Factors Affecting Outcomes Following Mini-Craniotomy Evacuation of Primary Chronic Subdural Hematoma: A Single-Center Retrospective Study

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BACKGROUND: Chronic subdural hematoma (CSDH) constitutes a radiologically heterogeneous pathology with multiple surgical treatment options. Mini-craniotomy (MC) is often reserved for patients with membranous or acute components. Although MC is considered a higher risk procedure than burr-hole craniostomy, outcomes are sparsely reported. METHODS: A single-center retrospective database search was performed between January 2009 and January 2020 to identify all adult patients who underwent MC evacuation of primary CSDH. Univariate and multivariate logistic/Cox regressions were performed to identify factors associated with clinical outcome, duration of hospital stay, discharge destination, and complications. RESULTS: Of 1544 procedures for CSDH, 143 cases met inclusion criteria. The median age was 76 years. Most patients were male (N = 95, 66.4%) and independent on admission (N = 138, 96.5%), with median Karnofsky Performance Score 80. Median preoperative Glasgow Coma Scale was 14. 86% of patients had favorable outcomes (Glasgow Outcome Score: 4-5) on discharge. Median hospital stay was 6 days. Recurrence and overall complication rates were 9.1% and 26.6%, respectively. Preoperative Glasgow Coma Scale ≥ 14 increased odds of favorable outcomes (odds ratio [OR]: 11.49, P < 0.001) and discharge home (OR: 4.53, P = 0.005) and reduced odds of postoperative complications (OR: 0.27, P = 0.011). An increasing Charlson Comorbidity Index and anticoagulants increased odds of postoperative complications (OR: 1.50, P = 0.03 and OR: 3.61, P = 0.018, respectively). Charlson Comorbidity Index ≥ 4 decreased odds of a favorable outcome (OR: 0.07, P = 0.021). Operating surgeon experience ≥ 4 years decreased odds of recurrence (OR: 0.26, P = 0.049). CONCLUSIONS: MC is safe and effective for managing primary CSDH in carefully selected patients.