Journal of neurological surgery. Part A, Central European neurosurgery最新文献

{"title":"A New Concept for Cervical Expansion Screws Using Shape Memory Alloy: A Feasibility Study.","authors":"Ronny Grunert, Dirk Winkler, Nikolas Knoop, Martin Weidling, Cornelia Matzke, Sebastian Scholz, Juergen Meixensberger, Felix Arlt","doi":"10.1055/a-2206-2578","DOIUrl":"10.1055/a-2206-2578","url":null,"abstract":"<p><strong>Background: </strong> In general, sufficient anchoring of screws in the bone material ensures the intended primary stability.</p><p><strong>Methods: </strong> Shape memory materials offer the option of using temperature-associated deformation energy in a targeted manner to compensate the special situation of osteoporotic bones or the potential lack of anchoring. An expansion screw was developed for these purposes. Using finite element analysis (FEA), the variability of screw configuration and actuator was assessed from shape memory. In particular, the dimensioning of the screw slot, the actuator length, and the actuator diameter as well as the angle of attack in relation to the intended force development were considered.</p><p><strong>Results: </strong> As a result of the FEA, a special configuration of expansion screw and shape memory element could be found. Accordingly, with an optimal screw diameter of 4 mm, an actuator diameter of 0.8 mm, a screw slot of 7.8 mm in length, and an angle of attack of 25 degrees, the best compromise between individual components and high efficiency in favor of maximum strength can be predicted.</p><p><strong>Conclusion: </strong> Shape memory material offers the possibility of using completely new forms of power development. By skillfully modifying the mechanical and shape memory elements, their interaction results in a calculated development of force in favor of a high primary stability of the screw material used. Activation by means of body temperature is a very elegant way of initializing the intended locking and screw strength.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"128-134"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Craniotomy versus Decompressive Craniectomy in Acute Subdural Hematoma Management: A Systematic Review and Meta-Analysis.","authors":"Mohammed Maan Al-Salihi, Maryam Sabah Al-Jebur, Yezan Al-Salihi, Elias Dumour, Ahmed Saleh, Mhran Daie, Firas Hammadi, Ali Ayyad","doi":"10.1055/s-0044-1791539","DOIUrl":"10.1055/s-0044-1791539","url":null,"abstract":"<p><strong>Background: </strong> This study aimed to compare the clinical outcomes of decompressive craniectomy (DC) and craniotomy in treating acute subdural hematoma (ASDH) to provide a more precise assessment of the procedures' outcomes.</p><p><strong>Methods: </strong> We searched for relevant articles in PubMed, Web of Science, Embase, Scopus, and Cochrane till August 2023, including cohort studies and randomized controlled trials comparing craniotomy and DC for ASDH. The analysis was conducted using \"Review Manager\" software, using the risk ratio along with a 95% confidence interval (CI) for categorical data, whereas continuous data were analyzed using the mean difference (MD) and 95% CI.</p><p><strong>Results: </strong> Our analysis included 13 studies with a total of 4,689 patients, of whom 1,910 (40.7%) underwent DC and 2,779 (59.3%) underwent craniotomy. The results revealed a statistically significant difference in favor of craniotomy concerning good recovery in delayed GOS (risk ratio [RR] = 1.42; 95% CI [1.12, 1.81]), postoperative mortality (RR = 0.81; 95% CI [0.71, 0.94]), mortality at last follow-up (RR = 0.75; 95% CI [0.62, 0.91]), and hospital stay (MD = -3.71; 95%CI [-5.82, -1.60]). A nonsignificant difference (RR = 1.06; 95% CI [0.52, 2.17]; <i>p</i> = 0.87) was found between the two interventions concerning seizures.</p><p><strong>Conclusion: </strong> Despite craniotomy's favorable clinical outcomes and mortality rates, the significant baseline differences between DC and craniotomy make these data inconclusive. To establish solid evidence regarding the use of DC versus craniotomy in ASDH, it is necessary to conduct well-controlled randomized studies with large sample sizes.