Hemorrhage irrigation reduces need for repeat operations in the most common neurosurgery emergency procedure

The Finnish study of intraoperative irrigation versus drain alone after evacuation of chronic subdural haematoma (FINISH) investigated whether it is worthwhile to irrigate a chronic subdural hematoma during surgery 

Half the patients had their hemorrhage irrigated and half did not. Otherwise, the procedure was carried out in the same way. The main result was that there was significantly less need for repeat procedures in patients who had their hemorrhage irrigated during surgery. Patients’ functional capacity and mortality did not differ between the groups. 

The research project involved all Finnish neurosurgery units from the university hospitals of Helsinki, Kuopio, Tampere, Turku, and Oulu. A total of 589 patients with symptomatic chronic subdural hematoma were included in the study. 

“Based on the results, we recommend that surgery be performed with irrigation as has been the current treatment protocol in Finland. The role of irrigation in surgery has not been previously studied in a randomized setting and the methods of intervention vary worldwide”, says Co-principal Investigator and Associate Professor Rahul Raj from HUS Neurocenter. 

Chronic subdural hematoma requires neurosurgical treatment in the emergency department 

Chronic subdural hematoma is the most common condition requiring neurosurgical treatment in the emergency department. Its symptoms may include difficulty walking, loss of strength, speech impediment, memory problems, headaches or epileptic seizures. Without treatment, a hematoma can be fatal. In a trephine craniostomy, a small hole is drilled in the skull and the clot is removed either by irrigating and then inserting a drain or by simply inserting a drain. 

Co-principal investigator, Pihla Tommiska, MD, adds that trepanation is one of the most common neurosurgical procedures and the number of operations has increased dramatically in Finland in recent decades. 

The study is historic in the field of neurosurgery, as a national randomized comparative study of five centers has never been conducted in Finland before.  

The study was designed and implemented in collaboration with the Finnish Centre for Evidence-Based Orthopaedics (FICEBO) research group at the University of Helsinki and HUS. The group is internationally renowned for its randomized comparative studies 

”When Rahul Raj, Pihla Tommiska and Kimmo Lönnrot presented their research idea in 2019, it was immediately clear to us that FICEBO would be putting its expertise and resources at the disposal of a great idea and ambitious young researchers. Our hope is that FINISH research can encourage young researchers to do more sustained research work," say Professor Teppo Järvinen and Research Director, Associate Professor Simo Taimela. 

The study was published in The Lancet journal on June 6, 2024

Reference:

Raj R*, Tommiska P*, Koivisto T, Leinonen V, Danner N, Posti JP, Laukka D, Luoto TM, Rauhala M, Tetri S, Korhonen TK, Satopää J, Kivisaari R, Luostarinen T, Schwartz C, Czuba T, Taimela S, Lönnrot K*, Järvinen TLN* on behalf of the Finnish study of intraoperative irrigation versus drain alone after evacuation of CSDH (FINISH) study group. Burr-hole drainage with or without irrigation for chronic subdural haematoma (FINISH): a Finnish, nationwide, parallel-group, multicentre, randomised, controlled, non-inferiority trial. The Lancet 2024; 6 June

Link to the publication: https://doi.org/10.1016/S0140-6736(24)00686-X

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