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CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1808073
Original Article

Pressure Neutralization in Surgical Management of Chronic Subdural Hematoma: An Enhancing Patient Safety Technique

Mohamed Ahmed Elnaggar
1   Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
,
Hany Elkholy
1   Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
,
Mohamed K. Eissa
1   Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
,
Hossam Elnoamany
1   Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
,
Nour Elnoamany
1   Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
,
Mohamed Said Mohamed Elsanafiry
1   Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
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Funding None.
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Abstract

Background Chronic subdural hematoma (CSDH) is a common neurosurgical condition, often presenting with progressive neurological deficits. Surgical evacuation via burr hole craniotomy is a standard treatment. This study evaluates the pressure neutralization technique for gradual decompression using wide bore cannula before dural opening.

Materials and Methods This retrospective study included 81 patients with CSDH and previous history of head trauma who underwent gradual decompression using wide bore cannula before dural opening. Preoperative, intraoperative, and postoperative parameters were evaluated.

Results The mean patient age was 67 ± 8.7 years, with a male predominance (69.1%). The most common presenting symptoms were hemiparesis (70.4%) and headache (29.6%). Hematoma was predominantly left-sided (61.7%) with a mean thickness of 2.46 ± 0.5 cm. Midline shift exceeded 10 mm in 63.0% of cases preoperatively. Postoperatively, Glasgow Coma Scale improved to 14.84 ± 0.37, with clinical improvement in 77.8% of patients showing resolution of weakness. Midline shift resolved at 76.5%, and residual hematoma was minimal in 16%. The average hospital stay was 4.2 ± 1.3 days, and only one patient (1.2%) underwent postoperative wound infection.

Conclusion Gradual decompression using wide bore cannula before dural opening is highly effective in managing CSDH, leading to significant clinical and radiological improvement with minimal complications. Radiological findings, particularly hematoma thickness and midline shift, are reliable indicators of surgical efficacy and patient recovery.

Keywords

chronic subdural hematoma - burr hole craniotomy - midline shift - hematoma evacuation - neurosurgery

Study Design

This retrospective study included 81 patients with CSDH and previous history of head trauma who underwent gradual decompression using wide-bore cannula before dural opening. Preoperative, intraoperative, and postoperative parameters were evaluated.


Note

This study was performed in the Department of Neurosurgery, Faculty of Medicine, Menoufia University Hospital, Egypt.


Authors' Contributions

All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition, analysis, and interpretation of data. All authors took part in drafting, revising, and final approval of the article. This article has been read and approved by all authors and all agreed to be accountable for all aspects of the work.


Ethical Approval

This study was approved by the clinical research committee of the Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt, and it followed the tenets of the Declaration of Helsinki.




Publication History

Article published online:
21 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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