Chronic Subdural Hematoma: A Questionnaire Survey of Management Practice in India and Review of Literature

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 chronic subdural hematoma: 1) demographic and institutional details; 2) choice of surgical procedure; 3) surgical adjutants such as placing a subdural drain; 4) pre-and postoperative care; and 5) recurrences and management. Responses obtained were entered in a SPSS data sheet and analyzed. RESULTS: Response rate of the survey was 9.3%. The majority of neurosurgeons (75%) preferred to do burr whole drainage for primary chronic subdural hematoma and also for recurrences. Only one third of routinely placed a 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. The present survey points towards the importance of making management guidelines for this common neurosurgical entity.