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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0044-1801757
Original Article

Trends in Neurosurgical Treatment for Chronic Subdural Hematoma in Germany: A National Survey

Robert Mertens
1   Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
2   Berlin Institute of Health, BIH Academy, Junior Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
,
Katharina Kersting
1   Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Zoe Shaked 
1   Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Peter Truckenmüller
1   Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Anton Früh
1   Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Peter Vajkoczy
1   Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Lars Wessels
1   Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
› Institutsangaben Funding Dr. Mertens is a participant of the BIH - Charité Junior Clinician Scientist Program that is funded by the Charité - Universitätsmedizin Berlin and the Berlin Institute of Health. All other authors did not receive any financial or nonfinancial support for authorship, research, and/or publication of this article.
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Abstract

Background Chronic subdural hematoma (cSDH) is a common neurosurgical condition of growing importance due to the aging population and increasing use of antithrombotic agents. Due to the lack of guidelines, great variability is observed in the treatment of cSDH. We conducted a multicenter, nationwide survey to assess the differences in treatment across Germany in the context of surgical practices discussed in the literature.

Methods A web-based survey was designed using the REDCap electronic data capture tool hosted at the Charité – Universitätsmedizin Berlin. The survey was divided into four parts: preoperative management and indication for surgery, perioperative management of medication, surgical technique, and postoperative management. The survey was distributed to German neurosurgical departments through the newsletter of the German Society of Neurosurgery and direct e-mail contact and could be answered by one member of each department between March 1 and May 31, 2023.

Results Overall, representatives of 46 German neurosurgical departments completed the survey. Participants needed a mean time of 16:25 minutes (standard deviation [SD] ± 27:47 minutes) to complete the survey. The mean caseload of the participating departments was 1,831.5 (range: 300–6,000; SD ± 1,130.7) operations per year, including 87.8 procedures for cSDH (range: 15–300; SD ± 73.6). Evidence found in the literature regarding the performance of a burr hole craniotomy, use of a drain, passive drainage, removal of the drain 48 hours after surgery, and early mobilization after surgery was consistently implemented in the management of the surveyed departments. On the contrary, recommendations regarding the performance of surgery under local anesthesia, use of subgaleal drains, postoperative Valsalva maneuvers, and avoidance of postoperative computed tomography (CT) if possible were not universally implemented.

Conclusion This survey indicates that there is no consensus on the treatment of cSDH in Germany and that the steadily increasing evidence from clinical trials must be implemented in national and international guidelines. The development of tailored treatment strategies for older patients with multiple risk factors and comorbidities is of particular importance.

Keywords

cSDH - survey - burr hole craniotomy - antiplatelet drugs - anticoagulants

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the Declaration of Helsinki (1964) and its later amendments or comparable ethical standards. For this type of study, no ethical approvement had to be obtained (ethics committee of the Charité University Hospital in Berlin, Germany). No patients were involved in this research.


Availability of Supporting Data

Supporting data are available upon reasonable request from the corresponding author (P.V.).


Authors' Contributions

P.V., R.M., and L.W. developed the concept and designed the study. R.M. and K.K. were responsible for data acquisition. All the author participated in data interpretation. Statistical analysis was done by R.M. and L.W. Drafting of the manuscript was done by R.M., L.W., and K.K. Critical revision of the manuscript for important intellectual content was done by all the authors.


Supplementary Material



Publikationsverlauf

Eingereicht: 06. Dezember 2023

Angenommen: 06. September 2024

Artikel online veröffentlicht:
20. Januar 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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