Chronic subdural hematoma—Craniotomy versus burr hole trepanation

Abstract

The authors present a series of more than 200 surgical procedures for chronic subdural hematoma in a 5-year-period. Clinical presentation and neurosurgical treatment were regarded with a special focus on the surgical technique. Between March 2003 and July 2008, 193 patients (113 male and 80 female, mean age 72.5 yrs [range 26–97 yrs]) suffering from chronic subdural hematoma were retrospectively analyzed. One-hundred-fifty-one craniotomies and 42 burr holes were performed. Forty-two craniotomy patients (27.8%) in contrast to 6 burr hole patients (14.3%) required surgical revision. A craniectomy was performed as an ultima ratio after at least 2 prior evacuations in 3 cases. Chronic subdural hematoma is a disease of the elderly. A craniotomy seems to possess a higher rate of recurrence of the chronic subdural hematoma so that a burr hole evacuation should be preferred. Craniectomy might be a good therapeutic option in complicated recurrent chronic subdural hematomas.

Key words:

• Chronic subdural hematoma
• craniotomy
• burrhole
• subdural hygroma

Declaration of interest: The authors gratefully acknowledge Dr. F.M. Oertel's support in the preparation of the manuscript. This study was not supported. The authors have nothing to disclose. Y. Mondorf and M. Abu-Owaimer were responsible for data collection. J. Oertel initiated the study and wrote most of the paper including the interpretation of the data. M. Gaab was involved in data collection and revision of the preliminary manuscript.