title: Membranectomy in organized chronic subdural hematomas: indications and technical notes.
abstract: BACKGROUND
  The aim of the present study is to present our operative method of removing organized CSDHs and to structure the criteria for choosing this approach as first treatment.
  
  
  METHODS
  Between 1991 and 1999 at our Institution, 14 consecutive patients with organized CSDHs required 16 craniotomies with membranectomy. They represent 5.8% of all patients (243) treated for CSDHs in the same period. All the patients had preoperative contrast-enhanced CT, and 9 patients also had contrast MRI.
  
  
  RESULTS
  Initially, 9 patients underwent one burr hole or twist-drill hole. Of these 9 patients, 3 were treated at the same surgery with craniotomy and membranectomy as second treatment, 3 underwent a second burr hole and then membranectomy at the same surgery, and 3 patients underwent a second burr hole 3, 4, and 21 days after the first one and then membranectomy. Five patients underwent immediate craniotomy and membranectomy. There were no morbidity or mortality associated with this procedure. All patients had a full recovery without recurrence.
  
  
  CONCLUSIONS
  Contrast-enhanced MRI has greatly improved opportunities for discovering neomembrane before surgical intervention. We believe that MRI detection of thick and extensive membranes or solid clot with mass effect makes an immediate craniotomy to remove CSDH necessary.
authors.affiliation: Department of Neurological Sciences, Neurosurgery, University of Rome La Sapienza, 00100 Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rocchi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Caroli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salvati
authors.forename: Roberto
authors.initials: R
authors.lastname: Delfini
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008566:Membranes / Q000601:surgery; D008875:Middle Aged; D018579:Patient Selection; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome