Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, the Netherlands; Department of Health Technology Assessment, Erasmus University Rotterdam.
Neurosurgical Centre Amsterdam, Amsterdam UMC, De Boelelaan, Amsterdam, the Netherlands; Department of Biology, University of California, San Diego, CA, USA; Department of Health Technology Assessment, Erasmus University Rotterdam.
Clin Neurol Neurosurg. 2020 Aug;195:105899. doi: 10.1016/j.clineuro.2020.105899. Epub 2020 May 20.
Chronic subdural hematoma (CSDH) is a condition that is frequently seen in the neurological and neurosurgical practice. Surgical treatment is overall preferred; however, conservative treatment is also an option. Both surgical and conservative treatment of CSDH vary across neurosurgeons. The aim of the present study was to evaluate different treatment strategies for CSDH among neurosurgeons in different countries.
We designed a survey that was sent to neurosurgeons affiliated with the Congress of Neurological Surgeons.The questions were related to the conservative and surgical treatment methods of CSDH. Furthermore, we also included questions related to post-operative care.
443 neurosurgeons completed the survey. 46.2 % of the respondents sometimes use dexamethasone as monotherapy. Overall, 26.2 % estimated dexamethasone to have a high efficacy on CSDH. A Glasgow Coma Score lower than 12 was considered to be the most important indication for surgery by 57.8 %. Double burr hole is the preferred surgical technique by 48.1 % of the respondents. One day after surgery, 69.3 % routinely orders a CT-scan.
The majority of the neurosurgeons worldwide remains reluctant in the use of conservative treatment methods in the management of CSDH. Further research is needed to assess the effectivity and side-effects of these conservative methods.
慢性硬脑膜下血肿（CSDH）是神经科和神经外科常见的病症。一般首选手术治疗，但也可以选择保守治疗。CSDH 的手术和保守治疗在神经外科医生中存在差异。本研究旨在评估不同国家神经外科医生对 CSDH 的不同治疗策略。
我们设计了一项调查，发送给神经外科医生协会的神经外科医生。问题涉及 CSDH 的保守和手术治疗方法。此外，我们还包括了与术后护理相关的问题。
443 名神经外科医生完成了调查。46.2%的受访者有时单独使用地塞米松作为治疗药物。总的来说，26.2%的受访者估计地塞米松对 CSDH 有很高的疗效。57.8%的人认为格拉斯哥昏迷评分（GCS）低于 12 是手术的最重要指征。48.1%的受访者首选双孔钻颅术作为手术方法。术后第一天，69.3%的人常规进行 CT 扫描。
全世界大多数神经外科医生仍不愿在 CSDH 治疗中使用保守治疗方法。需要进一步研究来评估这些保守方法的有效性和副作用。
