baseline inventory on current clinical practice and current attitudes toward CSDH-treatment is a stepping-stone in the eventual development and implementation of a national guideline.

DC Holl, J Blaauw, E Ista, CMF Dirven, KH Kho, K Jellema, NA van der Gaag, IP Miah, HM den Hertog, J van der Naalt, B Jacobs, D Verbaan, S Polinder, HF Lingsma, R Dammers, DSHR Collaboration.

Brain and Behavior (2022)

Change in hematoma size after dexamethasone therapy in chronic subdural hematoma subtypes: A prospective study in symptomatic patients.

CONCLUSIONS: Largest hematoma reduction and better clinical improvement was observed in chronic subdural hematoma without hyperdense components after dexamethasone therapy. Evaluation of these parameters can be part of an individualized treatment strategy.

IP Miah, A Blanter, Y Tank, E van Zwet, F Rosendaal, WC Peul, R Dammers, DC Holl, HF Lingsma, HM den Hertog, J van der Naalt, K Jellema, NA van der Gaag

Journal of Neurotrauma (2022)

Study Protocol on Defining Core Outcomes and Data Elements in Chronic Subdural Haematoma. 

CONCLUSIONS: This Delphi survey should result in consensus on a Core Outcome Set and a standardized CSDH Definition and Data Elements to be used in future CSDH studies.

DC Holl, A Chari, C Iorio-Morin, R Dammers, NA van der Gaag, AG Kolias, PJ Hutchinson, E Edlmann

Neurosurgery (2021)

Tranexamic acid for chronic subdural hematoma 

CONCLUSIONS: TXA could be considered as primary medical treatment in patients with a cSDH and mild symptoms. The results of current randomized clinical trials must be awaited.

R Lodewijkx, S Immenga, R Van den Berg, R Post, LG Westerink, RJA Nabuurs, A Can, WP Vandertop, D Verbaan 

British Journal of Neurosurgery (2021)

The first historical description of chronic subdural hematoma: A tale of inaccurate interpretation, inaccurate quoting and inaccurate requoting. 

CONCLUSIONS: With these early cases of alleged CSDH, we emphasize the importance of misquotation and blind copying of references, which are important citation errors.

R Dammers*, DC Holl*, B Kapiteijn, EJO Kompanje

Journal of the History of the Neurosciences (2021)

The effect of steroids as an adjunct to surgical treatment in patients with chronic subdural hematoma. 

CONCLUSIONS: Adjuvant steroid use was not significantly associated with recurrence rate (p = 0.10). Steroids as an adjunct to surgery in patients with cSDH did not have a favorable effect on the recurrence rate in our data after controlling for confounders. 

R Lodewijkx, DC Holl, KM Slot, V Volovici, CMF Dirven, R Dammers, WP Vandertop, D Verbaan

Journal of Neurotrauma (2021)

Presenting symptoms and functional outcome of chronic subdural hematoma patients. 

CONCLUSIONS: Cognitive complaints are independently associated with worse functional outcome, whereas headache and higher GCS scores are associated with better outcome. The increased probability of unfavorable outcome in patients with CSDH who present with cognitive complaints favors a more prominent place of assessing cognitive status at diagnosis.

Jurre Blaauw, Ghislaine A. Meelis, Bram Jacobs, Niels A. van der Gaag, Korné Jellema, Kuan H. Kho, Rob J.M. Groen, Joukje van der Naalt, Hester F. Lingsma, Heleen M. den Hertog  

Acta Neurologica Scandinavia (2021)

Prevalence of Cognitive Complaints and Impairment in Patients with Chronic Subdural Hematoma and Recovery after Treatment: A Systematic Review. 

CONCLUSIONS: We have shown that cognitive impairment (CI) and complaints (CC) are common in CSDH patients, underscoring the need for increased attention to the cognitive status either at presentation or after (surgical) treatment in this group. Future studies on this subject are needed in which CI and CC should be properly defined, and validated screening tools are needed to determine the extent of cognitive problems. Preferably, the interval between treatment and follow-up testing of the cognitive status of patients with CSDH should be at least 3 months.

Blaauw J, Boxum AG, Jacobs B, Groen RJM, Peul WC, Jellema K, Dammers R, van der Gaag NA,  Lingsma HF, den Hertog HM, van der Naalt J

Journal of Neurotrauma (2021)

Neurosurgical and Perioperative Management of Chronic Subdural Hematoma. 

