Single Frontal Burr-hole Craniostomy Under Local Anaesthesia for Treating Chronic Subdural Haematoma in the Septuagenarians and Older Adults: Surgical Technique and Results

Abstract

Introduction. Chronic subdural haematoma is not a totally benign disease in the elderly patients, especially those aged 70 years and above. Hence, the surgical treatment of CSDH in those aged patients needs to be as minimally disruptive as possibleMaterials and Methods. An annotated description of the surgical technique of single frontal burr-hole craniostomy performed under local anaesthesia and without closed tube drainage for evacuating CSDH in the septuagenarians and older adults is described. We also review the outcome of the procedure on a prospective consecutive cohort of patients in our serviceResults. Thirty patients, 25 males, aged 70 years and above successfully underwent this surgical procedure. Their mean age was 76.5 years (standard deviation, SD, 4.3). The CSDH was bilateral in 30% (9/30); more left-sided in the rest, the unilateral cases, and was of mixed density radiologically, in most cases (73%, 22/30). Clinical presentation was mainly gait impairment, cognitive decline, and headache; and 57% (17/30) presented in coma or stupor as assessed by the Markwalder grading scale. The surgery was successfully executed in all, median duration 45.0 minutes (IQR 37.3-60.0), and solely under local anaesthesia in 77% (23/30) or with momentary short-acting sedation in the rest. Outcome was very good in 83.3% (25/30) using the modified Rankin Scale (mRS) including two-third (20/30) completely asymptomatic (mRS 0), and 5/30 with only slight symptoms and no disability, mRS 1. Three patients died perioperatively.Conclusion. This surgical technique appears very effectual for CSDH, is executed at a comparatively low-cost, and, being much less disruptive than other traditional methods, may be a more homeostatic operative treatment in geriatric patients at least.