by DSHR members
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
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.
Lodewijkx R, Immenga S, Van den Berg R, Post R, Westerink LG, Nabuurs RJA, Can A, Vandertop WP, Verbaan D
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
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
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
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
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
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
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
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)
*Shared first author