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Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 164-169

Selection of an appropriate surgical method for the management of chronic subdural hematoma in a patient with poor physical status

Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

Correspondence Address:
Dr. Jae-Geun Ahn
Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 03476, 90, Baengnyeonsan-Ro, Eunpyeong-Gu, Seoul
Republic of Korea
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_354_20

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Physical status is an important factor to consider when treating patients with chronic subdural hematomas. Surgical treatment of chronic subdural hematoma is mainly by burr hole trephination. However, operative methods must be selected after careful consideration of mortality, morbidity, and recurrence rates. In the case presented here, a chronic subdural hematoma was noted in a 65-year-old patient with several comorbidities; therefore, minimally invasive burr hole trephination was performed. After thrice repetition of the burr hole trephination procedure, a craniectomy for hematoma removal and middle meningeal artery embolization was finally conducted, followed by cranioplasty to treat a subsequent epidural hemorrhage. In the case discussed here, we review the options for the treatment of chronic subdural hematoma and evaluate the factors that should be considered in determining the appropriate surgical course. Despite poor patient physical status, minimally invasive operation may not always be the best option. If the patient is at high risk for recurrent subdural hematoma, craniotomy with hematoma removal may be a better choice.

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