Scholarlink

Background <p>Chronic subdural haematoma (cSDH) is a common neurosurgical condition, many patients have significant comorbidity or are living with frailty. Surgery is effective and can be performed under local anaesthesia (with or without sedation) (LAS) or general anaesthesia (GA). Optimal technique for both GA and LAS is poorly defined but similar questions have been explored in other surgical settings. We sought to clarify the breadth of evidence for anaesthetic technique in cSDH surgery, while drawing on relevant literature from other disciplines to understand how a definitive trial of this question could be performed.</p> Materials and methods <p>We used a combination of review of trial registries, the Cochrane database, and a survey of anaesthetic and neurosurgical practitioners.</p> Results <p>We identified a paucity of high-quality studies, especially randomised trials, exploring this question. The literature, and survey of anaesthetists and surgeons suggest that LAS may achieve equivalent outcomes, but significant confounding exists in current studies. Registered trials are single centre, and Cochrane reviews in other fields present issues of equipoise, study design, and outcome choice as key challenges in designing a definitive trial.</p> Conclusions <p>There is significant interest in this topic as evidenced by published and emerging literature and views of anaesthetists and surgeons. No registered trial is multi-centre or draws on challenges identified in similar trials from other disciplines.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; survey and literature review of ongoing trials

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月28日

查看全文
  • Daniel J. Stubbs,
  • Conor S. Gillespie,
  • Matthew L. Watson,
  • Basil Nourallah,
  • Caroline M. Phillips,
  • George Gathercole,
  • Jamie Brannigan,
  • Keng Siang Lee,
  • Orla Mantle,
  • Vian Omar,
  • Adele Mazzoleni,
  • Githmi Palahepitiya Gamage,
  • Alvaro Yanez Touzet,
  • Munashe Veremu,
  • Youssef Chedid,
  • William H. Cook,
  • Karanjit Loyal,
  • Gideon Adegboyega,
  • Oliver D. Mowforth,
  • Edward Goacher,
  • Apoorva Singh,
  • Jonathan P. Coles,
  • Alexis Joannides,
  • Angelos Kolias,
  • Judith Dinsmore,
  • Iain Moppett,
  • Michael Nathanson,
  • Sally R. Wilson,
  • Amit Deshmukh,
  • Edoardo Viaroli,
  • David K. Menon,
  • Ellie Edlmann,
  • Benjamin M. Davies,
  • Peter J. Hutchinson

摘要

Background

Chronic subdural haematoma (cSDH) is a common neurosurgical condition, many patients have significant comorbidity or are living with frailty. Surgery is effective and can be performed under local anaesthesia (with or without sedation) (LAS) or general anaesthesia (GA). Optimal technique for both GA and LAS is poorly defined but similar questions have been explored in other surgical settings. We sought to clarify the breadth of evidence for anaesthetic technique in cSDH surgery, while drawing on relevant literature from other disciplines to understand how a definitive trial of this question could be performed.

Materials and methods

We used a combination of review of trial registries, the Cochrane database, and a survey of anaesthetic and neurosurgical practitioners.

Results

We identified a paucity of high-quality studies, especially randomised trials, exploring this question. The literature, and survey of anaesthetists and surgeons suggest that LAS may achieve equivalent outcomes, but significant confounding exists in current studies. Registered trials are single centre, and Cochrane reviews in other fields present issues of equipoise, study design, and outcome choice as key challenges in designing a definitive trial.

Conclusions

There is significant interest in this topic as evidenced by published and emerging literature and views of anaesthetists and surgeons. No registered trial is multi-centre or draws on challenges identified in similar trials from other disciplines.