Burr-Hole Craniostomy Versus Open Craniotomy for Treatment of Combined Chronic and Subacute Subdural Haemorrhage in Patients Above 90 Years Old

Objective: To compare the results of either craniotomy or burr hole surgery in highly old patients with subdural haemorrhage. Methods: 48 patients with chronic subdural haemorrhage (34 patients showed combined subacute blood in CT scan) were collected and followed preoperatively, immediate postoperative and 6 months after surgery. Patients were classified into two groups; (Group 1): 26 patients were operated by two Purr-hole craniostomies about 2cm width for each with subdural drain for subsequent few days. (Group II): 22 patients were operated by open craniotomy with subdural drain. They were assessed clinically (GCS, motor, sensory or speech deficits) and radiologically by CT scan preoperatively and in postoperative follow-up periods. Results: Statistically non-significant better clinical outcome for group I compared to Group II regarding GCS, improvement of neurological deficits, hospital stay (p<0.001) and postoperative morbidity. In spite of that, follow-up CT scan showed higher incidence of postoperative radiological complications in group I which were clinically insignificant. Conclusion: In spite of the high incidence of combined acute and subacute incidence of subdural haemorrhage, burr hole craniostomy still offers better outcome for those patients with higher safe margin.