CHRONIC SUBDURAL-HEMATOMA - THE ROLE FOR CRANIOTOMY REEVALUATED

THE MANAGEMENT OF chronic subdural hematoma in the adult patient is ap proached with a variety of different surgical techniques. The trend in recent years has been toward treatment with burr holes or twist-drill holes rather than craniotomy. The rationale for this has been based o n the assumption that burr holes and twist-drill holes offer equivalen t efficacy and lower morbidity and mortality. This viewpoint is not, h owever, universally accepted, and many surgeons feel that craniotomy i s superior to a burr hole for the management of this condition. In a r eview of 92 patients presenting over a 3-year period with 112 chronic subdural hematomas, 49 underwent craniotomy and 43 underwent burr-hole treatment. The recurrence of hematomas, requiring another operation, occurred in 8.6%; operative mortality was 2.2% at hospital discharge a nd 4.4% at follow-up. No patient died as a consequence of the operativ e procedure. There was no significant difference in the incidence of p ostoperative complications, hematoma recurrence, or operative mortalit y among the different surgical groups. Previous reports concerning the superiority of burr holes over craniotomy are not substantiated by th is review. Although the issue concerning optimal therapy has not been resolved by this review, at this time, craniotomy remains a valid and safe technique for the management of patients with chronic subdural he matoma.