Chronic Subdural Hematoma: Surgical Management, Functional Outcomes, and Approaches.

Chronic subdural hematomas (CSH) are a very common pathology that challenges neurosurgery, and over time there may be an increase in comorbidity in the aging population. Surgical interventions for treatment include either burr hole evacuation or craniotomy. The aim of this study is to analyze and emphasize the optimization of surgical intervention after trauma and penetration while ensuring safe hematoma removal and evacuation using the latest advanced techniques, including 3D reconstruction. This retrospective observational study included 40 patients who were diagnose and treated for CSH. The cohort included 26 males and 14 females, the patient age range spanned from under 40 to 85 years, this study was performed at the Moscow City Clinical Hospital №68, Demikhova V.P. Between January 2023 and November 2024. This study involved a retrospective observational analysis of N=40 patients, N=26 male and N=14 female. Preoperative protocols involved informed confirmation of diagnosis through MRI and CT scans and treatment for CSH. Among them, N=33 patients (82%) presented with altered consciousness, ranging from mild stupor to coma. Other observed clinical manifestations included hemiparesis in N=13 patients (32%), speech problems in N=8 patients (2%), pelvic organ dysfunction in N=6 patients (15%), and urinary retention in N=14 patients (35%). This study highlights that traumatic brain injury, particularly that resulting from traffic accidents in middle-aged and older adults, while infrequent in younger populations, has a high incidence of acute and subacute subdural hematoma, as well as falls in older adults, which are the leading cause of chronic subdural hematoma. Early diagnosis and intervention lead to a better recovery rate, but in our study, 87% of patients showed improvement after surgery. Keywords Chronic subdural hematoma, surgical techniques, clinical diagnosis, surgical management treatment outcomes