Comparative Results of Surgical Treatment of Chronic Subdural Hematoma with Single and Double Burr Hole

Abstract

Introduction: Chronic subdural hematomas (CSDH) are intracranial hematomas that are usually seen in the middle and advanced age. They are seen as a result of bleeding from the parasagittal bridging veins. The results of patients who were surgically treated with single- and double-burr hole drainage due to CSDH in our clinic were investigated. It has been tried to decide which of these two methods is more suitable for surgical treatment. Methods: We retrospectively reviewed 146 patients hospitalized with CSDH and treated with burrhole drainage in our clinic between 2011 and 2021. Informed consent forms were obtained from each patient. We divided the surgical treatments that we applied to the patients; into two groups: single burrhole without irrigation ( group A, n=41) and double burrhole with irrigation (group B, n=105). The results were compared as radiological and clinical factors. The width of hematomas was determined by magnetic resonance imaging and defined as the maximal diameter in the coronal orientation perpendicular to the skull curvature. The thickness of inner membrane was measured on constructive interference steady state images. The imaging characteristics of hematomas on computed tomography, if available, were also reviewed and defined as hypodense, hyperdense, and inodense in comparison with cerebral paraenchyma. Results: The change in subdural hematoma thickness was 68.38 +/- 10.10% in group A and 53.7%+/- 31.9% in group B. The change in midline shift was 58.6%+/- 24.5 in group A and 53.7%+/- 31.9% in group B. There was no statistically significant difference in hematoma evacuation and recovery of midline shift between the two groups. Recurrence occurred in 5 (12.1%) cases in group A and 8 (7.6%) cases in group B. In terms of recurrence, both groups were similar. Conclusion: Similar hematoma evacuation and midline shift improvement were observed between the two surgical techniques. We think that both methods have similar efficacy for treating CSDH.