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"182-195"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Prediction Model of Occurrence of Cerebral Vasospasms Based on Machine Learning.","authors":"Konstantinos Lintas, Stefan Rohde, Anna Mpoukouvala, Boris El Hamalawi, Robert Sarge, Oliver Marcus Mueller","doi":"10.1055/a-2402-6136","DOIUrl":"10.1055/a-2402-6136","url":null,"abstract":"<p><strong>Background: </strong> Symptomatic cerebral vasospasms are deleterious complication of the rupture of a cerebral aneurysm and potentially lethal. The existing scales used to classify the initial presentation of a subarachnoid hemorrhage (SAH) offer a blink of the outcome and the possibility of occurrence of symptomatic cerebral vasospasms. Altogether, neither are they sufficient to predict outcome or occurrence of events reliably nor do they offer a united front. This study tests the common grading scales and factors that otherwise affect the outcome, in an artificial intelligence (AI) based algorithm to create a reliable prediction model for the occurrence of cerebral vasospasms.</p><p><strong>Methods: </strong> Applying the R environment, an easy-to-operate command line was programmed to prognosticate the occurrence of vasospasms. Eighty-seven patients with aneurysmal SAH during a 24-month period of time were included for study purposes. The holdout and cross-validation methods were used to evaluate the algorithm (65 patients constituted the validation set and 22 patients constituted the test set). The Support Vector Machines (ksvm) classification method provided a high accuracy. The medical dataset included demographic data, the Hunt and Hess scale (H&H), Fisher grade, Barrow Neurological Institute (BNI) scale, length of intervention for aneurysmal repair, etc. RESULTS:  Our prediction model based on the AI algorithm demonstrated an accuracy of 61 to 86% for the event of symptomatic vasospasms. For subgroup analysis, 28.8% (<i>n</i> = 13) patients in the surgical cohort developed symptomatic vasospasm. Of these, 50% (<i>n</i> = 7) were admitted with Fisher scale grade 4, 37.5% (<i>n</i> = 5) with H&H 5, and 28.5% (<i>n</i> = 4) with BNI 5. In the endovascular cohort, vasospasms occurred in 31.8% (<i>n</i> = 14) patients. Of these, 69% (<i>n</i> = 9) patients were admitted with Fisher grade 4, 23% (<i>n</i> = 3) patients with H&H 5, and 7% (<i>n</i> = 1) patients with BNI 5.</p><p><strong>Conclusion: </strong> From our data, we may believe that the algorithm presented can help in identifying patients with SAH who are at \"high\" or \"low\" risk of developing symptomatic vasospasms. This risk balancing might further allow the treating physician to go for an earlier intervention trying to prevent permanent sequelae. Certainly, accuracy will improve with a higher caseload and more statistical coefficients.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"196-204"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Frameless Stereotactic Aspiration with Thrombolysis for Primary Pontine Hemorrhage: A Therapeutic Evaluation of a Retrospective Cohort Study.","authors":"Chongxi Xu, Wenbo He, Tong Yi, Hongtian Zhang, Jianguo Xu, Junpeng Ma","doi":"10.1055/a-2235-5453","DOIUrl":"10.1055/a-2235-5453","url":null,"abstract":"<p><strong>Background: </strong> There is still no consensus on whether primary pontine hemorrhage (PPH) should be managed conservatively or treated promptly via surgical evacuation of the hematoma. The purpose of this study was to assess the therapeutic effect of robotic frameless stereotactic aspiration with thrombolysis in the treatment of PPH.</p><p><strong>Methods: </strong> A total of 39 patients with PPH treated between January 2012 and November 2016 were included in the study. Sixteen patients underwent frameless stereotactic surgical treatment (ST group) and 23 patients underwent conservative treatment (CT group). Clinical and radiologic parameters were assessed, and the patient outcomes were analyzed over a 6-month follow-up period.</p><p><strong>Results: </strong> Surgical treatment did not result in any intracranial infections, or complications. Baseline characteristics did not significantly differ between the two groups. At discharge, the average Glasgow Coma Scale (GCS) score and the overall Glasgow Outcome Scale (GOS) score were significantly higher in the ST group compared to the CT group (<i>p</i> < 0.05). The mortality rate (GOS score 1) was significantly lower in the ST group (18.75%, 3/16) than in the CT group (52.17%, 12/23). For patients with hematoma volumes of 5 to 10 mL or GCS scores of 6 to 8, following treatment, the ST group exhibited markedly higher GOS scores in comparison to the CT group.