Inner membrane opening during the burrhole evacuation of a chronic subdural hematoma: risk-adding or recurrence preventing?

Abstract

Background: Chronic subdural hematoma (CSDH) is a common situation in neurosurgical practice. Only a few studies had mentioned the opening of the inner membrane during the burr-hole evacuation of a CSDH. This study was designed to assess the benefits of inner membrane opening in the burr-hole evacuation of a CSDH and to find out if there is an added risk of such a step that overweighs its benefits. Methods: This is a descriptive cohort study that retrospectively reviewed 81 patients who underwent CSDH evacuation in Ain Shams University hospitals from October 2007 to August 2017. Results: There were 54 (66.7%) males and 27 (33.3%) females. Age ranged from 40 to 84 years with a mean age of 64. 95 years. The mean of maximum hematoma thickness measured in the preoperative brain CT scan was 22.58 mm ranging from 12 to 42 mm. Preoperative midline shift ranged from 0 to 21 mm with a mean value of 10.65 mm. All patients had an adequate radiological evacuation of the CSDH and did not develop a new acute subdural hematoma or intracerebral hematoma. The mean follow-up duration was 16.77 months (ranging from 3 to 60 months). There were 3 patients (3.7%) complicated with a recollection of subdural blood that required a second surgery. Included patients neither had postoperative cerebrospinal fluid leakage nor subdural empyema. Conclusions: It can be concluded that this operative step was not a risk-adding but, apparently, a recurrence-preventing one. However, a prospective randomized controlled study is recommended to establish this finding.