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Frontal vs Parietal Eminence Drainage for Chronic Subdural Hematoma

25. Juli 2026 aktualisiert von: Jie Shen, The Second Hospital of Anhui Medical University

Frontal Versus Parietal Eminence Twist-Drill Drainage for Chronic Subdural Hematoma

This clinical trial aims to find out whether the puncture site used during minimally invasive surgery with twist-drill puncture and closed-system drainage affects the treatment of chronic subdural hematoma (cSDH).

The target population is adults with a unilateral chronic subdural hematoma who need surgical drainage based on their symptoms and imaging findings (CT/MRI).

The main questions this study is designed to answer are:

  • Does the puncture site affect the risk of same-side cSDH recurrence requiring reoperation within 3 months
  • Does the puncture site affect recovery and key clinical outcomes after surgery (including functional status and postoperative recovery measures)

There are two groups, researchers will compare:

  • Group A: patients receiving puncture at the frontal region vs.
  • Group B: patients receiving puncture near the parietal eminence to determine whether one puncture site leads to better outcomes than the other.

Participants will:

  • undergo a surgical procedure where, based on random assignment, the puncture site is either frontal or near the parietal eminence;
  • receive closed-system drainage after a twist-drill puncture;
  • complete follow-up assessments at discharge, 30 days, 3 months after surgery, which will include symptom review and imaging (CT) evaluations to check hematoma changes and recurrence;
  • have safety monitoring throughout the study period to record any complications or adverse events.

Studienübersicht

Status

Noch keine Rekrutierung

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

This is a (multi-center) prospective, randomized, parallel-group, assessor-blinded clinical trial in eligible patients with unilateral chronic subdural hematoma (cSDH) to compare the effects of puncture-site location on outcomes after minimally invasive drainage: participants will be randomly assigned 1:1 to Group A (frontal twist-drill puncture drainage) or Group B (parietal eminence twist-drill puncture drainage), with both groups receiving standardized closed-system subdural drainage and postoperative management; random allocation will be concealed using a secure electronic randomization system or sealed opaque envelopes prepared by a researcher not involved in surgery or outcome assessment. The primary outcome is the rate of ipsilateral cSDH recurrence requiring reoperation within 3 months after surgery (recurrence defined as symptomatic re-accumulation or enlargement confirmed by imaging and judged by the treating team to require repeat intervention). Secondary outcomes include postoperative residual hematoma maximum thickness and volume at 24-48 hours, pneumocephalus volume at 24-48 hours, reduction in midline shift, brain re-expansion rate, drainage duration, length of hospital stay, postoperative complications, Markwalder grading and modified Rankin Scale (mRS) scores at 30 days/3 months, and mortality at 30 days and 3 months; although surgeon blinding is not feasible, radiological and clinical outcome assessors and statisticians will be blinded whenever possible, with anonymized postoperative CT images assessed independently by trained reviewers.

Studientyp

Interventionell

Einschreibung (Geschätzt)

440

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienkontakt

Studienorte

  • China
    • Anhui
      • Hefei, Anhui, China, 230601
        • The Second Affiliated Hospital of Anhui Medical University
        • Kontakt:
          • Jie Shen, MD
          • Telefonnummer: +8613515515154
    • Jiangsu
      • Huai'an, Jiangsu, China, 223300
        • Huai'an first people's hospital
        • Kontakt:
      • Yangzhou, Jiangsu, China, 225009
        • Yangzhou University Affiliated Hospital
        • Kontakt:

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

  • Erwachsene
  • Älterer Erwachsener

Akzeptiert gesunde Freiwillige

Nein

Beschreibung

Inclusion Criteria:

  1. Age ≥ 18 years.
  2. Unilateral chronic subdural hematoma (cSDH) or subacute-to-chronic subdural hematoma, confirmed by CT or MRI.
  3. Presence of clinical symptoms attributable to cSDH, such as headache, limb weakness, gait disturbance, cognitive decline, speech disturbance, seizure, or impaired consciousness.

  4. Radiological indication for surgery, defined as one of the following:

    Maximum hematoma thickness ≥ 10 mm, and/or Midline shift ≥ 5 mm, or Even if these thresholds are not met, clinically significant symptoms requiring surgery as judged by the treating neurosurgeon.

  5. Plan to undergo twist-drill puncture drainage with a closed drainage system.
  6. Written informed consent signed by the participant or their legally authorized representative.

Exclusion Criteria:

  1. Bilateral cSDH requiring simultaneous bilateral surgery.
  2. Acute subdural hematoma, or a condition where the hematoma is predominantly composed of an acute hemorrhagic component.
  3. Markedly septated, organized, or calcified hematoma in which minicraniotomy or craniotomy is required preoperatively.
  4. Previous surgery on the ipsilateral side for cSDH.
  5. Concomitant intracranial conditions requiring specific treatment, including but not limited to: intracranial tumor, brain abscess, vascular malformation, or ruptured aneurysm.
  6. Severe coagulation disorder that cannot be corrected before surgery.
  7. Life expectancy < 6 months.
  8. Pregnancy.
  9. Any condition that, in the judgment of the investigator, makes the patient inappropriate for participation in the study.

