Journal Article

Exhaustive drainage versus fixed-time drainage for chronic subdural hematoma after one-burr hole craniostomy (ECHO): study protocol for a multicenter randomized controlled trial

Zhang, Hongbing, Zhang, Guobin, Zhu, Bingcheng, Zhou, Hui, Ou, Yunwei, Zhao, Shangfeng, Wu, Liang, Yu, Xiaofan, Li, Huaqing, Li, Jinping, Yang, Dawei, Ma, Dongming, Guo, Xufei, Sun, Zhaosheng, Yao, Jiemin, Tang, Jie, Chen, Huaqun, Liu, Zhigang, Wang, Xiaodong, Sun, Zelin, Xu, Long, Liu, Weiming, Feng, Enshan, Liu, Baiyun, Liu, Zaofu

2023

Overview

Background Chronic subdural hematomas (CSDHs) are one of the most common neurosurgical conditions. The standard surgical technique includes burr-hole craniostomy, followed by intraoperative irrigation and placement of subdural closed-system drainage. The drainage is generally removed after 48 h, which can be described as fixed-time drainage strategy. According to literature, the recurrence rate is 5–33% with this strategy. In our retrospective study, postoperative hematoma volume was found to significantly increase the risk of recurrence. Based on these results, an exhaustive drainage strategy is conducted to minimize postoperative hematoma volume and achieve a low recurrence rate and good outcomes. Methods This is a prospective, multicenter, open-label, blinded endpoint randomized controlled trial designed to include 304 participants over the age of 18–90 years presenting with a symptomatic CSDH verified on cranial computed tomography or magnetic resonance imaging. Participants will be randomly allocated to perform exhaustive drainage (treatment group) or fixed-time drainage (control group) after a one-burr hole craniostomy. The primary endpoint will be recurrence indicating a reoperation within 6 months. Discussion This study will validate the effect and safety of exhaustive drainage after one-burr hole craniostomy in reducing recurrence rates and provide critical information to improve CSDH surgical management. Trial registration Clinicaltrials.gov, NCT04573387. Registered on October 5, 2020.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Biomedicine / Burr-hole craniostomy / Care and treatment / Catheters / Chronic subdural hematoma / Clinical trials / Complications and side effects / Craniotomy / Craniotomy - adverse effects / CT imaging / Diagnosis / Diseases / Drainage - adverse effects / Drainage - methods / Drainage, Surgical / Exhaustive drainage / Fixed-time drainage / Health Sciences / Hematoma / Hematoma, Subdural, Chronic - diagnostic imaging / Hematoma, Subdural, Chronic - surgery / Hospitals / Humans / Informed consent / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / Multicenter Studies as Topic / Neurosurgery / Patient outcomes / Patients / Prospective Studies / Protocol / Randomized Controlled Trials as Topic / Recurrence / Relapse / Retrospective Studies / Statistics for Life Sciences / Study Protocol / Subdural hematoma / Surgery / Treatment Outcome