CONCLUSIONS: Bilateral CSDH is independently associated with higher recurrence rates. As recurrence rates in bilateral CSDH are similar for different surgical approaches, the optimal choice for primary bilateral decompression of bilateral CSDH could vary per patient. General anesthesia for surgical treatment of CSDH is associated with higher complication rates and longer hospital admission.

Blaauw J, Jacobs B, den Hertog HM, van der Gaag NA, Jellema K, Dammers R, Lingsma HF, van der Naalt J, Kho KH,  Groen RJM

Frontiers in Neurology (2020)

Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach. 

CONCLUSIONS: Pharmacological agents are a particular focus of CSDH management currently, and a wealth of studies on steroids will hopefully lead to more harmonised, evidence-based practice regarding this in the near future. Surgical techniques and new procedures such as MMA embolisation are also important focuses for improving patient outcomes. There is an on-going need for future RCTs and evidence-based guidelines in CSDH, particularly including low- and middle-income countries, and it is hoped that the establishment of the iCORIC (International COllaborative Research Initiative on Chronic Subdural Haematoma) will help address this.

Edlmann E, Holl DC, Lingsma HF, Bartek J Jr, Bartley A, Duerinck J, Jensen TSR, Soleman J, Shanbhag NC, Devi B, Laeke T, Rubiano AM, Fugleholm K, van der Veken J, Tisell M, Hutchinson PJ, Dammers R, Kolias AG; International Collaborative Research Initiative on Chronic Subdural Haematoma (iCORIC) study group

Acta Neurochirurgica (2020)

Dexamethasone therapy in symptomatic chronic subdural hematoma: A retrospective evaluation of initial corticosteroid therapy versus primary surgery (DECSA - R). 

CONCLUSIONS: To achieve a favorable clinical outcome, initial dexamethasone therapy was associated with a high rate of cross-over to surgery, significantly longer overall hospital stay and more complications compared to primary surgery. 

Miah IP, Herklots M, Roks G, Peul WC, Walchenbach R, Dammers R, Lingsma HF, den Hertog HM, Jellema K, van der Gaag NA

Journal of Neurotrauma (2020)

Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis. 

CONCLUSIONS: This meta-analysis suggests that the addition of corticosteroids to surgery might be effective in the treatment of CSDH. However, the results must be interpreted with caution in light of the serious risk of bias of the included studies. This study stresses the need for large randomized trials to investigate the use of corticosteroids in the management of CSDH.

Holl DC*, Volovici V*, Dirven CMF, van Kooten F, Miah IP, Jellema K,  Peul WC, van der Gaag NA, Kho KH, den Hertog HM, Dammers R, Lingsma HF 

Acta Neurochirurgica (2019)

Pathophysiology and Nonsurgical Treatment of Chronic Subdural Hematoma: From Past to Present to Future. 

CONCLUSIONS: Based on pathophysiologic mechanisms, animal experiments, and small patient studies, medical treatment may play a role in the treatment of CSDH. There is a lack of level I evidence in the nonsurgical treatment of CSDH. Therefore, randomized controlled trials, currently lacking, are needed to assess which treatment is most effective in each individual patient.

Holl DC*, Volovici V*, Dirven CMF, Peul WC, van Kooten F, Jellema K, van der Gaag NA, Miah IP, Kho KH, den Hertog HM, Lingsma HF, Dammers R

World Neurosurgery (2018)

Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial): study protocol for a randomised controlled trial. 

Miah IP, Holl DC, Peul WC, Walchenbach R, Kruyt N, de Laat K, Koot RW, Volovici V, Dirven CMF, van Kooten F, Kho KH, den Hertog HM, van der Naalt J, Jacobs B, Groen RJM, Lingsma HF, Dammers R, Jellema K, van der Gaag NA

Trials (2018) 

Ingezonden brief; naar aanleiding van het overzichtsartikel ‘Chronisch subduraal hematoom; is behandeling met dexamethason wel of niet geïndiceerd?’ 

Miah IP, Holl DC, Peul WC, Dirven CMF, van Kooten F, Volovici V, Kho KH, den Hertog HM, Lingsma HF, Dammers R, van der Gaag NA, Jellema K

Tijdschrift voor Neurologie en Neurochirurgie (2018)

Voorkomt tranexaminezuur een operatie bij chronisch subduraal hematoom? De TORCH-studie. 

Immenga S, Vandertop WP, Verbaan D
Nederlands Tijdschrift voor Geneeskunde (2018)

*Shared first author