Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary?

• Published in: Surgical neurology Vol. 61; no. 6; pp. 523 - 527
• Main Authors: Lee, Jin-Yul, Ebel, Heinrich, Ernestus, Ralf-Ingo, Klug, Norfrid
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2004
• Subjects: Adult; Aged; Brain - diagnostic imaging; Brain - pathology; Chronic subdural hematoma; Craniotomy; Female; hematoma recurrence; Hematoma, Subdural, Chronic - diagnosis; Hematoma, Subdural, Chronic - surgery; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures - methods; Outcome Assessment (Health Care); Recurrence; Reoperation; surgical treatment; Tomography, X-Ray Computed; hematoma recurrence; surgical treatment; Chronic subdural hematoma
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2003.10.026

The initial surgical management of chronic subdural hematoma (CSDH) is still controversial, and a standard therapy does not exist. Because of the advanced age and multiple medical problems of the patients, surgical therapy is frequently associated with complications. A retrospective study was performed on 172 patients with CSDH, comparing the efficacy of three different primary surgical methods: drainage of hematoma through two different burr-holes without membranectomy (Group A, n = 38); enlarged craniectomy with a size of about 30 mm craniotomy with partial membranectomy and drainage (Group B, n = 121); and extended craniotomy with partial membranectomy and drainage (Group C, n = 13). Independent of surgical method, the general outcome of the patients was good. The rate of reoperation in the group of burr-hole drainage was 16%, slightly lower than in partial membranectomy with enlarged craniectomy or extended craniotomy with 18% and 23%, respectively. In patients with coagulopathy, the rate of reoperation was 41% (16/43), significantly higher than the rate in noncoagulopathic patients 12% (15/129). In this study, an extended surgical approach with partial membranectomy has no advantages regarding the rate of reoperation and the outcome. As initial treatment, burr-hole drainage with irrigation of the hematoma cavity and closed-system drainage is recommended. Extended craniotomy with membranectomy is now reserved for instances of acute rebleeding with solid hematoma.