Introduction: Chronic subdural haematoma (CSDH) is a common neurosurgical condition with a reported recurrence rate up to 25%. The recurrence rate has been shown to be reduced by subdural drainage after simple burr hole surgery. In addition, a retrospective study has shown that patients treated with Angiotensin-converting enzyme (ACE) inhibitors have a reduced recurrence rate.
Methods: The present prospective randomized controlled study was designed to investigate if treatment with ACE inhibitors could reduce the recurrence rate after burr hole treatment for CSDH.
Results: 48 patients (39 males, 9 females, mean age 69.9 years) were included in the study and randomized to either placebo or active compound (Perindopril 5 mg/day). Treatment was initiated the morning after surgical evacuation and continued for three months. Surgical evacuation was performed by burr hole technique and followed by subdural or subgaleal drainage for up to 24 hrs. Six weeks post operatively, a control CT scan was made. Follow up was performed after three months.
No recurrences justifying surgical evacuation were found in the study group. Comparing the size of the haematoma six weeks post operatively revealed no difference in the size of residual CSDH in placebo versus active compound groups (p=0.50).
Conclusions: We conclude that systemic treatment with ACE inhibitors has no effect on the size of residual CSDH six weeks after surgical evacuation.
Patient Care: Patients should not be treated with ACE inhibitors for the purpose of reducing recurrence rate of chronic subdural haematoma
Learning Objectives: By the conclusion of this session, participants should know that ACE inhibitors has no effect on recurrence rate of chronic subdural haematoma after surgical evacuation.