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Nagashima Y, Araki Y, Nishida K, Kuramitsu S, Wakabayashi K, Shimato S, Kinkori T, Nishizawa T, Kano T, Hasegawa T, Noda A, Maeda K, Yamamoto Y, Suzuki O, Koketsu N, Okada T, Iwasaki M, Nakabayashi K, Fujitani S, Maki H, Kuwatsuka Y, Nishihori M, Tanei T, Nishikawa T, Nishimura Y, Saito R. Efficacy of intraoperative irrigation with artificial cerebrospinal fluid in chronic subdural hematoma surgery: study protocol for a multicenter randomized controlled trial. Trials 2024; 25:6. [PMID: 38166992 PMCID: PMC10759626 DOI: 10.1186/s13063-023-07889-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The surgical techniques for treatment of chronic subdural hematoma (CSDH), a common neurosurgical condition, have been discussed in a lot of clinical literature. However, the recurrence proportion after CSDH surgery remains high, ranging from 10 to 20%. The standard surgical procedure for CSDH involves a craniostomy to evacuate the hematoma, but irrigating the hematoma cavity during the procedure is debatable. The authors hypothesized that the choice of irrigation fluid might be a key factor affecting the outcomes of surgery. This multicenter randomized controlled trial aims to investigate whether intraoperative irrigation using artificial cerebrospinal fluid (ACF) followed by the placement of a subdural drain would yield superior results compared to the placement of a subdural drain alone for CSDH. METHODS The study will be conducted across 19 neurosurgical departments in Japan. The 1186 eligible patients will be randomly allocated to two groups: irrigation using ACF or not. In either group, a subdural drain is to be placed for at least 12 h postoperatively. Similar to what was done in previous studies, we set the proportion of patients that meet the criteria for ipsilateral reoperation at 7% in the irrigation group and 12% in the non-irrigation group. The primary endpoint is the proportion of patients who meet the criteria for ipsilateral reoperation within 6 months of surgery (clinical worsening of symptoms and increased hematoma on imaging compared with the postoperative state). The secondary endpoints are the proportion of reoperations within 6 months, the proportion being stratified by preoperative hematoma architecture by computed tomography (CT) scan, neurological symptoms, patient condition, mortality at 6 months, complications associated with surgery, length of hospital stay from surgery to discharge, and time of the surgical procedure. DISCUSSION We present the study protocol for a multicenter randomized controlled trial to investigate our hypothesis that intraoperative irrigation with ACF reduces the recurrence proportion after the removal of chronic subdural hematomas compared with no irrigation. TRIAL REGISTRATION ClinicalTrials.gov jRCT1041220124. Registered on January 13, 2023.
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Affiliation(s)
- Yoshitaka Nagashima
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kazuki Nishida
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shunichiro Kuramitsu
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | | | - Shinji Shimato
- Department of Neurosurgery, Handa City Hospital, Handa, Japan
| | - Takeshi Kinkori
- Department of Neurosurgery, Okazaki City Hospital, Okazaki, Japan
| | | | - Takahisa Kano
- Department of Neurosurgery, Anjo Kosei Hospital, Anjo, Japan
| | | | - Atsushi Noda
- Department of Neurosurgery, Nishio Municipal Hospital, Nishio, Japan
| | - Kenko Maeda
- Department of Neurosurgery, JCHO Chukyo Hospital, Nagoya, Japan
| | - Yu Yamamoto
- Department of Neurosurgery, Inazawa Municipal Hospital, Inazawa, Japan
| | - Osamu Suzuki
- Department of Neurosurgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Naoki Koketsu
- Department of Neurosurgery, Tosei General Hospital, Seto, Japan
| | - Takeshi Okada
- Department of Neurosurgery, Kainan Hospital, Yatomi, Japan
| | - Masashige Iwasaki
- Department of Neurosurgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kiyo Nakabayashi
- Department of Neurosurgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Shigeru Fujitani
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hideki Maki
- Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohide Nishikawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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