Surgical management of bilateral chronic subdural hematoma: A single-surgeon five-year experience in university hospital of Patras.

Abstract

Chronic bilateral subdural hematoma is a common entity in neurosurgery, but there is not a gold standard surgical algorithm. The current study intends to show a surgical technique with minimal complications. We present our experience of 12 patients with bilateral chronic subdural hematomas of sufficient size and neurological symptoms that require treatment in the University hospital of Patras. The hematomas were treated in the same surgical session, through 4 burr holes, 2 in each hemisphere (frontal and parietal bone) and by the placement of 4 subperiosteal drainage tubes after continuing irrigation. Throughout the entire procedure, the head of the patients remained in midline position. All the patients experienced significant improvement of their neurological status shortly after the operation, the complication rate was minimum, while the outcome was very good. At our institution, we developed and progressively standardized a surgical algorithm for bilateral CSDH based on controlled and sequential decompression, bilateral evacuation through multiple burr holes, and subperiosteal drainage.