Abstract
Background We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy
that optimizes dural opening and can be performed in elderly patients affected by
acute subdural or intracerebral hematomas, in therapy with antiplatelets or anticoagulants.
Methods We retrospectively analyzed the clinical records of 67 patients (mean age of 78.5
years) treated in our institution, during a period of 10 years, with this novel diamond-shaped
craniotomy. Seventeen patients were treated for intracerebral hemorrhage and 50 patients
for acute subdural hematomas. All the patients were in therapy with antiplatelets
or anticoagulants.
Results Approach-related complications were not detected. Ten of 67 patients (14.9%) presented
temporal muscle atrophy; there was no scar deformity, paresthesia, hyperalgesia, or
ramus frontalis palsy around the scalp incision. Thirty-day mortality was 22%. The
mean follow-up was 1.3 years. One-month postoperative brain computed tomography scans
showed a satisfactory hematoma evacuation in 57 of 67 patients (85%).
Conclusions The diamond-shaped mini-craniotomy for acute subdural and intracerebral hematomas
is safe and effective, and it should be considered as an alternative to traditional
approaches, particularly in elderly patients.
Keywords
intracerebral hemorrhage - acute subdural hematoma - craniotomy - elderly - anticoagulants
