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Selected Publication:
Fediuk, M.
Craniotomy versus Burr-hole Trepanation in the Treat-ment of the Chronic Subdural Haematoma
A retrospective comparison of a series of 362 patients
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2015. pp.
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- Authors Med Uni Graz:
- Advisor:
- Eustacchio Sandro
- Mrfka Manuel
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- Abstract:
- Abstract Background The chronic subdural haematoma is a disorder that frequently occurs in the neurosurgical daily routine which predominantly concerns elderly patients and will therefore experience a continuous increase in incidence due to the aging of the population. Because of the age of the patients and their increasingly existent comorbidities it is important to find a surgical method that is efficient and gentle at the same for the often multimorbid clients. At the Department of Neurosurgery Graz an average number of 100 patients are treated because of a chronic subdural haematoma every year. The two preferred surgical procedures are craniotomy and burr-hole trepanation. Methods In order to find out which evacuation method is superior, patients were retrospectively ana-lysed between January 2010 and December 2013 (n= 362) and the findings compared. Considered parameters included sex, age, surgical procedure, comorbidities, risk factors, time from trauma to chronic subdural haematoma (CSDH) preoperative symptoms, side and density of CSDH as well as midline shift, anaesthesia, drainage placement, duration of drainage, postoperative transfer, duration of hospitalisation, recurrence, postoperative com-plications and outcome. Results The analysed sample consisted of 197 male and 87 female (mean age 74,3 years, ranging from 30 to 93 years) patients showing a male predominance of 69,4%. Postoperative mor-tality could be seen in 5,3% (n=2) of all craniotomies and 0,3% (n=1) of all burr-hole trepa-nations, showing a difference above significance (p=0,028). 5 out of 38 craniotomies (13,2%) and 27 out of 339 BHTs (8%) required re-evacuation due to recurrence (p=0,209). Clinical outcome was good in both groups, 68,4% of the craniotomies and 78,2% of the BHTs led to an improvement (p=0,126). 26,3% of the craniotomies and 18,6% of the BHTs showed postoperative complications (p=0,175). Significant correlation between the surgical procedure and the required anaesthesia (p=0,016) as well as the surgical procedure and postoperative transfer (p=0,000) could be identified. Conclusion Due to higher mortality, recurrence and morbidity rates in the craniotomy group, burr-hole trepanation can be considered equal if not superior in the evacuation of the CSDH and should therefore be the first line treatment of choice.