title: Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma--a retrospective analysis.
abstract: BACKGROUND
  The incidence of chronic subdural hematoma (CSDH) is increasing, but optimal treatment remains controversial. Recent meta-analyses suggest burr hole (BH) drainage is the best treatment because it provides optimal balance between recurrence and morbidity. Mini-craniotomy may offer supplementary technical advantages while maintaining equal or better outcomes. This study investigates the outcome of mini-craniotomy as the sole treatment in patients with CSDH.
  
  
  METHODS
  We analyzed all patients operated on for CSDH with mini-craniotomy in our neurosurgical center between 2005-2010. Baseline patient characteristics (age, sex, comorbidities, imaging characteristics, known risk factors for development of CSDH and neurological examination at presentation) and outcomes (mortality, complications, recurrence and neurological examination at discharge) were recorded.
  
  
  RESULTS
  One hundred twenty-six adult patients were included, mean age was 73.9 (range 18 to 95) years old, and the sex ratio (M:F) was 2:1. Eighty-four percent of the patients showed clinical improvement at discharge, as shown by a decrease in the Markwalder score postoperatively (with 57 % Markwalder 0 and 23 % Markwalder 1). Recurrence rate was 8.7 %. Overall complication rate was 34.1 % (27.8 % medical complications and 6.3 % surgical complications). In-hospital mortality was 13.5 % (8.7 % due to pulmonary infections and 1.6 % to surgical complications). Preoperative Markwalder grade correlated significantly with complication rate, as did the presence of a neurodegenerative disease (p = 0.018). Factors significantly related to mortality in univariate analysis were arterial hypertension (p = 0.038), heart failure (p = 0.02), renal failure (p = 0.017), neurodegenerative disease (p = 0.001), cerebrovascular accident (p = 0.008) and coagulopathy (p = 0.019). Multivariate analysis was not able to confirm any significant relationship.
  
  
  CONCLUSIONS
  This is the first published series of CSDH in which all consecutive patients were operated on by mini-craniotomy. The invasiveness and complication rate of mini-craniotomy are equal to those of burr hole treatment, but visualization is superior, resulting in lower recurrences. A randomized controlled trial is indicated to identify the best surgical strategy for the treatment of CSDH.
authors.affiliation: Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium, jpvdveke@vub.ac.be.
authors.forename: Jorn
authors.initials: J
authors.lastname: Van Der Veken
authors.forename: Johnny
authors.initials: J
authors.lastname: Duerinck
authors.forename: Ronald
authors.initials: R
authors.lastname: Buyl
authors.forename: Katrijn
authors.initials: K
authors.lastname: Van Rompaey
authors.forename: Patrick
authors.initials: P
authors.lastname: Herregodts
authors.forename: Jean
authors.initials: J
authors.lastname: D'Haens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003399:Craniotomy / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D020200:Hematoma, Subdural, Chronic / Q000453:epidemiology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019636:Neurodegenerative Diseases / Q000453:epidemiology; D009460:Neurologic Examination; D010351:Patient Discharge; D011183:Postoperative Complications; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D014207:Trephining / Q000379:methods; D055815:Young Adult