Dexamethasone Versus Burr Hole Craniostomy for Symptomatic Chronic Subdural Hematoma

NCT ID: NCT02111785

Last Updated: 2018-12-11

Study Results

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

10 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-03-31

Study Completion Date

2017-12-31

Brief Summary

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Chronic subdural hematoma (cSDH) is condition where blood has slowly leaked out of small blood vessels surrounding the brain. Over time, the blood may cause a variety of symptoms including headache, confusion, limb weakness, and difficulty speaking.

There is currently no agreement among physicians as to the best way to treat this condition.

The study hypothesis to be tested was: For patients with unilateral, symptomatic chronic subdural hematoma, there is no difference in clinical outcomes, as measured by achievement of modified Rankin Score of 0-2 at 6 months, between those treated with a 2 week course of oral dexamethasone, compared with those treated with burr hole surgical drainage.

Detailed Description

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Chronic subdural hematoma (cSDH) is condition where blood has slowly leaked out of small blood vessels surrounding the brain. Over time, the blood may cause a variety of symptoms including headache, confusion, limb weakness, and difficulty speaking.

There is currently no agreement among physicians as to the best way to treat this condition. One option is to do a surgery to drain the blood that has collected. Usually the surgery involves drilling small holes in the skull to relieve pressure and allow blood and fluids to be drained. Another option is to give medications such as steroids that might reduce the swelling. However, no drugs have been approved by the Food and Drug Administration (FDA) specifically to treat this condition. Some patients elect to have no treatment.

The purpose of this study was to investigate whether investigational treatment with a 2 week course of oral dexamethasone is as effective as surgery for cSDH. The study hypothesis to be tested was: For patients with unilateral, symptomatic chronic subdural hematoma, there is no difference in clinical outcomes, as measured by achievement of modified Rankin Score of 0-2 at 6 months, between those treated with a 2 week course of oral dexamethasone, compared with those treated with burr hole surgical drainage.

Conditions

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Chronic Subdural Hematoma

Keywords

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Dexamethasone Burr hole craniostomy Chronic subdural hematoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Burr Hole Craniostomy randomized

Group receiving burr hole craniostomy and drainage of chronic subdural hematoma

Group Type ACTIVE_COMPARATOR

Burr Hole Craniostomy

Intervention Type PROCEDURE

Treatment with surgical burr hole craniostomy and evacuation of SDH

Dexamethasone randomized

Dexamethasone, tablet, initial dose 4mg q8h, total duration 15 days

Group Type EXPERIMENTAL

Dexamethasone

Intervention Type DRUG

Treatment with a short course of oral dexamethasone

Burr hole craniostomy observational

Observational cohort of patients selecting burr hole craniostomy

Group Type OTHER

Burr Hole Craniostomy

Intervention Type PROCEDURE

Treatment with surgical burr hole craniostomy and evacuation of SDH

Dexamethasone observational

Observational cohort of patients treated with dexamethasone protocol

Group Type OTHER

Dexamethasone

Intervention Type DRUG

Treatment with a short course of oral dexamethasone

Interventions

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Dexamethasone

Treatment with a short course of oral dexamethasone

Intervention Type DRUG

Burr Hole Craniostomy

Treatment with surgical burr hole craniostomy and evacuation of SDH

Intervention Type PROCEDURE

Other Intervention Names

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dex Burr hole drainage

Eligibility Criteria

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Inclusion Criteria

* Male or female subject aged 18 years of age or older
* Informed consent obtained from a patient or a legal representative before enrollment
* Enrollment into the study within 12 hours of detection of chronic subdural hematoma on cranial imaging
* Presence of symptoms referable to chronic subdural hematoma, including one or more of the following: Headache; altered mental status, limb weakness, dysphasia, or focal neurological deficit
* Demonstration of unilateral chronic subdural hematoma on cranial imaging, including the following features: On computed tomography imaging, iso- or hypo-intensity extra-axial collection with or without presence of acute component; radiologic interpretation of magnetic resonance imaging consistent with subacute or chronic SDH; with or without evidence of acute hemorrhagic component
* Maximum depth of subdural hematoma of less than 20mm, with less than 10mm of midline shift, as measured on axial CT or MR imaging
* Absence of skull fracture over the subdural hematoma
* Able to receive the drug treatment

Exclusion Criteria

* Presence of skull fracture over the subdural hematoma, or other specific etiology for cSDH not suitable for drainage by burr hole craniostomy, such as presence of a ventriculoperitoneal shunt
* Extent of subdural hematoma \> 20mm in maximal depth, or \> 10mm of midline shift, as measured on axial CT or MR imaging
* GCS \<8 or cSDH of an extent or size for which craniotomy, rather than burr hole drainage alone, is judged necessary by the neurosurgery attending on call
* Prior diagnosis of dementia
* Presence of symptomatic peptic ulcer, psychosis, active or suspected TB, acute infection, or documented hypersensitivity or allergy to dexamethasone
* Pregnancy (confirmed by a serum human chorionic gonadotropin pregnancy test) or breast feeding
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Virginia

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jennifer De Jong

Role: STUDY_DIRECTOR

University of Virginia

Locations

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University of Virginia Health System

Charlottesville, Virginia, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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17294

Identifier Type: -

Identifier Source: org_study_id