Randomized Controlled Trial Investigating Optimal Treatment for Chronic Subdural Hematoma
Chronic Subdural Hematoma
About this trial
This is an interventional treatment trial for Chronic Subdural Hematoma
Eligibility Criteria
Inclusion Criteria:
- All consecutive patients with chronic subdural hematoma with indication for surgical intervention: clinical symptoms as a result of the subdural collection, or important mass effect (as indicated by a midline shift of more than 5mm)
Exclusion Criteria:
- Patients under the age of 18 will be excluded
- Patients who have undergone previous cranial surgery which would limit surgical options (for example bone flap already in place)
Sites / Locations
- Universitair Ziekenhuis Brussel
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Active Comparator
Active Comparator
Mini-craniotomy
Twist Drill Craniostomy
Burr Hole Craniostomy
Intervention: Bone flap > 30mm and replaced, placement of Jackson-Pratt drain A linear incision located over the biggest bulk of the hematoma is made. Dura is opened and a wide opening of the pseudomembrane is done. A closed system subdural drain (Jackson-Pratt catheter) is inserted after irrigation until clear liquid return
Intervention: twist drill burr hole <5mm, placement of Integra basket-type drain A stab incision to the scalp is made, at the approximate location of the thickest diameter of hematoma. The twist-drill hole <5mm is placed obliquely to the surface of the skull, at an angle of about 45° until perforation of the dura. No irrigation is performed. A basket-type drain (Integra) is placed in the subdural space and tunneled underneath the skin
Intervention: 2 Burr Holes >5mm and <30mm, placement of Jackson-Pratt drain First burr hole at the site of maximal diameter, second anterior and superior to that point. The scalp incisions are so planned that they can be incorporated into a craniotomy if necessary. Visible membranes are opened with a sharp hook until the pia is visualized. Gentle irrigation is performed and continued until the returning liquid is clear. Two burr holes are placed to facilitate drainage. A closed system subdural drain (Jackson-Pratt catheter) is inserted after irrigation until clear liquid return