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
