Surgical Treatment of Chronic Subdural Hematoma by Single Burr Hole under Local Anesthesia: Outcome of a Prospective Study

Abstract

Purpose:  Surgery is the usual treatment of chronic subdural hematoma: the most commonly used procedure is double burr hole craniostomy under general anesthesia for evacuation of the hematoma. However, there is an alternative technique which is single burr hole under local anesthesia. The purpose behind this study is evaluation of the prognosis of this technique in the management of CSDH according to the cause, clinical presentation, surgical procedure, and outcome. Methodology: In this prospective study, 41 patients with CSDH underwent single burr hole craniostomy under local anesthesia from June, 2022 to May, 2023, at West Erbil Emergency Hospital based on the etiology, clinical picture, surgical procedure, and complications. We excluded some cases from our study: age less than 20 years, uncooperative patients, and multilocular hematomas. Findings: Patients were from 20 to 85 years of age and the mean age was 65 years. Among them, 24 (58.5%) were males and 17 (41.4%) were females. Previous trauma was the major cause of CSDH in 27 (65.8%) followed by coagulopathy in in 7 (17%), anticoagulant or antiplatelet drugs in 5 (12%) and ICP hypotension in 2 (4%). Contralateral weakness was the most common presentation in 23 (56%), headache in 16 (39%) disturbance in level of consciousness in 10 (24.3%), and convulsion in 6 (14%).