Chronic Subdural Haematoma : A comparative study of burr-hole craniostomy and small craniotomy as initial management

Background: Despite being one of the most common pathologies encountered by a neurosurgeon, management of chronic subdural haematoma (cSDH) continues to be tricky, often requiring multiple interventions with varied complications. Objective: The aim of this study was to compare small craniotomy with burr-hole craniostomy as a treatment modality in evacuation of cSDH at a tertiary care Hospital. Methods: A retrospective study encompassing chronic subdural haematoma patients presenting to the Department of Neurosurgery, NRS Medical College & Hospital over a period of one year was performed. Patients who underwent burr-hole craniostomy or a small craniotomy were included in the study. Patients with intrahaematomal membranes or organized cSDH were selected for craniotomy. The patients were followed up during their stay in the hospital and there demographic profiles, operative duration, hospital stay, complications and prognosis were thoroughly studied. A pre-operative and post-operative clinical assessment of the patients was done using Markwalder’s Grade Scale. Results: There was no difference in the pre-operative criteria in the two groups, however a significant difference was noted in the duration of surgery and hospital stay between the two groups. The burr-hole group also had more complications and re-operation than the craniotomy group. Conclusion: Small craniotomy seems to be a better alternative than burr-hole craniostomy for the management of chronic subdural haematomas with intrahaematomal membranes.