title: Chronic subdural hematoma treated by small or large craniotomy with membranectomy as the initial treatment.
abstract: OBJECTIVE
  There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results.
  
  
  METHODS
  Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization.
  
  
  RESULTS
  The mean ages were 69.4±12.1 and 55.6±9.3 years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups.
  
  
  CONCLUSIONS
  Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique.
authors: Department of Neurosurgery, Seoul Medical Center, Seoul, Korea.
authors: Jae-Hong
authors: JH
authors: Kim
authors: Dong-Soo
authors: DS
authors: Kang
authors: Jung-Hee
authors: JH
authors: Kim
authors: Min-Ho
authors: MH
authors: Kong
authors: Kwan-Young
authors: KY
authors: Song