ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotrauma
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1636167
Chronic subdural hematoma management in Thailand: A nationwide survey of clinical practice and trends
Provisionally accepted
Todsapon PraphanuwatChanon SrihagulangKriengsak LimpastanThunya NorasethadaTanat VaniyapongWanarak WatcharasaksilpChumpon JetjumnongPhonphimon Ruankham
Jirapong Vongsfak*- Chiang Mai University, Chiang Mai, Thailand
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Chronic subdural hematoma (CSDH) presents a growing challenge in neurosurgical care due to its increasing incidence, recurrence rates, and aging-related risk factors. Treatment approaches vary widely, particularly in Southeast Asia, where limited data exists regarding standardized management. This study aims to evaluate current clinical practices and emerging treatment trends for CSDH among Thai neurosurgeons.Methods: A nationwide cross-sectional survey was conducted in January 2025 among practicing neurosurgeons across Thailand. The 29-item web-based questionnaire covered demographics, surgical techniques, adjunct therapies, and postoperative care. Descriptive statistics were used to summarize responses. Results were synthesized and compared with previously published nationwide surveys to identify practice trends and deviations.Results: A total of 53 responses were received (76% response rate). Most respondents practiced in public hospitals (71.7%) and managed 10-30 CSDH cases annually (56.6%). The preferred surgical method was two burr-hole craniostomy (73.6%), with 96.2% of surgeons using intraoperative irrigation, predominantly with room-temperature normal saline. Drain placement was nearly universal (96.2%), with 72.5% opting for subdural drains. Postoperative care varied, with 30.2% prescribing 48-hour bed rest and 66% not performing routine postoperative CT scans. Corticosteroids were used by 37.7%, mostly in conservative cases, while 40% prescribed statins, and 39.6% utilized tranexamic acid. Adjunctive middle meningeal artery (MMA) embolization was employed by 45.3% of respondents. Decisions to resume antiplatelet or anticoagulant therapy were guided by postoperative imaging in over half of the cases.This survey highlights substantial heterogeneity in the management of chronic subdural hematoma (CSDH) across Thailand. While burr-hole craniostomy with irrigation and drainage remains the standard surgical approach, notable variations exist in medical therapy and postoperative care. The widespread use of middle meningeal artery (MMA) embolization and other adjunctive therapies reflects evolving treatment trends. These findings emphasize the need for national, evidence-based guidelines to standardize care, reduce variability, and improve patient outcomes.
Keywords: chronic subdural hematoma, Survey study, nationwide, Burr hole drainage, MMA embolization
Received: 27 May 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Praphanuwat, Srihagulang, Limpastan, Norasethada, Vaniyapong, Watcharasaksilp, Jetjumnong, Ruankham and Vongsfak. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jirapong Vongsfak, Chiang Mai University, Chiang Mai, Thailand
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.