title: Perindopril and residual chronic subdural hematoma volumes six weeks after burr hole surgery: a randomized trial.
abstract: OBJECTIVE
  Recurrence rates of between 5% and 25% have been reported following surgery for chronic subdural hematoma (CSH). A previous study showed that the treatment with angiotensin converting enzyme (ACE) inhibitors decreases the risk of recurrence. To test the effects of ACE inhibitors on the recurrence CSH and CSH remnant six weeks after surgery, we conducted a prospective double-blinded randomized controlled clinical trial on patients with CSHs from July 2009 until October 2012.
  
  
  METHODS
  Patients eligible for burr hole surgery for CSH were randomized into either an ACE inhibitor perindopril 5mg or placebo treatment daily for three months prior to surgery. Cerebral CT scans were performed after six weeks, and clinical follow-ups were performed three months after surgery. Additionally, a retrospective analysis of the data and CT scans from all nonrandomized patients from the same time period was performed.
  
  
  RESULTS
  Forty-seven patients were included in the randomized study. The patients' preoperative Glasgow Coma Scale scores were 15. None of the patients in the randomized group developed a recurrence after surgery. Measurements of the sizes of the CSH before and six weeks after surgery revealed no difference between the placebo and perindopril-treated groups. In the retrospective group (245 patients), there was no correlation between the risk of recurrence and ACE inhibitor treatment.
  
  
  CONCLUSIONS
  Our data suggest that perindopril does not diminish the size of residual CSHs six weeks after burr hole surgery and that ACE inhibitors do not decrease the risk of CSH recurrence.
authors.affiliation: Department of Neurosurgery, Odense University Hospital, DK-5000 Odense , Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark. Electronic address: frantz.r.poulsen@rsyd.dk.
authors.forename: Frantz Rom
authors.initials: FR
authors.lastname: Poulsen
authors.affiliation: Department of Neurosurgery, Odense University Hospital, DK-5000 Odense , Denmark; Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark.
authors.forename: Sune
authors.initials: S
authors.lastname: Munthe
authors.affiliation: Department of Neurosurgery, Odense University Hospital, DK-5000 Odense , Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Søe
authors.affiliation: Department of Neurosurgery, Odense University Hospital, DK-5000 Odense , Denmark; Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark.
authors.forename: Bo
authors.initials: B
authors.lastname: Halle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D020913:Perindopril / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril
keywords: Angiotensin-converting enzyme inhibitors; Chronic; Hematoma; Recurrence; Subdural