Craniotomy Does Have its Share in the Management of Chronic Subdural Hematoma

Abstract

Background Burr hole drainage (BHD) is the most popular technique for surgical management of chronic subdural hematoma (CSDH) and is able to successfully address the problem in majority of patients. However, in a select few cases, the formation of subdural membrane necessitates a wider surgical approach to relieve the compressed cerebral parenchyma. We evaluated the need for craniotomy and associated issues in management of CSDH in a consecutive series of 114 patients.

Material and Method Data of 114 patients, who underwent surgical management of CSDH in our neurosurgical unit were analyzed. We specifically looked for the cases requiring craniotomy, it's indication and surgical outcome.

Results Craniotomy was required in 12 patients (8.6%)—as primary procedure in 8 patients and as add-on secondary procedure in 4 patients. Clinical outcome was good. Mild subdural bleed, not requiring any surgical intervention, was observed in two patients as postoperative complication. There was no mortality.

Conclusion In the presence of thick subdural membranes, BHD alone may not help relieve the cerebral compression. Wider surgical approach in form of craniotomy and membranectomy is the answer in such situations and can be safely performed with low complications. Good quality computed tomography and magnetic resonance imaging are essential in preoperative identification of membrane and appropriate surgical planning.

Keywords

chronic subdural hematoma - craniotomy - subdural membrane - burr hole drainage

• References

• 1 Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg 2010; 113 (03) 615-621
• 2 Abecassis IJ, Kim LJ. Craniotomy for treatment of Chronic subdural hematoma. Neurosurg Clin N Am 2017; 28 (02) 229-237
• 3 Oh HJ, Lee KS, Shim JJ, Yoon SM, Yun IG, Bae HG. Postoperative course and recurrence of chronic subdural hematoma. J Korean Neurosurg Soc 2010; 48 (06) 518-523
• 4 Huang YH, Lin WC, Lu CH, Chen WF. Volume of chronic subdural haematoma: is it one of the radiographic factors related to recurrence?. Injury 2014; 45 (09) 1327-1331
• 5 Tanaka Y, Ohno K. Chronic subdural hematoma - an up-to-date concept. J Med Dent Sci 2013; 60 (02) 55-61
• 6 Kim JH, Kang DS, Kim JH, Kong MH, Song KY. Chronic subdural hematoma treated by small or large craniotomy with membranectomy as the initial treatment. J Korean Neurosurg Soc 2011; 50 (02) 103-108
• 7 Senturk S, Guzel A, Bilici A. et al. CT and MR imaging of chronic subdural hematomas: a comparative study. Swiss Med Wkly 2010; 140 (23) (24) 335-340
• 8 Balevi M. Organized chronic subdural hematoma treated by large craniotomy with extended membranectomy as the initial treatment. Asian. J Neurosurg 2017; 12 (04) 598-604
• 9 Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery 1993; 33 (01) 67-72
• 10 Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma–craniotomy versus burr hole trepanation. Br. J Neurosurg 2009; 23 (06) 612-616
• 11 Sahyouni R, Mahboubi H, Tran P, Roufail JS, Chen JW. Membranectomy in Chronic Subdural Hematoma: Meta-Analysis. World Neurosurg 2017; 104: 418-429