How I do it: simplified craniotomy for acute subdural hematoma in the elderly

Area of Science:

• Neurosurgery
• Trauma Surgery

Background:

• Acute subdural hematoma (ASH) is a significant cause of death and disability, particularly in elderly populations.
• Traditional surgical approaches for ASH can be demanding, especially in frail patients.

Purpose of the Study:

• To describe a simplified craniotomy technique for managing acute subdural hematoma (ASH) in elderly patients.
• To evaluate the perioperative tolerance and functional recovery associated with this simplified approach.

Main Methods:

• A supine patient positioning with specific head rotation and padding, avoiding a head clamp.
• A linear frontotemporal skin incision, twice the diameter of the bone flap, for complete subdural space access.
• Ensuring complete temporal fossa decompression to prevent uncal herniation, with optional subdural drain placement and saline irrigation for a closed system.

Main Results:

• The simplified craniotomy technique facilitates access to the entire subdural space.
• The procedure aims to decompress the temporal fossa, mitigating the risk of uncal herniation.
• Patients demonstrated early mobilization, sitting on postoperative day 1 and walking on postoperative day 2.

Conclusions:

• Simplified craniotomy for ASH is a feasible technique in military neurosurgery.
• This method reduces operative time and enhances perioperative tolerance in elderly patients.
• The technique leads to faster functional recovery, improving overall patient outcomes.