</p><p><strong>Conclusion: </strong> Our study suggests that robotic frameless stereotactic aspiration with thrombolysis is a safe and efficient method for the treatment of PPH. Patients with hematomas of 5 to 10 mL or GCS scores of 6 to 8 could benefit from surgery.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"111-119"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Safe Surgical Parameters for Placement of C2 Pedicle Screws: A Retrospective Study.","authors":"Bekir Tunç, Denizhan Divanlıoğlu, Göksal Günerhan, Egemen Işıtan, Emin Çağıl, Ali Dalgıç","doi":"10.1055/a-2235-5381","DOIUrl":"10.1055/a-2235-5381","url":null,"abstract":"<p><strong>Background: </strong> The study aimed to evaluate the safety and feasibility of transpedicular instrumentation for the C2 vertebra and to establish the precise anatomical parameters and boundaries within which this procedure can be safely and effectively performed.</p><p><strong>Methods: </strong> This retrospective study analyzed 66 patients who underwent C2 transpedicular screw fixation. Preoperative and postoperative axial, sagittal, and coronal computed tomography (CT) scans were examined. Anatomical measurements were taken to determine the horizontal and vertical distances from the C2 pedicle projection to the vertebral foramen using CT images. Based on the anatomical location of the vertebral artery within the C2 vertebral foramen, the patients were divided into four subgroups using the horizontal pedicle width (HPW) and vertical pedicle width (VPW) of the C2 spine.</p><p><strong>Results: </strong> The average age of the patients included in the study was 46.48 years. The patient population comprised 32 (48.5%) males and 34 (51.5%) females. Based on the anatomical measurements, the distribution of C2 vertebra types was as follows: type 1 accounted for 68.9%, type 2 for 3.8%, type 3 for 16.7%, and type 4 for 10.6%. Significantly narrower pedicle widths were observed in types 2 and 4 compared to other vertebra types. Type 2 had the largest medial angle (MA), while type 4 had the narrowest MA. In terms of the sagittal plane, type 4 exhibited the widest MA and type 3 had the narrowest MA, but these differences were not statistically significant. Among the cases, 12 (18.1%) involved the vertebral foramen, with 1 case (8.3%) showing screw-related vertebral artery injury (0.75% of all screws). No vertebral artery injuries were observed with the other transpedicular screws.</p><p><strong>Conclusion: </strong> Preoperative anatomical measurements for patients undergoing transpedicular instrumentation on the C2 vertebra should include planning CT images on three planes: axial, sagittal, and coronal.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"162-168"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Extension of Traumatic Subdural Hematoma into the Interhemispheric Fissure Is Associated with Coagulation Disorders: A Retrospective Study.","authors":"Lennart W Sannwald, Dag Moskopp, Mats L Moskopp","doi":"10.1055/s-0043-1777859","DOIUrl":"10.1055/s-0043-1777859","url":null,"abstract":"<p><strong>Background: </strong> This study investigates the correlation of the radiologic sign of interhemispheric subdural hematoma (iSDH) in different injury patterns with clinical coagulation disorders. It is hypothesized that the presence of iSDHs is correlated with clinical coagulation disorders in patients with traumatic brain injuries and subdural hematoma (SDH).</p><p><strong>Methods: </strong> Between January 1, 2020 and June 30, 2022, 154 patients with SDH were identified. Coagulation disorders were assessed using chart review and patients were divided into four groups: SDH without iSDH without further injuries (SDH), SDH with iSDH without further injuries (SDH + iSDH), SDH without iSDH with further brain injuries (Combi), SDH with iSDH with further injuries (Combi + iSDH). These four groups were formed under the assumption that isolated SDHs result from a highly specific trauma mechanism (rupture of bridging veins) in predisposed elderly patients, while combined brain injuries with SDH result from a severe global traumatic brain injury combining different pathophysiologic mechanisms often in younger patients. The groups were analyzed for patient demographics, clinical presentation, and association with coagulation disorders. The significance level was set at <i>p</i> < 0.005.