Surgical Management of Chronic Subdural Hematoma: A Single Center Experience

Chronic subdural hematoma (CSDH) is a condition that is frequently observed in the elderly population and may lead to severe neurological outcomes.

This study aims to comprehensively examine the treatment strategies by analyzing the effectiveness of surgical methods, patient outcomes, and recurrence rates in the management of CSDH.

A retrospective analysis was conducted on 202 patients diagnosed and treated for CSDH at our clinic between January 2017 and January 2024. Data on patient demographics, history of trauma, anticoagulant medication use, surgical approaches, and postoperative complications were thoroughly analyzed.

The most commonly employed surgical method was unilateral burr-hole craniostomy (56.9%), followed by bilateral burr-hole craniostomy (30.2%) and craniotomy (12.9%). The mean patient age was 63.06 ± 21.01 years. Moreover, 40.6% of patients had a history of trauma, and 39.1% were on anticoagulant therapy. The recurrence rate was 9.4%, with no significant differences between surgical methods. Postoperative mortality was found to be 2.0%.

Individualized surgical approaches and multidisciplinary treatment strategies play a critical role in the successful management of CSDH. While burr-hole craniostomy can be safely conducted in cases of noncomplex CSDH, craniotomy should be considered for complex CSDH characterized by large hematomas and prominent membrane structures or in cases of recurrence. Even though no significant differences in postoperative outcomes were observed regarding drain placement, subgaleal drains can be safely utilized in those undergoing burr-hole craniostomy.