Surgical Procedure in the Treatment of Organized Chronic Subdural Hematoma: A Single-Center Experience

Abstract

Background Organized chronic subdural hematoma (CSDH) is a special type of CSDH. However, the optimal surgical procedure has not been established. We present our experience here to discuss the surgical procedure in treatment of organized CSDH. Methods Thirty-three patients with organized CSDH were admitted between January 1, 2008 and January 1, 2018. Age, gender, clinical symptoms, imaging data, type of surgical procedure, Barthel index (BI), and postoperative complications were collected and retrospectively analyzed. The BI was assessed both pre and postoperatively (1 week and 1 month after surgery). Results Overall, 14 patients underwent large craniotomy and 19 patients underwent small craniotomy. No significant differences in gender, age, initial clinical symptoms, and preoperative BI were found between the groups (p > 0.05). Among the 14 patients who underwent large craniotomy, 2 patients developed epilepsy after the operation, while 1 patient had postoperative aphasia. None of the patients had recurrence in 6 months postoperatively. Among the 19 patients who underwent small craniotomy, 1 patient developed an acute subdural hematoma and 1 patient developed aphasia. No obvious complications were found in the remaining 18 patients and none of the 19 patients had recurrence in 6 months postoperatively. BI scores of the small craniotomy group were significantly better than those of the large craniotomy group at 1 week postoperatively (p < 0.05). However, there was no significant difference in the 1-month results (p > 0.05). Conclusion According to our single-center experience, a small craniotomy for treating organized CSDH can be considered as an alternative to a larger craniotomy.

Middle meningeal artery embolization before craniotomy for infected organizing chronic subdural hematoma: A case report and review of the literature

“…[ 2 , 3 ] Since many patients with CSDHs are the elderly, craniotomy under general anesthesia may be avoided. As an alternative treatment, endoscopic removal of the hematoma by enlarging the perforating head or small craniotomy has been reported,[ 4 , 14 , 15 ] but as previously mentioned, the source of bleeding is fragile capillaries at the border between the outer and inner membranes, so radical treatment is difficult with these procedures. During craniotomy, it is controversial whether the inner membrane should be removed or preserved to prevent hematoma recurrence.…”

“…The usefulness of craniotomy, small craniotomy, and endoscopic hematoma removal has all been reported. [ 3 , 4 , 6 , 14 , 15 ] Some reports recommend total removal of the inner membrane to prevent recurrence of hematoma,[ 2 ] while others suggest preservation of the inner membrane due to the risk of postoperative complications, such as acute subdural hematoma and epilepsy. [ 3 ]…”

Microvascular proliferation in the clots: The key finding of acute subdural hematoma transforming into chronic subdural hematoma?

“…However, similar to a previous study, the residual hematoma resolved spontaneously following the partial removal. [ 2 ] There may be undetected factors for spontaneous regression of CSDHs after craniotomy and partial removal of the hematomas. In this case, the nodular lesion buried in the subdural hematoma was targeted for investigation, because it was a distinct structure and was expected to provide clues to the underlying etiology.…”

“…Recently, less-invasive endoscopic techniques and hematoma removals through small craniotomies have been advocated as alternative approaches for such CSDHs. [1,2,12] In contrast with trauma-associated ASDH, spontaneous or non-traumatic ASDH is thought to occur infrequently in association with a variety of pathological processes. [3,4,6] Here, we present a unique case of organized CSDH that transformed from a non-traumatic ASDH and became symptomatic for 2 weeks, exhibiting microvascular proliferation in the subdural clots.…”

“…Recently, less-invasive endoscopic techniques and hematoma removals through small craniotomies have been advocated as alternative approaches for such CSDHs. [ 1 , 2 , 12 ]…”