Discussion
cSDH, hematoma, hematomas, confusion/disorientation
HEMATOMA, RECURRENCE, HEMATOMAS, COMPLICATION
In this multicenter randomized clinical trial, we showed that cSDH managed with burr hole evacuation and intraoperative irrigation at body temperature (37 °C) resulted in a statistically significant and clinically relevant reduction of cSDH recurrence compared with patients treated with intraoperative irrigation at room temperature (22 °C). There were no differences in complication frequency, quality of life, or mortality between groups. These results confirm the findings of our previously published retrospective single-center study.In this randomized clinical trial, the baseline factors were comparable, except for more cases of preoperative confusion/disorientation in the RT group compared with the BT group. However, it is unlikely that this had an impact on the results because bilateral hematomas, hematoma size, and mass effect (midline shift) did not differ between the 2 groups.One of the reasons why irrigation of body temperature is superior to irrigation at room temperature in the evacuation of cSDH might be that rinsing the subdural space from factors mediating hematoma progression is more effective. It has been shown that the aqueous solubility of organic materials is doubled with every 20 °C increase of temperature.The efficacy of postoperative drainage after cSDH evacuation has been established with solid evidence, but the use of other adjuncts is either not backed by evidence or has failed to demonstrate net benefit. Many randomized clinical trials exploring different aspects of cSDH surgery are ongoing.