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Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an
E Edlmann1,2, D C Holl3, H F Lingsma4
1Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. eedlmann@nhs.net.
Insights
This review identifies 26 ongoing randomized controlled trials for chronic subdural hematoma (CSDH). Key research areas include steroid application, surgical techniques, and tranexamic acid, aiming to improve evidence-based CSDH management.
Area of Science:
- Neurosurgery
- Clinical Trials Research
- Evidence-Based Medicine
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition lacking robust evidence-based guidelines.
- There is a growing interest in optimizing CSDH management and patient outcomes.
- A systematic review of ongoing randomized controlled trials (RCTs) is needed to guide future research.
Purpose of the Study:
- To systematically review all currently running RCTs for chronic subdural hematoma (CSDH).
- To identify key areas of investigation in CSDH management and outcomes.
- To inform the planning of future collaborative CSDH research initiatives.
Main Methods:
- Searched major clinical trials databases (Cochrane, WHO ICTRP, clinicaltrials.gov) for relevant RCTs.
- Identified trials that are currently active and adhere to robust RCT methodology.
- Compiled and categorized ongoing research based on therapeutic interventions and management strategies.
Main Results:
- A total of 26 RCTs are currently active in CSDH research.
- The most frequent research topics include steroid application (7 trials), surgical techniques (5 trials), and tranexamic acid (5 trials).
- Other investigated areas include pharmacological agents (4 trials), middle meningeal artery (MMA) embolization (2 trials), and peri-operative management (3 trials).
Conclusions:
- Pharmacological agents, particularly steroids, are a significant focus, potentially leading to more standardized CSDH treatment.
- Advancements in surgical techniques and novel procedures like MMA embolization show promise for improving patient outcomes.
- There is a continued need for high-quality RCTs and evidence-based guidelines in CSDH, emphasizing global collaboration, especially from low- and middle-income countries through initiatives like iCORIC.
Background:
Chronic subdural haematoma (CSDH) is a pathology that is frequently encountered by neurosurgeons. Nevertheless, there is a lack of guidelines based on solid evidence. There has been a recent and considerable increase in the interest on management and outcomes for CSDH. Therefore, we systematically reviewed all currently running randomised controlled trials (RCTs) in chronic subdural haematoma to understand the areas under investigation and plan future collaborative trials.
Methods:
Clinical trials databases (Cochrane Controlled Register of Trials, WHO ICTRP and clinical trials.gov) were searched for trials relevant to chronic subdural haematoma. It was then established which trials were currently running and fulfilled robust research methodology for a RCT.
Results:
There are 26 currently running RCTs in CSDH, with the most common topics covering application of steroids (7), surgical techniques (5) and tranexamic acid (5). Further to this, there are trials running on other pharmacological agents (4), middle meningeal artery (MMA) embolisation (2) and peri-operative management (3).
Conclusions:
Pharmacological agents are a particular focus of CSDH management currently, and a wealth of studies on steroids will hopefully lead to more harmonised, evidence-based practice regarding this in the near future. Surgical techniques and new procedures such as MMA embolisation are also important focuses for improving patient outcomes. There is an on-going need for future RCTs and evidence-based guidelines in CSDH, particularly including low- and middle-income countries, and it is hoped that the establishment of the iCORIC (International COllaborative Research Initiative on Chronic Subdural Haematoma) will help address this.
