Pihla Tommiska

MD, PhD | Helsinki University Hospital & University of Helsinki, Finland | Interested in chronic subdural hematomas

[Pihla Tommiska @PTommiska]

🩸Our FINISH trial out in @TheLancet !

💉Intraoperative subdural irrigation seems beneficial in reducing the recurrence of chronic subdural hematomas

🧠Thankful for the team and participants @rahulbrraj @shamteppo @HUS_fi @helsinkiuni

👇Link below

#csdh #rct #neurosurgery

[Rahul Raj @rahulbrraj]

Regarding TBIs, the e-scooter is not the problem. It is driving them under the influence of alcohol 🍺 https://t.co/iq1gPK6bRs @PTommiska

[Pihla Tommiska @PTommiska]

We analyzed all e-scooter–related TBIs treated in Helsinki emergency departments during 2021–2023. Alcohol intoxication was documented in 82% of patients, and #TBI incidence decreased 56% after nighttime restrictions and speed limits.🚑🧠

https://t.co/TwKcXooWeF

@JNNP_BMJ

[Pihla Tommiska @PTommiska]

New insights on #CSDH surgery:
• Higher drainage volume → ↑ reoperations
• Longer drainage time → ↓ reoperations
• No link with 6-month outcomes

CSDH drainage management may need more personalized strategies, not one standard drain time for all. https://t.co/eZupaJbjri

[Rahul Raj @rahulbrraj]

New post hoc analysis of the FINISH trial: Mortality & causes of death after #CSDH surgery (n=589). Key findings: 6-month mortality was 6.6%, increasing to 13.9% at ~16 months. Leading causes of death: Circulatory (34%), Accidents (16%), Dementia (15%). Mortality is strongly driven by comorbidities (Dementia HR 5.31, Arrhythmia HR 3.23). It’s the underlying #Frailty, not just the CSDH https://t.co/KndEsgIAak @ActaNeuro @PTommiska @LuotoTM

[Pihla Tommiska @PTommiska]

After surgery for #CSDH, 14% of patients died during ~16 months follow-up.

Top causes of death:
• Circulatory diseases 34%
• Accidents 16%
• Dementia 15%

Comorbidities, especially dementia, arrhythmias and prior stroke, were predictors of mortality.

https://t.co/Br75lKNKv4

[Rahul Raj @rahulbrraj]

1/5 🚨 The RELACS Trial 🧠 The management of Chronic Subdural Hematoma (#CSDH) in patients with Atrial Fibrillation is a daily clinical dilemma. Approximately 20–25% of CSDH patients are on anticoagulants. @MKorja @LuotoTM @shamteppo @HUS_fi @HelsinkiUniMed

[Pihla Tommiska @PTommiska]

The RELACS protocol is out!

No evidence-based guidelines exist on when to safely resume anticoagulation after #CSDH surgery in AF patients (≈20–25% of cases).

RELACS compares early (5d) vs late (30d) restart to balance bleeding and thrombosis risks.

📄 https://t.co/luEUwVlqhs

[Rahul Raj @rahulbrraj]

🧠 Latest from the FINISH study group: 1 in 5 patients fails to improve functionally after burr-hole drainage. In patients with a pre-existing diagnosis of dementia, half fails to improve ⚠️ Importantly, reoperation for hematoma recurrence does not appear to influence functional outcome ⚠️ #Neurosurgery #CSDH #Dementia #Frailty @Age_and_Ageing

https://t.co/sKqomNcQEr

[Rahul Raj @rahulbrraj]

⏳🧠 Early surgery (≤22h) for chronic subdural hematoma was associated with significantly better functional outcomes compared to delays >22h. Time seems to matter—even in CSDH⏱️ https://t.co/4q7F5v4SdR @WorldNeurosurg

[Pihla Tommiska @PTommiska]

After #CSDH surgery, thromboembolic events (8%) were slightly more common than hemorrhagic (6%) in patients on pre-op anticoagulation for #AF. Thromboembolic events severely worsened outcomes, emphasizing the need for prevention strategies.

@ActaNeuro https://t.co/OS6c3yLmWO

[Rahul Raj @rahulbrraj]

🩸Postoperative management of anticoagulated chronic subdural hematoma patients is complex, with 19% of patients experiencing thromboembolic or hemorrhagic complications, or vascular death within six months ⚠️ https://t.co/QBdvPd7AJV #HelsinkiNeurosurgery @PTommiska @ActaNeuro

[Pihla Tommiska @PTommiska]

Night-time surgery for #CSDH shows no worse outcomes than daytime surgery—plus, fewer severe adverse events at night. Our findings challenge the traditional preference for daytime CSDH surgery.

Read more in @ActaNeuro: https://t.co/X8LkCMFb3t
@HUS_fi @HelsinkiUniMed @rahulbrraj

[The Lancet Neurology @TheLancetNeuro]

New in @TheLancet, results of the FINISH trial, a randomised non-inferiority trial of burr-hole drainage with or without irrigation for chronic subdural haematoma https://t.co/J5sNnQRegH

[Lääkärilehti @Laakarilehti]

Kroonisen kovakalvonalaisen verenpurkauman kallonporausleikkauksessa tehtävä huuhtelu vähentää uusintaleikkauksia, todettiin Lancetissa julkaistussa suomalaistutkimuksessa.

#kallonporaus #tutkimus
https://t.co/h187gWpjjR

[Pihla Tommiska @PTommiska]

https://t.co/JMVURRfqo1

[Pihla Tommiska @PTommiska]

🩸Our FINISH trial out in @TheLancet !

💉Intraoperative subdural irrigation seems beneficial in reducing the recurrence of chronic subdural hematomas

🧠Thankful for the team and participants @rahulbrraj @shamteppo @HUS_fi @helsinkiuni

👇Link below

#csdh #rct #neurosurgery

[HUS Helsingin yliopistollinen sairaala @HUS_fi]

Irrigation during craniotomy for chronic subdural hemorrhage reduces the need for repeat procedures. A Finnish study on the most common neurosurgical emergency procedure has been published in The Lancet. #HUS https://t.co/cYIqlxIyD2 @HelsinkiUniMed

[Rahul Raj @rahulbrraj]

Pleased to share the final results of the FINISH trial published in @TheLancet! Our findings support using subdural irrigation to reduce hematoma recurrence risk. A huge thank you to all collaborators and participants. Read more: https://t.co/GKRgfDNzGJ

[HUS Helsingin yliopistollinen sairaala @HUS_fi]

Kroonisen kovakalvonalaisen verenpurkauman kallonporausleikkauksessa tehtävä huuhtelu vähentää uusintaleikkauksia. Suomalaistutkimus yleisimmästä neurokirurgian päivystysleikkauksesta on julkaistu The Lancet -lehdessä. https://t.co/EhWGhsiYWi #HUS @HelsinkiUniMed

[Kari Tikkinen @KariTikkinen]

@HUS_fi Neurokirurgian klinikka maailmankuulu

Ei kauan tällä menoa

#hoitajapula romuttaa yhden terveydenhuollon kruununjalokivistämme ja potilaat kärsivät

Samaan aikaan #Apotti:in tuhlataan satoja miljoonia!

Herätys päätöksentekijät!

@mediuutiset: https://t.co/CFODvqXNcN