Document Detail

Choosing the best operation for chronic subdural hematoma: a decision analysis.
MedLine Citation:
PMID:  19877806     Owner:  NLM     Status:  MEDLINE    
OBJECT: Chronic subdural hematoma (CSDH), a condition much more common in the elderly, presents an increasing challenge as the population ages. Treatment strategies for CSDH include bur-hole craniostomy (BHC), twist-drill craniostomy (TDC), and craniotomy. Decision analysis was used to organize existing data and develop recommendations for effective treatment. METHODS: A Medline search was used to identify articles about treatment of CSDH. Direct assessment by health care professionals of the relative health impact of common complications and recurrences was used to generate utility values for treatment outcomes. Monte Carlo simulation and sensitivity analyses allowed comparisons across treatment strategies. A second simulation examined whether intraoperative irrigation or postoperative drainage affect the outcomes following BHC. RESULTS: On a scale from 0 to 1, the utility of BHC was found to be 0.9608, compared with 0.9202 for TDC (p = 0.001) and 0.9169 for craniotomy (p = 0.006). Sensitivity analysis confirmed the robustness of these values. Craniotomy yielded fewer recurrences, but more frequent and more serious complications than did BHC. There were no significant differences for BHC with or without irrigation or postoperative drainage. CONCLUSIONS: Bur-hole craniostomy is the most efficient choice for surgical drainage of uncomplicated CSDH. Bur-hole craniostomy balances a low recurrence rate with a low incidence of highly morbid complications. Decision analysis provides statistical and empirical guidance in the absence of well-controlled large trials and despite a confusing range of previously reported morbidity and recurrence.
Bradley C Lega; Shabbar F Danish; Neil R Malhotra; Seema S Sonnad; Sherman C Stein
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  113     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-02     Completed Date:  2010-09-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  615-21     Citation Subset:  AIM; IM    
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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MeSH Terms
Computer Simulation
Craniotomy / adverse effects,  methods
Decision Support Techniques*
Drainage / adverse effects,  methods
Hematoma, Subdural, Chronic / epidemiology,  surgery*
Irrigation / adverse effects,  methods
Monte Carlo Method
Neurosurgical Procedures / adverse effects,  instrumentation,  methods
Postoperative Complications / epidemiology
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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