Factors Affecting Outcomes Following Mini-Craniotomy Evacuation of Primary Chronic Subdural Hematoma: A Single-Center Retrospective Study.

BACKGROUND

Chronic subdural hematoma (CSDH) constitutes a radiologically heterogeneous pathology with multiple surgical treatment options. Mini-craniotomy (MC) is often reserved for patients with membranous or acute components. Although MC is considered a higher risk procedure than burr-hole craniostomy, outcomes are sparsely reported.

METHODS

A single-center retrospective database search was performed between January 2009 and January 2020 to identify all adult patients who underwent MC evacuation of primary CSDH. Univariate and multivariate logistic/Cox regressions were performed to identify factors associated with clinical outcome, duration of hospital stay, discharge destination, and complications.

RESULTS

Of 1544 procedures for CSDH, 143 cases met inclusion criteria. The median age was 76 years. Most patients were male (N = 95, 66.4%) and independent on admission (N = 138, 96.5%), with median Karnofsky Performance Score 80. Median preoperative Glasgow Coma Scale was 14. 86% of patients had favorable outcomes (Glasgow Outcome Score: 4-5) on discharge. Median hospital stay was 6 days. Recurrence and overall complication rates were 9.1% and 26.6%, respectively. Preoperative Glasgow Coma Scale ≥ 14 increased odds of favorable outcomes (odds ratio [OR]: 11.49, P < 0.001) and discharge home (OR: 4.53, P = 0.005) and reduced odds of postoperative complications (OR: 0.27, P = 0.011). An increasing Charlson Comorbidity Index and anticoagulants increased odds of postoperative complications (OR: 1.50, P = 0.03 and OR: 3.61, P = 0.018, respectively). Charlson Comorbidity Index ≥ 4 decreased odds of a favorable outcome (OR: 0.07, P = 0.021). Operating surgeon experience ≥ 4 years decreased odds of recurrence (OR: 0.26, P = 0.049).

CONCLUSIONS

MC is safe and effective for managing primary CSDH in carefully selected patients.