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Acta Neurochirurgica

, Volume 156, Issue 5, pp 981–987 | Cite as

Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma—a retrospective analysis

  • Jorn Van Der VekenEmail author
  • Johnny Duerinck
  • Ronald Buyl
  • Katrijn Van Rompaey
  • Patrick Herregodts
  • Jean D’Haens
Review Article - Brain Injury

Abstract

Background

The incidence of chronic subdural hematoma (CSDH) is increasing, but optimal treatment remains controversial. Recent meta-analyses suggest burr hole (BH) drainage is the best treatment because it provides optimal balance between recurrence and morbidity. Mini-craniotomy may offer supplementary technical advantages while maintaining equal or better outcomes. This study investigates the outcome of mini-craniotomy as the sole treatment in patients with CSDH.

Method

We analyzed all patients operated on for CSDH with mini-craniotomy in our neurosurgical center between 2005–2010. Baseline patient characteristics (age, sex, comorbidities, imaging characteristics, known risk factors for development of CSDH and neurological examination at presentation) and outcomes (mortality, complications, recurrence and neurological examination at discharge) were recorded.

Results

One hundred twenty-six adult patients were included, mean age was 73.9 (range 18 to 95) years old, and the sex ratio (M:F) was 2:1. Eighty-four percent of the patients showed clinical improvement at discharge, as shown by a decrease in the Markwalder score postoperatively (with 57 % Markwalder 0 and 23 % Markwalder 1). Recurrence rate was 8.7 %. Overall complication rate was 34.1 % (27.8 % medical complications and 6.3 % surgical complications). In-hospital mortality was 13.5 % (8.7 % due to pulmonary infections and 1.6 % to surgical complications). Preoperative Markwalder grade correlated significantly with complication rate, as did the presence of a neurodegenerative disease (p = 0.018). Factors significantly related to mortality in univariate analysis were arterial hypertension (p = 0.038), heart failure (p = 0.02), renal failure (p = 0.017), neurodegenerative disease (p = 0.001), cerebrovascular accident (p = 0.008) and coagulopathy (p = 0.019). Multivariate analysis was not able to confirm any significant relationship.

Conclusion

This is the first published series of CSDH in which all consecutive patients were operated on by mini-craniotomy. The invasiveness and complication rate of mini-craniotomy are equal to those of burr hole treatment, but visualization is superior, resulting in lower recurrences. A randomized controlled trial is indicated to identify the best surgical strategy for the treatment of CSDH.

Keywords

Chronic subdural hematoma Mini-craniotomy 

Notes

Competing interests

The authors have declared that no competing interests exist.

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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Jorn Van Der Veken
    • 1
    Email author
  • Johnny Duerinck
    • 1
  • Ronald Buyl
    • 2
  • Katrijn Van Rompaey
    • 1
  • Patrick Herregodts
    • 1
  • Jean D’Haens
    • 1
  1. 1.Department of NeurosurgeryUniversitair Ziekenhuis BrusselBrusselsBelgium
  2. 2.Department of Biostatistics and Medical InformaticsVrije Universiteit BrusselBrusselsBelgium

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