Large Craniotomy vs. Endoscopic Surgery for Treatment of Septated Chronic Subdural Hematoma: A Two-Centre Retrospective Comparison Study

Abstract

Background and Objective: Optimal treatment method for septated chronic subdural hematoma (SCSDH) is still debatable. This study aims to compare safety and efficacy of large craniotomy and endoscopic –assisted mini-craniotomy with membranectomy for management of SCSDH with multiple membranes and analyze surgical outcome and complications.

Materials and Method: We retrospectively studied 225 cases with membranous septated CSDH including 100 cases in large craniotomy and 125 cases in endoscopic surgery from January 2016 to October 2023 in two institutions. Age, sex, etiologies, Markwalder’s (Neurological) grading score (MGS) at admission, concomitant disease, hospital stay’s day, outcome as MGS at discharge, recurrence and complications were assessed.

Results: There were 75% male and 25 % female patients in craniotomy group; and 87.2% male and 12.8% female in endoscopic group. In both group, age more than 50 year were significantly higher compared to age less than 50 years. Similarly, patient with MGS ≥2 had significantly more unfavorable outcome compared to MGS ≤1 at the time of admission in both groups. Organized hematoma had significantly more unfavorable outcome compared liquefied hematoma associated with septated CSDH in both groups. Similar rate of complications were found between two groups, and hospital stay in endoscopic group was shorter as compared to large craniotomy group.

Conclusion: Endoscopic surgery was associated with shorter hospital stay however both large craniotomy and endoscopic assisted mini-craniotomy along with membranectomy are safe and effective for SCSDH.