The Mini-Craniotomy for cSDH Revisited: New Perspectives.

Area of Science:

• Neurosurgery
• Radiology
• Neurology

Background:

• Chronic subdural hematomas (cSDH) are increasingly common, particularly in aging populations and those using anticoagulants.
• Current treatments for cSDH, including surgical and medical options, have variable success rates.
• Recurrence rates for cSDH historically range from 5% to 30%.

Purpose of the Study:

• To evaluate the efficacy of mini-craniotomy with inner membrane fenestration for cSDH treatment.
• To assess the impact of pre-operative CT findings on surgical decision-making and outcomes.
• To investigate the role of brain re-expansion and glymphatic flow in cSDH management.

Main Methods:

• Retrospective review of 34 consecutive mini-craniotomies for cSDH performed by a single surgeon.
• Analysis of patient demographics, pre-operative CT findings (including inner membrane signs, midline shift), and surgical details.
• Extraction of post-operative outcomes such as recurrence, seizures, infections, and length of stay from electronic medical records.

Main Results:

• Mini-craniotomy was the primary treatment for 29 patients, with a mean age of 68.9 years.
• Pre-operative CT scans indicated inner subdural membranes in 33 patients, and fenestration was performed in all but one case.
• No symptomatic recurrences, re-operations, or surgical site infections were observed within 6 months of follow-up.

Conclusions:

• Pre-operative CT identification of inner subdural membranes can guide targeted mini-craniotomy.
• Mini-craniotomy with inner membrane fenestration is a highly effective treatment for cSDH, achieving zero recurrence in this series.
• Brain re-expansion and restored interstitial flow, potentially linked to glymphatic pathways, may be crucial for favorable long-term cSDH outcomes.