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Published on: June 18, 2021
Modified surgical technique for recurrent organized chronic subdural hematoma: a preliminary retrospective case
Sheng Li1, Guangzhao Li2, Yulong Wang3
1Department of Neurosurgery, Xinghua People's Hospital Affiliated to Yangzhou University, Xinghua, China.
Insights
This study shows a modified craniotomy technique is safe and effective for recurrent chronic subdural hematoma (CSDH), with no recurrence observed in a short-term follow-up.
Area of Science:
- Neurosurgery
- Neurology
- Surgical Innovation
Background:
- Chronic subdural hematoma (CSDH) incidence rises with age.
- Recurrent CSDH management remains challenging.
- High recurrence rates after burr-hole drainage necessitate advanced treatments.
Purpose of the Study:
- To evaluate a modified craniotomy technique for recurrent organized CSDH.
- Assess safety, neurological improvement, and recurrence control.
- Investigate craniotomy with middle meningeal artery occlusion and temporalis muscle grafting.
Main Methods:
- Retrospective analysis of 17 patients with recurrent organized CSDH.
- Procedure: Craniotomy, hematoma evacuation, middle meningeal artery occlusion, temporalis muscle grafting.
- Neurological assessment using GCS, mRS, Markwalder grading, GOS; monitoring complications and recurrence.
Main Results:
- Complete hematoma evacuation achieved in all patients.
- Significant neurological improvement observed post-surgery.
- 5 patients (29.41%) experienced manageable complications; no recurrence at 90 days or 1 year.
Conclusions:
- Modified craniotomy is feasible and safe for selected recurrent CSDH patients.
- Encouraging short-term neurological improvement and no recurrence noted.
- Preliminary data; larger controlled studies are needed to confirm efficacy.
Background:
The incidence of chronic subdural hematoma (CSDH) increases with age, and the recurrence rate after burr-hole drainage remains relatively high. The clinical management of recurrent organized CSDH continues to pose a challenge. This study aimed to preliminarily evaluate the safety, neurological improvement, and recurrence control of craniotomy for hematoma evacuation combined with middle meningeal artery occlusion and temporalis muscle grafting in the treatment of recurrent organized CSDH.
Methods:
A retrospective analysis was performed on 17 patients with recurrent organized CSDH admitted between January 2021 and December 2023, all of whom underwent the above modified procedure. Perioperative parameters were recorded. Neurological function before and after surgery was assessed using the Glasgow Coma Scale (GCS), modified Rankin Scale (mRS), Markwalder grading system, and Glasgow Outcome Scale (GOS). Postoperative complications and hematoma recurrence were monitored during follow-up.
Results:
Complete hematoma evacuation was achieved in all patients, with improved midline shift and satisfactory brain re-expansion. Neurological function was improved postoperatively, as reflected by optimized GCS, mRS, Markwalder grade, and GOS scores. Postoperative complications occurred in 5 patients (29.41%), including subdural effusion, cerebrospinal fluid leak, secondary intracranial hemorrhage, and epilepsy, all of which resolved with conservative management. No recurrence was observed according to the 90-day postoperative recurrence criteria. No ipsilateral hematoma recurrence or new neurological deficits were noted during 1-year follow-up.
Conclusion:
In highly selected patients with recurrent organized CSDH, this modified craniotomy technique appears feasible and reasonably safe, with encouraging short-term neurological improvement. No recurrence was observed per the predefined 90-day endpoint; 1-year follow-up was descriptive. This study is a small-sample, single-center, uncontrolled retrospective case series in a highly selected cohort. The results should be interpreted as preliminary safety and feasibility data, and no assertions regarding superior efficacy or recurrence reduction can be made. Large-scale controlled studies are warranted to further validate clinical utility.