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Mini-Craniotomy Under Local Anesthesia for Chronic Subdural Hematoma: An Effective Choice for Elderly Patients and
Shaikh Danish Mahmood1, Muhammad Waqas2, Mirza Zain Baig1
1Medical College, The Aga Khan University Hospital, Karachi, Pakistan.
Insights
Mini-craniotomy for chronic subdural hematoma (CSDH) under local anesthesia (LA) is as effective as general anesthesia (GA). This approach reduces risks for elderly patients and avoids intensive care unit (ICU) stays.
Area of Science:
- Neurosurgery
- Anesthesiology
Background:
- Chronic subdural hematoma (CSDH) surgery often uses general anesthesia (GA), necessitating intensive care unit (ICU) stays, particularly for elderly patients.
- Limited ICU bed availability and risks associated with GA prompted the exploration of local anesthesia (LA) for CSDH procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of mini-craniotomy for CSDH performed under local anesthesia (LA) compared to general anesthesia (GA).
- To assess the impact of LA on postoperative outcomes, including ICU admission and recurrence rates in elderly patients undergoing CSDH surgery.
Main Methods:
- A retrospective medical chart review was conducted over one year at a single institution.
- Patients aged 55 years and older undergoing mini-craniotomy for CSDH were divided into two groups: local anesthesia (LA) and general anesthesia (GA).
- Clinical characteristics, hospital stay, postoperative complications, and recurrence rates were compared between the LA and GA groups.
Main Results:
- Sixteen patients received LA, and 19 received GA for CSDH mini-craniotomy.
- The LA group showed fewer postoperative complications (4 vs. 7) and a significantly reduced need for postoperative ICU beds (1 vs. none specified for GA).
- No recurrence was observed in the LA group, with an overall recurrence rate of 2.86% across both groups.
Conclusions:
- Mini-craniotomy for CSDH under LA is a safe and effective alternative to GA, especially for elderly patients.
- LA obviates the need for postoperative ICU admission, minimizes GA-related risks in older individuals, and potentially reduces operative time and hospital stay.
Background:
Mini-craniotomy for chronic subdural hematoma (CSDH) is associated with lower rates of recurrence. However, the procedure is performed mostly with the patient under general anesthesia (GA) and therefore frequently requires an intensive care unit (ICU) facility, especially in the elderly population. Because of the unavailability of ICU beds, and to avoid GA, we started to perform this procedure with the patient under local anesthesia (LA).
Materials And Methods:
This was a retrospective medical chart review conducted in the section of Neurosurgery at the Aga Khan Hospital in Karachi, Pakistan. The study duration was 1 year. We included patients aged 55 years or older undergoing surgery for CSDH. Clinical characteristics, hospital stay, and recurrence rates were compared between 2 groups, local versus general anesthesia.
Results:
Thirty-five patients underwent mini-craniotomy for CSDH in the study period. Sixteen patients underwent mini-craniotomy under LA versus 19 patients for GA. Median age for the LA group was 67 years compared with 70 years in the GA group. Four patients from the LA group experienced postoperative complications versus 7 from the GA group. Only one patient in the LA group required an ICU bed in the postoperative period. There was no recurrence in LA group. The overall recurrence was 2.86%.
Conclusions:
Mini-craniotomy for CSDH under LA is an equally effective procedure compared with mini-craniotomy under GA. In addition, it minimizes the risks of GA in the elderly population and obviates the need of a postoperative ICU bed. It also reduces operative time and hospital stay as compared with GA.
