Management of Chronic Subdural Hematoma: a Brazilian National Survey and Systematic Literature Review

Alisson R. Teles, MD1

1Porto Alegre, Brazil

Keywords: subdural hematoma, survey, outcome, craniotomy, burr hole

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     There are many controversies in the literature on the treatment of chronic subdural hematoma (CSDH).
     The objective of this study was to ascertain neurosurgical practices on its treatment, and to review the best evidence existing in the literature.
     This study was conducted in two phases. Firstly, a systematic literature review was undertaken using Medline/Cochrane databases (N = 633). The criteria of Centre for Evidence Based Medicine were used to obtain the quality of studies and grades of recommendation. After, a Brazilian National Survey (BNS) was performed through a telephone interview with 10 closed-ended questions about CSDH.
     The analysis of the literature (N = 107) demonstrate: (1) Burr-hole craniostomy (BHC) is the most effective surgical technique for CSDH (B); (2) there is conflicting evidence on the number of BHC (C); (3) use of subdural drain reduces the recurrence of CSDH (A); (4) flat head position reduces recurrence of CSDH following BHC drainage (B); (5) early mobilization of elderly patients reduces clinical complications without increasing recurrence rates (C). Results from the BNS demonstrate that BHC is the procedure of choice for 85.5%. A minority of the respondents do not use drain postoperatively (16.3%). The majority leave the drain at the subdural space (87.8%) and remove it until 48 hours (82.9%). Flat position is preferred by 59.2% of the participants.
     This is a retrospective review.
     This study highlights the best evidence on the management of CSDH and presents the Brazilian neurosurgical practices on this relatively common pathology.
     The review provides useful information for future research on this condition.


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A. Teles ()