Minimal Access Surgical Evacuation of Unilateral Chronic Subdural Hematoma

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions occurring mostly in elderly and ideally treated with surgical drainage. Many surgical techniques of different degrees of invasiveness have been proposed for its treatment with controversy about the best surgical procedure. The study aims to evaluate the efficacy of the minimal access technique of single burr-hole craniostomy and massive irrigation for treatment of unilateral CSDH. The study is a prospective descriptive study involved all patients with symptomatic radiologically proven unilateral CSDH admitted and treated surgically in department of Neurosurgery, Al-Hussein University hospital, Al-Azhar University, Cairo, Egypt, over 3 years, from January 2013 to January 2016. In the results we found that total 64 patients of CSDH, treated surgically by this procedure. Men formed 72% and women 28%. Age range was 51 to 82 years; the mean age was 65 years. Clinical presentation was impaired consciousness in 7%, headache (59%), right hemiparesis in 56% and left hemiparesis in 37%. CT was done for 91% and MRI 27% patients. The hematoma was left in 61% and right in 39%. Surgical evacuation utilizing this procedure was done in all patients. Complete recovery was obtained in 82% of patients and partial recovery in 11% of patients. Follow up for 4 months was done. Recurrence was detected in 6% of patients. We concluded that unilateral CSDH can be treated effectively by single nondependent burr-hole craniostomy and massive irrigation with excellent outcome.