Comparison of Burr Holes and Decompressive Craniotomy in the Surgical Treatment of Traumatic Acute Subdural Hematoma

Introduction: Acute subdural haematoma (ASDH) represents a challenge for neurosurgeons due to its high mortality and morbidity rates. The lethal nature of ASDH is largely explained by its frequent association with primary brain damage, consisting of contusion and brain swelling. The most severe lesion associated with ASDH is acute swelling of the hemispheres. Purpose: The aim of the study is to compare decompressive craniotomy (DC) versus burr holes craniotomy and whether it has any therapeutic advantage as a treatment modality for traumatic acute subdural hematoma. Patients and Methods: In this study, we reviewed 20 patients with traumatic acute subdural haematoma, 10 of whom were treated with haematoma evacuation via burr holes craniotomy and 10 of whom were treated with DC according to the randomization order. Patients were analyzed for prehospital trauma conditions, followed postoperatively for 2 months to assess postoperative complications and outcome on Glasgow outcome scale (GOS). Results: The mortality rate was higher in the craniotomy group (80% vs. 50%) than in the DC. Age and signs of herniation were significantly associated with an unfavourable outcome, regardless of the type of surgery. Apart from initial Glascow coma scale (GCS) and the pupillary status, time elapsed between trauma and treatment is the most important and can be intervened. Conclusion: Regarding the type of surgery, We concluded that although DC is a more lengthy procedure, with higher incidence of convulsions, subgaleal effusion than burr hole craniotomy, but it has less incidence of residual ASDH, better control on the source of bleeding, Consequently less incidence of rebleeding and need for reoperation, and has better results in lowering of the intracranial pressure (ICP), associated with lower mortality and better functional recovery.