Chronic subdural haematoma: disseminating and implementing best practice

Chronic subdural haematoma (CSDH) is one of the most common ‘neurosurgical’ conditions, with a rising incidence especially among elderly patients [6]. The placement of a subdural drain following burr-hole evacuation had been supported as a type B recommendation (i.e. based on class II evidence) in an authoritative review published in 2003 [13] but the utilisation of this simple and inexpensive manoeuvre was infrequent in the UK according to a questionnaire survey conducted in 2006 [11]. Subsequently, our unit sought to provide class I evidence for the role of subdural drains in the management of CSDH with the conduct of the Cambridge CSDH Trial. This randomised trial was published in 2009 and provided high-quality evidence that the use of a subdural drain can more than halve the risk of recurrence (recurrence rate 9.3% with a drain vs. 24% without a drain, p = 0.003) without an increase in the rate of complications [10]. Additionally, in this issue of the Acta Neurochirurgica longer-term results from the Cambridge CSDH trial are presented showing that subdural drains are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex [5]. …