</p><p><strong>Results: </strong> The presence of an iSDH was associated with a higher likelihood of concomitant coagulation disorder or anticoagulants in cases of isolated subdural hemorrhage (56.8% of the population in SDH vs. 94.7% in SDH + iSDH, <i>p</i> < 0.005). This effect was not significant in the cases with combined traumatic brain injuries (33.3% in Combi vs. 53.6% in Combi + iSDH, <i>p</i> > 0.005).</p><p><strong>Conclusion: </strong> Our data indicate a high positive predictive value (PPV = 94.7%) for coagulation disorders in traumatic SDH patients with iSDH without any further focal and diffuse brain injuries. We consider this a relevant finding since it hints at the presence of coagulation disorders and might be used in early hemostaseologic assessment and emergency management.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"148-155"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140326702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Germinoma Staining: A Technical Note.","authors":"Emanuil Naydenov, Petar Karazapryanov, Velislav Pavlov, Dimitar Metodiev, Krasimir Minkin","doi":"10.1055/a-2389-5353","DOIUrl":"10.1055/a-2389-5353","url":null,"abstract":"<p><p>As the main treatment modality of central neural system germinomas is radiotherapy and/or chemotherapy, the exact initial diagnosis of the disease is crucial. Depending on the different national protocols, histologic verification can be obligatory in some instances. This is a serious challenge, taking into account the usual location and nonspecific macroscopic appearance of these lesions. Here, we propose a safe and effective method of intraoperative tumor enhancement that can increase the confidence of the surgeon during the intervention.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"213-216"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Antibiotics Impregnated Bone Cement in Reducing Surgical Site Infections in Spine Surgery: A Systematic Review.","authors":"Alexander Erick Purnomo, Yang Yang Endro Arjuna, Jephtah Furano Lumban Tobing","doi":"10.1055/a-2524-9910","DOIUrl":"https://doi.org/10.1055/a-2524-9910","url":null,"abstract":"<p><strong>Background and study aims: </strong>Spine surgeries are one of the most widely accepted method of surgery in orthopaedics. However, one of the most common complications of spine surgeries is surgical site infection (SSI), that associated with various post operative morbidities. The use of antibiotics impregnated bone cement (AIBC) is common in orthopaedics surgeries. Therefore, we aim to provide comprehensive review of AIBC use in spine surgeries.</p><p><strong>Methods: </strong>Data was gathered from PubMed, Europe PMC, and ScienceDirect using keywords associated with AIBC and spine surgeries. We included all publications associated with AIBC and spine surgeries. Studies without full paper, non-English publications, review articles, and animal or cadaveric studies are excluded. The quality of each included studies assessed using Newcastle Ottawa Scale (NOS) and Joana Briggs Institute (JBI) Critical Appraisal for case reports, case series, and quasi experimental studies.</p><p><strong>Results: </strong>15 studies with total of 322 patients using AIBC in spine surgery were included. 10 of 15 studies reported 100% infection-free event with AIBC administration with or without given systemic antibiotics. Two studies did not report 100% infection free event due to MRSA infections and technical causes. 3 studies reported the use of AIBC without disclosing outcomes. Various types of bacteria ranging from MSSA to MRSA have been discovered, with PMMA and vancomycin being the most frequently used AIBC.</p><p><strong>Conclusion: </strong>Antibiotics impregnated bone cement can be used to prevent post-operative infections due to its high effectiveness, easy administration, and no side effects have ever been reported. Further studies are needed to determine the most appropriate antibiotics, dose, and type of cement.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Pedicle Screw Placement Surgery Based on Integration of Surgical Guides and Augmented Reality.","authors":"Huiyang Kong, Shuyi Wang, Can Zhang, Zan Chen, Zhanglei Wu, Jiayu Wang","doi":"10.1055/a-2200-3585","DOIUrl":"10.1055/a-2200-3585","url":null,"abstract":"<p><strong>Background: </strong> Augmented reality is a new technology that, when applied to spinal surgery, offers the potential for efficient, safe, and accurate placement of pedicle screws. This study investigated whether augmented reality combined with a guide board improved the safety and accuracy of pedicle screw placement compared to traditional freehand screw placement.