The role of craniectomy in the treatment of chronic subdural hematomas

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Abstract
A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. After undergoing excision of the cranial vault overlying the hematoma site, 6 of these 7 patients demonstrated a significant clinical improvement. Craniectomy should apparently be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. This procedure probably has no efficacy once extensive cerebral infarction has occurred.