Comparative Analysis of Surgical Techniques in the Management of Chronic Subdural Hematomas and Risk Factors for Poor Outcomes.

Abstract

Abstract Background. Chronic subdural hematomas (CSDH) are increasingly prevalent, especially among the elderly. Surgical intervention is essential in most cases. However, the choice of surgical technique, either craniotomy or burr-hole opening, remains a subject of debate. Additionally, the risk factors for poor long-term outcomes following surgical treatment remain poorly described. Methods. This article presents a 10-year retrospective cohort study conducted at a single center that aimed to compare the outcomes of two common surgical techniques for CSDH evacuation: burr hole opening and craniotomy. The study also identified risk factors associated with poor long-term outcome, which was defined as an mRS score ≥ 3 at 6 months. Results. This study included 582 adult patients who were surgically treated for unilateral CSDH. Burr-hole opening was performed in 43% of the patients, while craniotomy was performed in 57%. Recurrence was observed in 10% of the cases and postoperative complications in 13%. The rates of recurrence, postoperative complications, death and poor long-term outcome did not differ significantly between the two surgical approaches. Multivariate analysis identified postoperative general complications, recurrence, and preoperative mRS score ≥ 3 as independent risk factors for poor outcomes at 6 months. Conclusion. Burr-hole opening is as effective and less invasive than craniotomy and should be preferred. Although chronic subdural hematoma is often considered benign, general complication and recurrence are significant long-term prognostic factors that should not be overlooked. Our results highlight the importance of preventing postoperative complications through early mobilization and avoiding the prescription of corticosteroids in this elderly population.