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Single

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: Frontal (Anterior) Burr Hole Puncture Drainage (twist-drill drainage)
The puncture point is selected within the anterior coverage region of the hematoma area-typically within the frontal bone region anterior to the coronal suture-avoiding the frontal sinus, obvious cortical veins, and key functional areas. The exact location is determined based on preoperative CT 3D reconstruction, with principles of safe entry into the subdural hematoma space and an appropriate catheter direction toward the main hematoma cavity/compartment.
Verfahren: Frontal-region puncture drainage
Patients will undergo burr-hole puncture drainage at the frontal region (frontal puncture) for chronic subdural hematoma (cSDH).
Aktiver Komparator: Parietal Eminence Burr Hole Puncture Group(twist-drill drainage)
The puncture point is selected at the vertex (crown vertex) region within the hematoma area. The exact location is determined based on preoperative CT 3D reconstruction, with principles of safe entry into the subdural hematoma space and an appropriate catheter direction toward the main hematoma cavity/compartment.
Verfahren: Parietal Eminence region puncture drainage
Patients will undergo burr-hole puncture drainage at the Parietal Eminence/tubercle region (vertex puncture) for cSDH.

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Ipsilateral cSDH recurrence requiring reoperation within 3 months after surgery
Zeitfenster: 3 months
Recurrence defined as ipsilateral hematoma re-enlargement or symptom recurrence, confirmed by imaging, and judged by the treatment team to require repeat surgical intervention.
3 months

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Residual hematoma maximum thickness
Zeitfenster: "Day 2", "Month 1", "Month3" after operation
Measured on postoperative CT as the maximum thickness of the residual ipsilateral cSDH.
"Day 2", "Month 1", "Month3" after operation
Residual hematoma volume
Zeitfenster: "Day 2", "Month 1", "Month3" after operation
Measured on postoperative CT as the hematoma volume of the residual ipsilateral cSDH.
"Day 2", "Month 1", "Month3" after operation
Intra-cranial pneumocephalus volume
Zeitfenster: "Day 2", "Month 1" after operation
Measured on postoperative CT as the volume of intracranial pneumocephalus (air within the cranial cavity).
"Day 2", "Month 1" after operation
Improvement in midline shift
Zeitfenster: "Day 2", "Month 1", "Month3" after operation
Assessed on follow-up imaging by comparing the midline shift against baseline/protocol-defined preoperative value; reported as the degree of improvement.
"Day 2", "Month 1", "Month3" after operation
Drain duration / catheter indwelling time
Zeitfenster: immediately after the procedure
Time from catheter placement to catheter removal, reported as hours/days per protocol.
immediately after the procedure
Postoperative complications
Zeitfenster: From operation up to 3 months postoperatively

Any adverse events occurring postoperatively, including (but not limited to):

acute subdural hematoma, intracerebral hemorrhage, seizure, infection, tension pneumocephalus, and drain/catheter misplacement.
From operation up to 3 months postoperatively
Markwalder grade at 7days, 30 days and 3 months
Zeitfenster: "Day 7", "Month 1", "Month3" after operation
Neurological symptom severity scored using the Markwalder scale at the specified follow-up time points.
"Day 7", "Month 1", "Month3" after operation
Modified Rankin Scale (mRS) at 7days, 1 months, and 3 months
Zeitfenster: "Day 7", "Month 1", "Month3" after operation
Functional status measured by mRS at the specified follow-up time points.
"Day 7", "Month 1", "Month3" after operation
Mortality rate within 3 months after operation
Zeitfenster: From operation up to 3 months postoperatively
Death from any cause assessed at 3 months after surgery.
From operation up to 3 months postoperatively

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

The Second Hospital of Anhui Medical University

Mitarbeiter

Yangzhou University
Huai'an First People's Hospital

Ermittler

  • Studienleiter: qi li, MD, The Second Hospital of Anhui Medical University

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Geschätzt)

1. Januar 2027

Primärer Abschluss (Geschätzt)

1. Dezember 2028

Studienabschluss (Geschätzt)

1. Juni 2029

Studienanmeldedaten

Zuerst eingereicht

22. Juli 2026

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

25. Juli 2026

Zuerst gepostet (Tatsächlich)

28. Juli 2026

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

28. Juli 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

25. Juli 2026

Zuletzt verifiziert

1. Juli 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Schlüsselwörter

Zusätzliche relevante MeSH-Bedingungen

Andere Studien-ID-Nummern

  • SAHAMU-CSDH-RCT-002
  • 202512022 (Andere Zuschuss-/Finanzierungsnummer: Anhui Provincial International Joint Research Center for Advanced Technology in Medical Imaging, Anhui University)

Plan für individuelle Teilnehmerdaten (IPD)

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NEIN

Arzneimittel- und Geräteinformationen, Studienunterlagen

Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt

Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

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