Clinical investigation of chronic subdural hematoma: Relationship between surgical approach, drainage location, use of antithrombotic drugs and postoperative recurrence

Abstract

Objectives: Chronic subdural hematoma (CSDH) is one of the most common diseases in the routine neurosurgical practice. The most usual procedures for CSDH treatment include single or multiple burr hole drainage craniectomy. There is still controversy, however, about the risks and benefits of the different surgical approaches and types of drainage. The aim of the current study is to evaluate the postoperative complications of the various surgical techniques of CSDH.

Patients and methods: We conducted a single center retrospective analysis on 414 patients surgically treated for CSDH over a period of 6 years. Comparisons were made after dividing the patients into 4 groups based on the surgical technique and type of drainage: Single burr hole with subdural drainage (Group Ia), single burr hole with subgaleal drainage (Group Ib), craniotomy with subdural drainage (Group IIa), and craniotomy with subgaleal drainage (Group IIb). 238 cases underwent burr hole with irrigation, while 290 cases were treated with craniotomy. Of the analysed patients, subdural drainage was inserted in 382 cases, while subgaleal drain was used only in 146 patients, for a total of 528 procedures.

Results: Re-operation was performed in 9.47 % of cases. The frequency of re-intervention for recurrences appeared to be lower in the Group I a (5.06 %), while the frequency of the re-intervention was higher in the craniotomy with subdural drainage group (Group IIa, 11.6 %). 14 patients (2.65 %) developed acute subdural rebleeding in the immediate postoperative period with 6 of them on antiplatelets/anticoagulants in the preoperative period.

Conclusion: Recurrence rate and functional outcome after surgical drainage of CSDH does not appear to be affected by surgical technique (craniotomy vs burrhole) and drainage location. To our opinion, surgeons may elect procedures on a case-by-case basis.

Keywords: Chronic subdural hematoma; Craniectomy; Craniotomy; Drain; Hemorrhage; Recurrence; Subdural drainage; Subgaleal drainage.