</p><p><strong>Methods: </strong> Four trainers were divided into augmented reality navigation and freehand groups. Each group consisted of a novice and an experienced spine surgeon. A total of 80 pedicle screws were implanted. First, the AR group reconstructed the three-dimensional (3D) model and planned the screw insertion route according to the computed tomography (CT) data of L2 lumbar vertebrae. Next, the Microsoft HoloLens 2 was used to identify the vertebral model, and the planned virtual path was superimposed on the real cone model. Then, the screw was placed according to the projected trajectory. Finally, Micron Tracker was used to measure the deviation of screws from the preoperatively planned trajectory, and pedicle screws were evaluated using the Gertzbein-Robbins scale.</p><p><strong>Results: </strong> In the augmented reality group, the linear deviation of the experienced doctors and novices was 1.59 ± 0.39 and 1.73 ± 0.52 mm, respectively, and the deviation angle was 2.72 ± 0.61 and 2.87 ± 0.63 degrees, respectively. In the freehand group, the linear deviation of the experienced doctors and novices was 2.88 ± 0.58 and 5.25 ± 0.62 mm, respectively, and the deviation angle was 4.41 ± 1.18 and 7.15 ± 1.45 degrees, respectively. The screw placement accuracy rate was 97.5% in the augmented reality navigation group and 77.5% in the freehand group.</p><p><strong>Conclusions: </strong> Augmented reality navigation improves the accuracy and safety of pedicle screw implantation compared with the traditional freehand method and can assist inexperienced doctors in successfully completing the surgery.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61563218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Neurosurgical Treatment for Chronic Subdural Hematoma in Germany: A National Survey.","authors":"Robert Mertens, Katharina Kersting, Zoe Shaked, Peter Truckenmüller, Anton Früh, Peter Vajkoczy, Lars Wessels","doi":"10.1055/s-0044-1801757","DOIUrl":"https://doi.org/10.1055/s-0044-1801757","url":null,"abstract":"<p><strong>Background: </strong> Chronic subdural hematoma (cSDH) is a common neurosurgical condition of growing importance due to the aging population and increasing use of antithrombotic agents. Due to the lack of guidelines, great variability is observed in the treatment of cSDH. We conducted a multicenter, nationwide survey to assess the differences in treatment across Germany in the context of surgical practices discussed in the literature.</p><p><strong>Methods: </strong> A web-based survey was designed using the REDCap electronic data capture tool hosted at the Charité - Universitätsmedizin Berlin. The survey was divided into four parts: preoperative management and indication for surgery, perioperative management of medication, surgical technique, and postoperative management. The survey was distributed to German neurosurgical departments through the newsletter of the German Society of Neurosurgery and direct e-mail contact and could be answered by one member of each department between March 1 and May 31, 2023.</p><p><strong>Results: </strong> Overall, representatives of 46 German neurosurgical departments completed the survey. Participants needed a mean time of 16:25 minutes (standard deviation [SD] ± 27:47 minutes) to complete the survey. The mean caseload of the participating departments was 1,831.5 (range: 300-6,000; SD ± 1,130.7) operations per year, including 87.8 procedures for cSDH (range: 15-300; SD ± 73.6). Evidence found in the literature regarding the performance of a burr hole craniotomy, use of a drain, passive drainage, removal of the drain 48 hours after surgery, and early mobilization after surgery was consistently implemented in the management of the surveyed departments. On the contrary, recommendations regarding the performance of surgery under local anesthesia, use of subgaleal drains, postoperative Valsalva maneuvers, and avoidance of postoperative computed tomography (CT) if possible were not universally implemented.</p><p><strong>Conclusion: </strong> This survey indicates that there is no consensus on the treatment of cSDH in Germany and that the steadily increasing evidence from clinical trials must be implemented in national and international guidelines. The development of tailored treatment strategies for older patients with multiple risk factors and comorbidities is of particular importance.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}