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Updated: May 6, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Factors Affecting Outcomes Following Mini-Craniotomy Evacuation of Primary Chronic Subdural Hematoma: A Single-Center
Vishnu Suresh1, Susruta Manivannan1, Ben Edwards2
1Department of Neurosurgery, Southampton General Hospital, University Hospital Southampton NHS Trust, Southampton, UK.
Insights
Mini-craniotomy (MC) is a safe and effective surgical option for chronic subdural hematoma (CSDH) in selected patients. Higher preoperative Glasgow Coma Scale scores predict favorable outcomes and fewer complications.
Area of Science:
- Neurosurgery
- Neurology
- Surgical Pathology
Background:
- Chronic subdural hematoma (CSDH) presents heterogeneous radiological features and multiple surgical options.
- Mini-craniotomy (MC) is typically reserved for specific CSDH types, despite limited outcome data.
- MC is considered higher risk than burr-hole craniostomy, with sparse outcome reporting.
Purpose of the Study:
- To evaluate the safety and effectiveness of mini-craniotomy (MC) for primary chronic subdural hematoma (CSDH).
- To identify factors influencing clinical outcomes, hospital stay, discharge destination, and complications following MC for CSDH.
Main Methods:
- Retrospective analysis of adult patients undergoing MC for primary CSDH from January 2009 to January 2020.
- Univariate and multivariate logistic/Cox regression analyses to determine predictors of outcomes.
- Inclusion criteria focused on primary CSDH treated with MC.
Main Results:
- 143 patients (median age 76) underwent MC; 86% achieved favorable outcomes (Glasgow Outcome Score 4-5).
- Higher preoperative Glasgow Coma Scale (≥14) correlated with better outcomes and fewer complications.
- Factors increasing complications included higher Charlson Comorbidity Index and anticoagulant use; surgeon experience reduced recurrence.
Conclusions:
- Mini-craniotomy (MC) is a safe and effective procedure for carefully selected patients with primary chronic subdural hematoma (CSDH).
- Patient selection and surgeon experience are crucial for optimizing MC outcomes in CSDH management.
Background:
Chronic subdural hematoma (CSDH) constitutes a radiologically heterogeneous pathology with multiple surgical treatment options. Mini-craniotomy (MC) is often reserved for patients with membranous or acute components. Although MC is considered a higher risk procedure than burr-hole craniostomy, outcomes are sparsely reported.
Methods:
A single-center retrospective database search was performed between January 2009 and January 2020 to identify all adult patients who underwent MC evacuation of primary CSDH. Univariate and multivariate logistic/Cox regressions were performed to identify factors associated with clinical outcome, duration of hospital stay, discharge destination, and complications.
Results:
Of 1544 procedures for CSDH, 143 cases met inclusion criteria. The median age was 76 years. Most patients were male (N = 95, 66.4%) and independent on admission (N = 138, 96.5%), with median Karnofsky Performance Score 80. Median preoperative Glasgow Coma Scale was 14. 86% of patients had favorable outcomes (Glasgow Outcome Score: 4-5) on discharge. Median hospital stay was 6 days. Recurrence and overall complication rates were 9.1% and 26.6%, respectively. Preoperative Glasgow Coma Scale ≥ 14 increased odds of favorable outcomes (odds ratio [OR]: 11.49, P < 0.001) and discharge home (OR: 4.53, P = 0.005) and reduced odds of postoperative complications (OR: 0.27, P = 0.011). An increasing Charlson Comorbidity Index and anticoagulants increased odds of postoperative complications (OR: 1.50, P = 0.03 and OR: 3.61, P = 0.018, respectively). Charlson Comorbidity Index ≥ 4 decreased odds of a favorable outcome (OR: 0.07, P = 0.021). Operating surgeon experience ≥ 4 years decreased odds of recurrence (OR: 0.26, P = 0.049).
Conclusions:
MC is safe and effective for managing primary CSDH in carefully selected patients.
