Mini-Craniotomy for Chronic Subdural Hematoma: A Reliable Surgical Option

Area of Science:

• Neurosurgery
• Neurology

Background:

• Chronic subdural hematoma (SDH) is a common neurosurgical condition.
• Current surgical options include twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy.
• Mini-craniotomy without membrane excision may improve outcomes and reduce complications.

Purpose of the Study:

• To evaluate the efficacy and safety of mini-craniotomy without membranectomy for chronic SDH management.
• To assess complication rates, recurrence, and residual collections associated with this technique.

Main Methods:

• A retrospective study included 77 patients with chronic SDH operated between September 2013 and September 2022.
• Mini-craniotomy (40-60 mm) with a cruciate dural incision was performed, leaving the dura open and sutured to the craniotomy edge.
• A drain was placed, and preoperative/postoperative clinical and radiological parameters were recorded.

Main Results:

• No recurrences were observed in the 77 patients.
• Fourteen patients had residual collections that resolved within 6 weeks.
• Two patients experienced wound infections, one requiring bone flap removal due to osteomyelitis. Two patients with comorbidities expired due to medical causes.

Conclusions:

• Mini-craniotomy without membranectomy is a safe and effective method for complete chronic SDH evacuation under vision.
• This approach avoids membranectomy complications and is not associated with an increased complication rate.
• The technique facilitates rapid radiological brain expansion, potentially reducing follow-up requirements.