Minimally invasive approach in bilateral chronic subdural hematomas: surgical selection and outcome in 74 cases

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tomography (CT) and magnetic resonance imaging (MRI), the higher incidence and diagnostic innovation provide a new cogitation for our clinical practice.At present, there are many treatment techniques, such as conservative treatment, twist drill craniotomy, minicraniectomy or burr-hole, craniotomy or craniectomy and so on (1,2,17,21).Early intervention and minimally invasive are often recommended, just as our center does.These treatment protocols are conducted with methods not requiring general █ INTRODUCTION C hronic subdural hematoma (CSDH) is one of the most common clinical diseases in neurosurgical work, and the overall rate was about 14.1 in 100,000 persons per year in general population (3,12,18).In developing countries, the incidence reached 0.0074% in elderly group (5).As a large percent of CSDH, bilateral lesions had been reported to be approximately 20% (6,16).Due to the rising of life expectancy and the introduction of auxiliary tools such as computed AIm: To investigate the effect of minimally invasive approaches on the outcome of bilateral chronic subdural hematoma.mATERIAl and mEThODS: A retrospective analysis was performed in 74 hospitalized bilateral chronic subdural hematoma patients from January 2010 to January 2013 in Northern Jiangsu People's Hospital.Patients' gender, age, hematoma location, history of trauma, surgical approaches, the operation time, hospitalized time and follow-up three months after discharge were recorded.Prognostic indicators including symptom relief and post-hospital neuro-imaging findings were extracted.Statistical methods were conducted to evaluate surgical efficacy.RESUlTS: Both twist drill and burr-hole surgeries had a satisfying symptomatic relief (84.93%).Twist drill needs less operation time (p<0.001) and less hospitalized time (p=0.001).Maximal width of hematoma in computed tomography (CT) findings was significantly different between twist drill group and burr-hole group (p=0.026).Maximal width in CT findings was significantly associated with follow-up outcomes (p=0.021).CONClUSION: Twist drill is a safe and effective minimally invasive surgery, especially for elderly patients with bilateral chronic subdural hematoma and a reasonable surgical operation seems to have more significant impact upon the surgical outcome.