Craniotomy Does Have its Share in the Management of Chronic Subdural Hematoma

Abstract

Background Burr hole drainage (BHD) is the most popular technique for surgical management of chronic subdural hematoma (CSDH) and is able to successfully address the problem in majority of patients. However, in a select few cases, the formation of subdural membrane necessitates a wider surgical approach to relieve the compressed cerebral parenchyma. We evaluated the need for craniotomy and associated issues in management of CSDH in a consecutive series of 114 patients. Material and Method Data of 114 patients, who underwent surgical management of CSDH in our neurosurgical unit were analyzed. We specifically looked for the cases requiring craniotomy, it's indication and surgical outcome. Results Craniotomy was required in 12 patients (8.6%)—as primary procedure in 8 patients and as add-on secondary procedure in 4 patients. Clinical outcome was good. Mild subdural bleed, not requiring any surgical intervention, was observed in two patients as postoperative complication. There was no mortality. Conclusion In the presence of thick subdural membranes, BHD alone may not help relieve the cerebral compression. Wider surgical approach in form of craniotomy and membranectomy is the answer in such situations and can be safely performed with low complications. Good quality computed tomography and magnetic resonance imaging are essential in preoperative identification of membrane and appropriate surgical planning.