Subacute subdural hematomas: Comparison of surgical methods and clinical outcomes

Abstract

Aim: Although subacute subdural hematoma (SSDH) patients are considered to be similar to chronic subdural hematoma (CSDH) patients, it was aimed to set forth the clinical follow-up and treatment differences between these groups and to compare and discuss the results of different surgical treatments that can be applied. Material and Method: Sixty-seven patients diagnosed with SSDH were retrospectively reviewed, and 57 of them treated surgically. Clinical findings and signs of progress were recorded. The patients were divided and evaluated in two groups: those who underwent surgery with burr-hole trepanation method (Group 1) and those who underwent membranectomy with craniotomy (Group 2). Outcomes were compared in 2 groups. The way how the membranectomy with the craniotomy procedure is applied has been explained. Results: In Group 1 subdural space and pneumocephalus were wider in the early postoperative period (average width: 13,2 mm; 24,6 mm). In Group 2, subdural space and pneumocephalus widths and lengths were an average of 4,6 mm and 11 mm. In Group 1, the late period re-operation rate was 17,1%, whereas, in Group 2, those rates were determined to be 9,1%. Discussion: SSDH patients show different clinical course than CSDH patients. Burr-hole trepanation method is not as efficient as the craniotomy method in surgical patients. In patients undergoing craniotomy and membranectomy, the likelihood of the remnant and pneumocephalus is lower in the postoperative period. Parenchymal expansion can be achieved in the early period with positive-end-expiration-pressure for a few seconds in the intraoperative period.