Comparative Study on Recurrence of Chronic Subdural Haematoma Operated by Burr Hole Evacuation with or without Partial Cortical Membranectomy

Abstract

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly in the elderly, with a remarkable risk of post-operative recurrence. Burr hole evacuation (BHE) with or without partial cortical membranectomy is frequently used, but comparative evidence on recurrence and outcomes remains limited.

Objective: The purpose of the present study was to compare the recurrence rate of chronic subdural hematoma (CSDH) operated by burr hole evacuation (BHE) with or without partial cortical membranectomy.

Methodology: This randomized, controlled study was conducted in the Department of Neurotrauma at National Institute of Neurosciences & Hospital, Dhaka, Bangladesh from July 2016 to December 2017. A total 74 adults (≥18 years) with clinically and radiologically confirmed CSDH were enrolled and randomized to Group A (BHE with partial cortical membranectomy, n=37) or Group B (BHE alone, n=37). Patients with intracerebral hematoma, other mass lesions, or multi-organ failure were excluded. Pre- and postoperative evaluations included Glasgow Coma Scale (GCS), Markwalder Grading Scale (MGS), and CT imaging to assess hematoma characteristics and midline shift (MLS).

Results: The mean age was 61.9 ± 12.4 years in Group A and 67.1 ± 11.7 years in Group B (p=0.078); males predominated in both groups. Trivial falls were the most common cause of injury, limb weakness the predominant symptom, and hypertension the most frequent comorbidity, with no significant intergroup differences (p>0.05). Pre-operative MLS, hematoma characteristics, and admission neurological status were comparable. Post-operatively, complete MLS resolution occurred in most patients (Group A: 75.7%, Group B: 73.0%), but mean post-operative MLS was lower in Group B (0.14 ± 0.34 cm vs 1.56 ± 0.39 cm, p=0.001). All patients achieved full neurological recovery (MGS G-0, GCS 15) and favorable functional outcomes (GOS 4–5). Post-operative complications, hospital stay, and three-month recurrence rates were similar between groups (p>0.05).

Conclusion: BHE with or without partial cortical membranectomy resulted in comparable clinical outcomes and low recurrence rates. BHE alone achieved slightly better midline shift reduction, but both techniques were safe and effective.

Journal of National Institute of Neurosciences Bangladesh, July 2025;11(2):114-120