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Chronic subdural hematoma: the role for craniotomy reevaluated
M G Hamilton1, J B Frizzell, B I Tranmer
1University of Calgary, Department of Clinical Neurosciences, Alberta, Canada.
Neurosurgery
|July 1, 1993
Summary
Surgical management of chronic subdural hematoma in adults shows burr holes and craniotomy have similar outcomes. This study found no significant differences in recurrence, complications, or mortality between the two surgical techniques.
Area of Science:
- Neurosurgery
- Surgical Neurology
Background:
- Chronic subdural hematoma (CSH) management in adults involves various surgical techniques.
- Recent trends favor burr holes/twist-drill holes over craniotomy, assuming lower morbidity and mortality.
- This assumption is debated, with some surgeons preferring craniotomy.
Purpose of the Study:
- To compare the efficacy and safety of craniotomy versus burr hole treatment for chronic subdural hematoma.
- To evaluate recurrence rates, postoperative complications, and operative mortality for each surgical approach.
Main Methods:
- Retrospective review of 92 adult patients with 112 chronic subdural hematomas over 3 years.
- Patients were surgically treated with either craniotomy (49 cases) or burr hole (43 cases).
- Outcomes analyzed included hematoma recurrence, complications, and mortality.
Main Results:
- Overall recurrence rate was 8.6%; operative mortality was 2.2% at discharge and 4.4% at follow-up.
- No significant differences were observed in postoperative complications, recurrence, or mortality between craniotomy and burr hole groups.
- No deaths were directly attributed to the surgical procedures.
Conclusions:
- The presumed superiority of burr holes over craniotomy for CSH is not supported by this review.
- Craniotomy remains a valid and safe surgical option for managing chronic subdural hematoma in adult patients.
- Further research may be needed to definitively resolve the optimal surgical therapy for CSH.