AUTHOR=Praphanuwat Todsapon , Srihagulang Chanon , Limpastan Kriengsak , Norasethada Thunya , Vaniyapong Tanat , Watcharasaksilp Wanarak , Jetjumnong Chumpon , Ruankham Phonphimon , Vongsfak Jirapong 

TITLE=Chronic subdural hematoma management in Thailand: a nationwide survey of clinical practice and trends

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1636167

DOI=10.3389/fneur.2025.1636167

ISSN=1664-2295

ABSTRACT=BackgroundChronic 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.MethodsA 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.ResultsA 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-h 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.ConclusionThis 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.