FINISH

Why is this trial needed?

Surgery for chronic subdural haematomas (CSDHs) is the most common emergency neurosurgical procedure. CSDHs are typically caused by minor head trauma, leading to a haemorrhage under the dura mater. For symptomatic CSDHs, the standard treatment is burr-hole evacuation, followed by intraoperative irrigation and placement of a subdural drain.

Although irrigation is widely considered an essential (“uncontested”) part of the surgical procedure, its true value has never been established in a randomized controlled trial setting. In the FINISH trial, we compared single burr-hole evacuation of CSDH followed by intraoperative irrigation and drainage to evacuation with drainage alone (without irrigation).

What is the primary objective of the FINISH trial?

The aim of this trial is to determine whether intraoperative irrigation adds any benefit to simple evacuation and subsequent drainage in the treatment of CSDHs. FINISH is a non-inferiority trial. The primary outcome is symptomatic CSDH recurrence requiring reoperation within 6 months. If no difference in recurrence rates is observed between intraoperative irrigation and no irrigation, CSDH surgery could be performed faster and more safely by omitting irrigation.

Where are we now?

Recruitment began in January 2020 and was completed in August 2022. Rahul and Kimmo, together with study coordinator Maarit Tuomisto, did outstanding work coordinating this large multi-centre project across all five neurosurgical centres in Finland.

Six-month follow-up concluded with the last patient in February 2023. After that, the team embarked on an intensive process of data cleaning, analyses, manuscript drafting, and final revisions. Following this multistep effort, The Lancet published our main results on June 6, 2024.

After the primary publication, the FINISH study continues with a series of planned secondary analyses, which are now underway.

The trial protocol was published in BMJ Open in 2021 and is available here.

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FINISH study group

Abdirisak Ahmed – Tarmo Areda – Jiri Jr Bartek – Tomasz Czuba – Nils Danner – Antti-Pekka Elomaa – Janek Frantzén – Ilkka Haapala – Joonas Haapasalo – Juuso Heikkilä – Minttu Hellman – Henna Henttonen – Nora Huuska – Teppo LN Järvinen – Henna-Kaisa Jyrkkänen – Aku Kaipainen – Olli-Pekka Kämäräinen – Hanna Kämppi – Milla Kelahaara – Riku Kivisaari – Nikolai Klimko – Oula A Knuutinen – Timo Koivisto – Tommi Korhonen – Janne Koskimäki – Anselmi Kovalainen – Xenia Kuparinen – Dan Laukka – Martin Lehecka – Kai Lehtimäki – Ville Leinonen – Kimmo Lönnrot – Antti Luikku – Teemu Luostarinen – Teemu Luoto – Janne Luotonen – Lauriina Lustig-Tammi – Henna-Riikka Maanpää – Jenni Määttä – Timo Möttönen – Eliisa Netti – Laura Nevaharju-Sarantis – Mika Niemelä – Tero Niskakangas – Mette Nissinen – Ville Nurminen – Minna Oinas – Teemu Ollonen – Anna Östberg – Elias Oulasvirta – Krista Pantzar – Katri Piilonen – Anni Pohjola – Markus Polvivaara – Jussi P Posti – Rahul Raj – Linnea Rajala – Jonas Ranstam – Minna Rauhala – Behnam Rezai Jahromi – Miika Roiha – Ilkka Saarenpää – Antti Sajanti – Henrikki Salmi – Jarno Satopää – Christoph Schwartz – Niina Shemeikka – Pia Sorto – Simo Taimela – Sami Tetri – Tuomo Thesleff – Pihla Tommiska – Maarit Tuomisto – Nuutti Vartiainen – Ville Vasankari – Jyri Virta – Mikko Visuri – Paula Walle – Frederick A Zeiler

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