Neuroendoscopy-assisted Drainage Versus Burr Hole Drainage for Chronic Subdural Hematoma

NCT ID: NCT07144423

Last Updated: 2025-08-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

770 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-08-31

Study Completion Date

2026-12-31

Brief Summary

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Chronic subdural hematoma (CSDH) is a frequent condition in neurosurgery, leading to fluid accumulation between the meninges, brain compression, neurological dysfunction, and potentially herniation. The efficacy of treatments and their long-term outcomes remain uncertain, with no established standard. Notably, neuroendoscopy-assisted hematoma evacuation, in contrast to burr-hole drainage, enables direct visualization and thorough removal of the hematoma, thereby minimizing residue, lowering recurrence rates, and shortening drainage duration. This study will undertake a multicenter trial to compare these two methods and determine the superior treatment approach for CSDH.

Detailed Description

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Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. It is generally considered to be a closed fluid collection situated between the dura mater and arachnoid mater, formed by blood or blood degradation products. This collection causes a local mass effect, compressing adjacent brain tissue and leading to varying degrees of neurological dysfunction. In severe cases, it can induce brain herniation, endangering the patient's life. In recent years, despite the availability of various pharmacological and surgical treatment options for CSDH, the efficacy and long-term prognosis of these treatment methods and strategies remain not entirely clear, and a standardized treatment approach has yet to be established. Neuroendoscopy-assisted hematoma drainage is one of the treatment methods for CSDH, but its current application is not widespread. The core of this method involves neurosurgeons directly observing the hematoma structure during surgery with the assistance of a neuroendoscope, enabling them to thoroughly irrigate and aspirate the hematoma under direct vision and sever hematoma septations. This approach enhances the hematoma clearance rate, ultimately reducing the amount of postoperative hematoma residue. Compared with conventional burr-hole drainage, neuroendoscopy-assisted burr-hole drainage reduces the recurrence rate of CSDH and shortens the duration of postoperative drainage. This study aims to conduct a multicenter randomized controlled trial comparing neuroendoscopy-assisted hematoma drainage with burr-hole drainage, with the objective of scientifically and rigorously determining the optimal clinical treatment strategy for CSDH.

Conditions

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Chronic Subdural Hematoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The design is open labeled with only the investigators for postoperative follow-up evaluation, the outcome assessors, and data analysts being blinded in all 24 centers. Before outcome assessment begins at every follow-up evaluation, the patients will be reminded not to reveal any information about their group allocation. If details of group allocation can be detected by the investigator during follow-ups, another blinded researcher will replace to evaluate outcome.

Study Groups

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Neuroendoscope-assisted hematoma drainage

Under the guidance of a visualized neuroendoscope, the hematoma is thoroughly irrigated and evacuated.

Group Type EXPERIMENTAL

Endoscope-assisted hematoma drainage

Intervention Type PROCEDURE

The procedure of endoscope-assisted hematoma drainage is performed under local anesthesia with sedation or general anesthesia. During the operation, a single burr hole is drilled at the midpoint of the thickest layer of the hematoma cavity as shown on CT scan. A bone flap measuring 2.0 cm × 2.0 cm is then created using a milling cutter. Under the guidance of a visualized neuroendoscope, the hematoma is thoroughly irrigated and evacuated. A subdural drainage tube is inserted, and postoperatively, continuous subdural drainage of the hematoma is maintained until the drainage ceases naturally or the drainage tube is removed at a maximum of 48 hours postoperatively to terminate the drainage.

Burr hole hematoma drainage

The hematoma cavity is irrigated intraoperatively until the drainage fluid becomes clear.

Group Type OTHER

Burr hole hematoma drainage

Intervention Type PROCEDURE

The procedure of burr hole drainage is performed under local anesthesia with sedation or general anesthesia. During the operation, a single burr hole is drilled at the midpoint of the thickest layer of the hematoma cavity as indicated by CT scan. A subdural drainage tube is then inserted. The hematoma cavity is irrigated intraoperatively until the drainage fluid becomes clear. Postoperatively, continuous subdural drainage of the hematoma is maintained until the drainage ceases naturally or the drainage tube is removed at a maximum of 48 hours postoperatively to terminate the drainage.

Interventions

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Endoscope-assisted hematoma drainage

The procedure of endoscope-assisted hematoma drainage is performed under local anesthesia with sedation or general anesthesia. During the operation, a single burr hole is drilled at the midpoint of the thickest layer of the hematoma cavity as shown on CT scan. A bone flap measuring 2.0 cm × 2.0 cm is then created using a milling cutter. Under the guidance of a visualized neuroendoscope, the hematoma is thoroughly irrigated and evacuated. A subdural drainage tube is inserted, and postoperatively, continuous subdural drainage of the hematoma is maintained until the drainage ceases naturally or the drainage tube is removed at a maximum of 48 hours postoperatively to terminate the drainage.

Intervention Type PROCEDURE

Burr hole hematoma drainage

The procedure of burr hole drainage is performed under local anesthesia with sedation or general anesthesia. During the operation, a single burr hole is drilled at the midpoint of the thickest layer of the hematoma cavity as indicated by CT scan. A subdural drainage tube is then inserted. The hematoma cavity is irrigated intraoperatively until the drainage fluid becomes clear. Postoperatively, continuous subdural drainage of the hematoma is maintained until the drainage ceases naturally or the drainage tube is removed at a maximum of 48 hours postoperatively to terminate the drainage.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Patient (18 years to 90 years) presenting with clinical symptoms and neurological deficits of CSDH.
2. CSDH verified on cranial computed tomography or magnetic resonance imaging.
3. Written informed consent from patients or their next of kin according to the patient's cognitive status.

