Chronic subdural hematoma: pathophysiology, diagnosis, and management – a review with 45 operated cases in a single center

Abstract

Background : Chronic subdural hematoma (cSDH) is a common neurosurgical condition with rising prevalence due to aging populations and increased use of anticoagulant/antiplatelet therapies. It presents with varied symptoms, from headaches to neurological deficits. Diagnosis is usually via CT scan, with MRI used in unclear cases. Treatment options include conservative management for small hematomas and surgery for larger or symptomatic ones. Surgical techniques such as twist drill craniostomy, burr-hole craniostomy (with drainage), and craniotomy are used, with burr-hole craniostomy being the most common due to its effectiveness and low complication rate. The two-burr hole approach has shown better outcomes in terms of lower recurrence, shorter hospital stays, and reduced infection risk. This study confirms that two-burr hole craniostomy is a safe, effective method for treating cSDH, offering good recovery and low mortality. Methods : This prospective study assessed the effectiveness of two-burr hole craniostomy in treating chronic subdural hematoma (cSDH) in 47 patients aged 40–75 years with GCS ≥4, conducted at SVP Hospital and Smt. NHL Medical College from January 2022 to March 2025. The procedure involved creating two burr holes in the frontal and parietal regions, followed by irrigation and drainage. Patients received postoperative care including head-down positioning, oral hydration, spirometry, and a 7-day antibiotic course. Most patients showed significant clinical improvement and were discharged within a week. Follow-up CT scans on day 5 confirmed good outcomes. Statistical analysis revealed favorable results in safety, low recurrence, and recovery. The study concludes that two-burr hole craniostomy is a safe, effective, minimally invasive option for cSDH with low morbidity and rapid functional recovery. Results : This prospective study evaluated the effectiveness of two-burr hole craniostomy in treating chronic subdural hematoma (cSDH) in 45 patients aged 40–75 years. Most patients were male (80%), with a mean age of 68 years. Common symptoms included headache (82%), motor deficits (62%), and gait disturbance (44%). CT scans showed unilateral hematomas in 80% of patients, mostly with mixed density (69%). All underwent two-burr hole craniostomy with irrigation and drainage, resulting in symptom relief in 44 patients. The average hospital stay was 5 days. Postoperative imaging showed residual fluid but anatomical improvement. No recurrence occurred within 6 weeks. Two patients (4.44%) developed intraparenchymal hemorrhage; one died from pneumonia. Statistical analysis confirmed favorable outcomes in safety, recovery, and low recurrence. The study supports two-burr hole craniostomy as a safe, effective, minimally invasive procedure for cSDH with rapid recovery and low complication rates. Conclusion : The patient demographics and clinical features in this study align with global trends, confirming that chronic subdural hematoma (cSDH) primarily affects elderly males, often with a history of minor trauma. Surgical outcomes were favorable, with no recurrence observed, matching or exceeding international standards. The low complication rate is attributed to the use of two-burr hole craniostomy with drainage and standardized postoperative monitoring, underscoring the effectiveness of this approach in managing cSDH.