Comparative Analysis of Surgical Techniques in the Management of Chronic Subdural Hematomas and Risk Factors for Poor Outcomes.

Background: . Chronic subdural hematomas (CSDH) are increasingly prevalent, especially among the elderly. Surgical intervention is essential in most cases. However, the choice of surgical technique, either craniotomy or burr-hole opening, remains a subject of debate. Additionally, the risk factors for poor long-term outcomes following surgical treatment remain poorly described. Methods: . This article presents a 10-year retrospective cohort study conducted at a single center that aimed to compare the outcomes of two common surgical techniques for CSDH evacuation: burr hole opening and craniotomy. The study also identified risk factors associated with poor long-term outcome, which was defined as an mRS score ≥ 3 at 6 months. Results: . This study included 582 adult patients who were surgically treated for unilateral CSDH. Burr-hole opening was performed in 43% of the patients, while craniotomy was performed in 57%. Recurrence was observed in 10% of the cases and postoperative complications in 13%. The rates of recurrence, postoperative complications, death and poor long-term outcome did not differ significantly between the two surgical approaches. Multivariate analysis identified postoperative general complications, recurrence, and preoperative mRS score ≥ 3 as independent risk factors for poor outcomes at 6 months. Conclusion: . Burr-hole opening is as effective and less invasive than craniotomy and should be preferred. Although chronic subdural hematoma is often considered benign, general complication and recurrence are significant long-term prognostic factors that should not be overlooked. Our results highlight the importance of preventing postoperative complications through early mobilization and avoiding the prescription of corticosteroids in this elderly population.