Exclusion Criteria

1. No clinical symptoms correlating with chronic subdural hematoma.
2. Lack of mass effect and midline shift \< 5 mm on the radiological image, or no need surgery judged clinically by neurosurgeons.
3. Previous surgery for CSDH during the past 6 months.
4. Previous intracranial surgery for any other neurological disorder.
5. Poor medication conditions or the presence of severe comorbidities so that surgery cannot be tolerated, or follow-up cannot be completed.
6. Severe coagulopathy or a high risk of life-threatening bleeding (including any one of the following three criteria: prothrombin time or activated partial thromboplastin time prolonged by more than 10 seconds; international normalized ratio \> 3.0; absolute platelet count \< 100×109/L).
7. Postoperative compliance is suspected to be insufficient for 3-month follow-up visit.
8. Reproductive-age women without verified negative pregnancy testing.
9. Participating in another research.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Beijing Tiantan Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Guoyi Gao, MD

Role: PRINCIPAL_INVESTIGATOR

Beijing Tiantan Hospital

Liang Wu, MD

Role: STUDY_DIRECTOR

Beijing Tiantan Hospital

Locations

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Beijing Tiantan Hospital, Capital Medical University

Beijing, Beijing Municipality, China

Site Status

First Affiliated Hospital of Xiamen University

Xiamen, Fujian, China

Site Status

Jiangmen Central Hospital

Jiangmen, Guangdong, China

Site Status

Shantou central hosital

Shantou, Guangdong, China

Site Status

People's Hospital of Longhua, Shenzhen

Shenzhen, Guangdong, China

Site Status

Liuzhou worker's Hospital

Liuzhou, Guangxi, China

Site Status

The Second Affiliated Hospital of Guangxi Medical University

Nanning, Guangxi, China

Site Status

Nanning First People's Hospital

Nanning, Guangxi, China

Site Status

The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine

Nanning, Guangxi, China

Site Status

Wuzhou Gongren Hospital

Wuzhou, Guangxi, China

Site Status

Hebei University of Engineering Affiliated Hospital

Handan, Hebei, China

Site Status

Xingtai Central Hospital

Xingtai, Hebei, China

Site Status

Changde First People's Hospital

Changde, Hunan, China

Site Status

People's Hospital of Xiangxi Prefecture, Hunan Province

Jishou, Hunan, China

Site Status

Yueyang Central Hospital

Yueyang, Hunan, China

Site Status

Heji Hospital affiliated with Changzhi Medical College

Changzhi, Shanxi, China

Site Status

Linfen People's Hospital

Linfen, Shanxi, China

Site Status

Shanxi Provincial People's Hospital,Shanxi Medical University

Taiyuan, Shanxi, China

Site Status

The second affiliated hospital of Xi'an Medical University

Xi’an, Shanxi, China

Site Status

Mianyang 404 Hospital

Mianyang, Sichuan, China

Site Status

the First People'S Hospital of Yibin

Yibin, Sichuan, China

Site Status

First Affiliated Hospital of Xinjiang Medical University

Ürümqi, Xinjiang, China

Site Status

Pu'er People's Hospital

Pu'er, Yunnan, China

Site Status

First Affiliated Hospital of Wenzhou Medical University

Wenzhou, Zhejiang, China

Site Status

Countries

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China

Central Contacts

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Liang Wu, MD

Role: CONTACT

18301674233

Yu Yan, MB

Role: CONTACT

13701141637

Facility Contacts

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Guoyi Gao, MD

Role: primary

13801874393 ext. +86

Zhanxiang Wang, M.D.

Role: primary

13666082686

Jiyong Gu, M.D.

Role: primary

18029602088

Ke Xu, M.D.

Role: primary

15915553501

Zheng Liu, M.D.

Role: primary

15889644064

Quan Liu, M.D.

Role: primary

15577718510

Chunhai Tang, M.D.

Role: primary

15077195824

Feng Wei, M.D.

Role: primary

15978192443

Yi Huang, M.D.

Role: primary

18677140190

Zhongyong Deng, M.D.

Role: primary

13878401206

Xiushan Li, M.D.

Role: primary

13592602885

Jinmin Hao, M.D.

Role: primary

13932995289

Jiangli Wen, M.D.

Role: primary

18397356106

Changhua Xiang, M.D.

Role: primary

13762109008

Jian Zhou, M.D.

Role: primary

15071057913

Tiezhu Guo, M.D.

Role: primary

15635559010

Honggang Ren, M.D.

Role: primary

18835791653

Xiaohui Yao, M.D.

Role: primary

13803439803

Haikang Zhao, M.D.

Role: primary

18302996683

Zhiyong Gou, M.D.

Role: primary

18909010077

Hua Peng, M.D.

Role: primary

15183906301

Yongxin Wang, M.D.

Role: primary

18699147876

Xingchang Li, M.D.

Role: primary

18087915959

Zhipeng Su, M.D.

Role: primary

18324239321

References

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Other Identifiers

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HX-A-2025027

Identifier Type: -

Identifier Source: org_study_id

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