Surgical Treatment of Chronic Subdural Hematoms in Adults

Abstract

One hundred and eighty patients with chronic subdural hematoma were surgically treated by burr-hole craniostomy (150) or by craniotomy (30). The age ranged from 21 to 91 years, mean 64.2 years. At presentation 61.1% of the patients showed reduced vigilance, 3.9% were comatose, 31.7% had hemiparesis. Minor head trauma was detected in 49%. At discharge the thickness of the hematoma was clearly reduced. Eightythree per cent of the patients were conscious and fully orientated, hemiparesis was diminished to 6.7%. The outcome was not significatly different for the burr-hole craniostomy and for the craniotomy, but the mortality raised from 3.1% to 13.3%. We conclude that burr-hole trepanation was a save and effective treatment of chronic subdural hematoma in adults and that craniotomy should be confined to recurrent unsuccessful burr-hole trepanations, multiple cavities and solid hematomas.