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Published on: October 15, 2021
Surgical Procedure in the Treatment of Organized Chronic Subdural Hematoma: A Single-Center Experience
Keng Chen1, Kun Wang1, Danzhi Chen2
1Department of Neurosurgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
Insights
Small craniotomy offers a viable surgical option for organized chronic subdural hematoma (CSDH). This approach demonstrated comparable recurrence rates and improved short-term functional outcomes compared to large craniotomy.
Area of Science:
- Neurosurgery
- Neurology
- Surgical Innovation
Background:
- Organized chronic subdural hematoma (CSDH) presents unique challenges in neurosurgical management.
- The optimal surgical approach for organized CSDH remains an area of ongoing investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of small craniotomy versus large craniotomy in treating organized CSDH.
- To compare postoperative outcomes, including functional status and complications, between the two surgical techniques.
Main Methods:
- Retrospective analysis of 33 patients with organized CSDH treated between 2008 and 2018.
- Comparison of outcomes between patients undergoing large craniotomy (n=14) and small craniotomy (n=19).
- Assessment of Barthel index (BI) preoperatively and at 1 week and 1 month postoperatively.
Main Results:
- No significant differences in baseline characteristics between the large and small craniotomy groups.
- Small craniotomy group showed significantly better Barthel index scores at 1 week postoperatively (p<0.05).
- Both groups had similar recurrence rates at 6 months, with comparable complication profiles.
Conclusions:
- Small craniotomy is a safe and effective alternative for treating organized CSDH.
- The procedure offers potential advantages in early functional recovery compared to large craniotomy.
Background:
Organized chronic subdural hematoma (CSDH) is a special type of CSDH. However, the optimal surgical procedure has not been established. We present our experience here to discuss the surgical procedure in treatment of organized CSDH.
Methods:
Thirty-three patients with organized CSDH were admitted between January 1, 2008 and January 1, 2018. Age, gender, clinical symptoms, imaging data, type of surgical procedure, Barthel index (BI), and postoperative complications were collected and retrospectively analyzed. The BI was assessed both pre and postoperatively (1 week and 1 month after surgery).
Results:
Overall, 14 patients underwent large craniotomy and 19 patients underwent small craniotomy. No significant differences in gender, age, initial clinical symptoms, and preoperative BI were found between the groups (p > 0.05). Among the 14 patients who underwent large craniotomy, 2 patients developed epilepsy after the operation, while 1 patient had postoperative aphasia. None of the patients had recurrence in 6 months postoperatively. Among the 19 patients who underwent small craniotomy, 1 patient developed an acute subdural hematoma and 1 patient developed aphasia. No obvious complications were found in the remaining 18 patients and none of the 19 patients had recurrence in 6 months postoperatively. BI scores of the small craniotomy group were significantly better than those of the large craniotomy group at 1 week postoperatively (p < 0.05). However, there was no significant difference in the 1-month results (p > 0.05).
Conclusion:
According to our single-center experience, a small craniotomy for treating organized CSDH can be considered as an alternative to a larger craniotomy.
