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Updated: Jun 21, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Comparison of surgical techniques for the treatment of chronic subdural hematomas: A single‑center case series
Stefanos Chatzidakis1, Zoe Michelle Bakiri2, Konstantinos Faropoulos3
1Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Insights
Multiple burr hole evacuation with subperiosteal drains is a safe and effective surgical technique for chronic subdural hematoma (CSDH). This method offers reduced recurrence, shorter hospital stays, and improved patient outcomes compared to other CSDH treatments.
Area of Science:
- Neurosurgery
- Surgical Techniques
- Clinical Outcomes
Background:
- Chronic subdural hematoma (CSDH) presents significant neurosurgical challenges.
- Comparing surgical techniques is crucial for optimizing patient care.
Observation:
- A retrospective cohort study analyzed 122 patients with CSDH.
- Patients were divided into three groups based on surgical technique: burr hole with subperiosteal drain, burr hole with intradural drain, and mini-craniotomy.
- Outcomes measured included hospitalization duration, recurrence, complications, Glasgow Coma Scale, and mortality.
Findings:
- Multiple burr hole evacuation with subperiosteal drain placement showed zero mortality.
- This technique significantly reduced CSDH recurrence risk compared to single burr hole with intradural drain (OR 0.76, P<0.01).
- Patients undergoing subperiosteal drain placement had a lower probability of depressed consciousness post-discharge (OR 0.249, P=0.031) and shorter hospital stays.
Implications:
- Multiple burr hole evacuation with subperiosteal drain placement is a highly promising technique for CSDH.
- This approach leads to favorable postoperative outcomes, including reduced recurrence and hospitalization.
- Optimizing surgical strategy can improve the quality of life for CSDH patients.
Abstract:
Chronic subdural hematoma (CSDH) is one of the most challenging realities in the neurosurgical world. The aim of the present study was to compare different surgical techniques, such as burr hole evacuation with subperiosteal drain or subdural drain and mini-craniotomy, and to review the diverse outcomes on the post-operative clinical state of patients. The present study was a retrospective cohort study with 122 patients with CSDH treated at a single center. The patients were separated into three groups according to the surgical technique used as follows: group 1, two burr holes with the placement of a subperiosteal drain; group 2, single burr hole per hematoma with the placement of an intradural drain; and group 3, mini-craniotomy. The duration of hospitalization, hematoma recurrence, complications, Glasgow coma scale at discharge and mortality were reported as outcome measures. A total of 3 patients succumbed following hematoma evacuation; of these 2 patients were from group 2 and 1 patient was from group 3. The patients from groups 1 and 3 exhibited a significantly lower odds ratio (OR) of hematoma recurrence than patients in group 2 (OR, 0.76; P<0.01; and OR, 0.8; P<0.01, respectively). The patients in group 1 exhibited a significantly lower probability of having a depressed level of consciousness on discharge (OR, 0.249; P=0.031). Group 2 was associated with a statistically significant prolongation of hospitalization. On the whole, the present study demonstrates that multiple burr hole hematoma evacuation with subperiosteal drain placement and mild suction is a very promising technique with very beneficial post-operative outcomes, such as zero mortality, a low CSDH recurrence risk, a reduced period of hospitalization and an improved post-operative quality of life.
