Diamond-Shaped Mini-Craniotomy: A New Concept in Neurosurgery

Area of Science:

• Neurosurgery
• Minimally Invasive Surgical Techniques
• Geriatric Medicine

Background:

• Elderly patients with acute subdural or intracerebral hematomas often present challenges due to comorbidities and anticoagulant/antiplatelet therapy.
• Traditional craniotomy approaches may carry higher risks in this vulnerable patient population.
• A modified, less invasive surgical technique is needed to optimize outcomes.

Purpose of the Study:

• To describe a novel diamond-shaped mini-craniotomy technique for treating acute subdural and intracerebral hematomas.
• To evaluate the safety and efficacy of this approach in elderly patients, particularly those on antiplatelet or anticoagulant medications.
• To present a step-by-step description of the surgical procedure.

Main Methods:

• Retrospective analysis of 67 elderly patients (mean age 78.5 years) undergoing diamond-shaped mini-craniotomy over 10 years.
• Patients treated included 17 for intracerebral hemorrhage and 50 for acute subdural hematomas.
• All patients were on antiplatelet or anticoagulant therapy.

Main Results:

• No approach-related complications were observed.
• Satisfactory hematoma evacuation was achieved in 85% of patients (57/67) within one month post-surgery.
• Thirty-day mortality was 22%, with a mean follow-up of 1.3 years.

Conclusions:

• The diamond-shaped mini-craniotomy is a safe and effective surgical option for acute subdural and intracerebral hematomas.
• This technique is particularly suitable for elderly patients, including those on antithrombotic therapy.
• It represents a valuable alternative to traditional surgical approaches.