Management Of Chronic Subdural Hematomas: Surgical Techniques And Outcomes

Abstract

As people age, chronic subdural hematomas (CSDH) are a prevalent neurosurgical disease, yet optimal surgical strategies and recurrence predictors remain debated. This retrospective observational study analyzed outcomes in 221 patients treated with Craniotomy, twist drill craniostomy, or burr hole craniostomy over five years at a tertiary care center. Burr hole craniostomy was the most frequently performed procedure (74.2%), followed by craniotomy (14.0%) and twist drill (11.8%). Overall, recurrence occurred in 12.7% of patients, with the lowest rate in the burr hole group (10.4%). Multivariate logistic regression identified bilateral hematomas (adjusted odds ratio [aOR] 2.35), absence of subdural drain placement (aOR 3.12), and admission Glasgow Coma Scale score <13 (aOR 2.74) as independent predictors of recurrence. Although associated with higher complication rates, craniotomy remains a viable option for complex or septated hematomas. Favorable functional outcomes (modified Rankin Scale 0–2) were observed in 58.8% of the cohort, with the highest rate seen in the burr hole group (63.4%). According to these results, the majority of patients prefer burr hole craniostomy with drain placement and provide evidence-based guidance for tailoring interventions. The study underscores the need for prospective multicenter trials to refine standardized protocols and long-term outcome evaluation in CSDH management.