Chronic Subdural Hematoma; A Questionnaire Survey Of Management Practice In India and review of Literature

• Published in: World neurosurgery Vol. 96; pp. 355 - 361
• Main Authors: Avanali, Raghunath, MCh in Neurosurgery, Bhadran, Biju, M.Ch in Neurosurgery, P, Krishna Kumar, M.Ch in Neurosurgery, Vijayan, Abhishek, M.Ch in Neurosurgery, S, Arun, MS in Surgery, Musthafa, Aneeze.M., M.Ch in Neurosurgery, Panchal, Sunil, MS in Surgery, Gopal, Vinu.V., M.Ch in Neurosurgery
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2016
• Subjects: Anticonvulsants - therapeutic use; Burr hole drainage; Chronic Disease; Chronic subdural hematoma; Data Collection; Disease Management; Female; Follow-Up Studies; Hematoma, Subdural - diagnostic imaging; Hematoma, Subdural - epidemiology; Hematoma, Subdural - therapy; Humans; India - epidemiology; Male; Neurosurgeons - psychology; Neurosurgery; Neurosurgical Procedures - methods; Practice Patterns, Physicians; Review Literature as Topic; Surveys and Questionnaires; Twist drill craniostomy; Angiotensin-converting enzyme inhibitors; Chronic subdural hematoma; Computed tomography scan; Tissue plasminogen activator; CSDH; INR; Tranexamic acid in chronic subdural hematomas trial; International Normalized Ratio; TRACS trial; SEPS; Subdural evacuating port system; Twist drill craniostomy; Burr hole drainage; CT scan; ACE inhibitors; t-pa; CT; ACE
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.09.010

Objective To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. Methods A questionnaire was prepared for the survey and sent via e mail to neurosurgeons. It covered the following aspects of managing the CSDH. 1) Demographic and institutional details. 2) Choice of surgical procedure. 3) Surgical adjutants such as placing a subdural drain 4) Pre and Post operative care 4) Recurrences and management. Responses obtained were entered in SPSS data sheet and analyzed. Results Response rate of the survey was 9.3%. Majority of neurosurgeons (75%) preferred to do burr whole drainage for primary CSDH and also for recurrences. Only one third of them routinely placed subdural drain. Considerable practice variations exist for medical and perioperative management. Conclusions Bedside twist drill drainage which is effective and less costly than operative room procedures, has not gained popularity in practice. Present survey points towards the importance of making management guidelines for this common neurosurgical entity.