Effect of the postoperative Trendelenburg position on chronic subdural hematoma recurrence: a pilot clinical trial.

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Neurosurgical focus Pub Date : 2025-10-01 DOI:10.3171/2025.7.FOCUS25449

Jorge H Montenegro, Santiago Ángel, Pablo A Botero, Juanita Salazar, Sonia M Rodríguez, Daniel Londoño, Óscar A Villada, Juan D Gutiérrez, Yeison E Montoya, Ignacio A González, Andrés M Rubiano

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Abstract

Objective: The aim of the study was to evaluate the effect of the postoperative Trendelenburg position on the recurrence of chronic subdural hematoma (CSH) in patients after surgical drainage.

Methods: A pilot randomized, controlled clinical trial was conducted in 3 hospitals in Colombia. Patients with CSH were enrolled and assigned to a Trendelenburg position (30° leg elevation and 10° head tilt; intervention group) or to a flat position (control group) for 24 hours postoperatively. CSH recurrence was measured at 3 months, along with functional outcome (modified Rankin Scale [mRS] score), adverse events, and patient comfort.

Results: Twenty-three patients were assigned to the Trendelenburg group and 23 to the control group. Two patients from the intervention group were assigned to the control group because of minor complications. Recurrence of CSH was 4.8% in the intervention group and 28.6% in the control group (p = 0.038). A favorable outcome (mRS score 0-2) was achieved in 95.2% of the intervention group versus 66.7% in the control group (p = 0.025). Patient comfort was equal in both groups (47.6% vs 48%, p = 0.979).

Conclusions: In patients with CSH who require surgery, the postoperative Trendelenburg position is associated with lower recurrence and improved functional outcome at 3 months. Further studies are required to obtain more clinical evidence.

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术后Trendelenburg体位对慢性硬膜下血肿复发的影响：一项试点临床试验。

目的：探讨术后Trendelenburg体位对慢性硬膜下血肿（CSH）引流术后复发的影响。方法：在哥伦比亚3家医院开展随机对照临床试验。CSH患者入组，术后24小时采用Trendelenburg体位（腿部抬高30°，头部倾斜10°；干预组）或平卧位（对照组）。在3个月时测量CSH复发，以及功能结果（改良Rankin量表[mRS]评分）、不良事件和患者舒适度。结果：Trendelenburg组23例，对照组23例。干预组中有2例患者因出现轻微并发症被分配到对照组。干预组CSH复发率为4.8%，对照组为28.6% （p = 0.038）。干预组95.2%的患者预后良好（mRS评分0-2分），对照组66.7% （p = 0.025）。两组患者舒适度相当（47.6% vs 48%, p = 0.979）。结论：在需要手术的CSH患者中，术后Trendelenburg体位与3个月时的低复发率和改善的功能结果相关。需要进一步的研究来获得更多的临床证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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