Choice of operative approach in the treatment of chronic subdural hematoma-an insight.

The management of chronic subdural hematoma in the adult patient is approached with a variety of different surgical techniques. The trend in recent years has been toward treatment with burr holes or twist-drill holes rather than craniotomy. The rationale for this has been based on the assumption that burr holes and twist-drill holes offer equivalent efficacy and lower morbidity and mortality. In a review of 121 patients presenting over 1-year period (2015-16) with chronic subdural hematomas, 13 underwent twist drill craniostomy and 108 underwent burr-hole craniectomy treatment. The recurrence of hematomas, requiring another operation, occurred in 3.3%; operative mortality was 2.48% at hospital discharge and 1.65% at follow-up. There was no significant difference in the incidence of postoperative complications, hematoma recurrence, or operative mortality among the different surgical groups. Previous reports concerning the superiority of burr holes over craniotomy are substantiated by this review.