Practice variation in the conservative and surgical treatment of chronic subdural hematoma

Objective: 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. Material and Methods: 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. Results: 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. Conclusions: 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.

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