Burr-hole craniotomy treating chronic subdural hematoma: a report of 398 cases.

OBJECTIVE To investigate the treatment of chronic subdural hematoma (CSDH) with burr-hole craniotomy in our hospital. METHODS From January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females (male/female equal to 5.63/1), received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of (58.1 ± 18.1) years, (65.0 ± 14.5) years for females and (57.0 ± 18.2) years for males. Trauma history was determined in 275 patients (69.1%). Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients'neurological status on admission and at discharge was also classified to judge the outcomes. RESULTS Generally, trauma history showed few differences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients (60.0% of 204 cases) suffering from head injuries were under 60 years, whereas 35 female patients (85.4% of 41 cases) with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was (84.0 ± 61.7) days (range, 0-1493 days). Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients (95.6%) treated with burr-hole craniotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases. CONCLUSION Burr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.

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