Chronic subdural hematoma (CSH) is a common neurosurgical condition associated with substantial healthcare utilization, particularly in elderly patients. The role of inner membranectomy during burr-hole evacuation remains controversial. This study aimed to evaluate the association between inner membranectomy and short-term outcomes, including length of hospital stay and postoperative subdural residual thickness. In this retrospective observational study, 186 patients who underwent burr-hole evacuation for CSH between January 2013 and December 2023 were analyzed. Patients were grouped according to whether inner membranectomy was performed. Residual subdural thickness was measured on computed tomography at the early postoperative period, at hospital discharge, and at one-month follow-up. Length of hospital stay was recorded. Multivariable analyses were performed to adjust for age, sex, etiology of subdural hematoma, comorbidity, and preoperative subdural thickness. Inner membranectomy was performed in 91 patients (48.9%), while 95 patients (51.1%) did not undergo membrane opening. Baseline demographic and clinical characteristics were comparable between groups. After multivariable adjustment, inner membranectomy was independently associated with a shorter length of hospital stay (p = 0.015). In adjusted linear regression analysis, lack of inner membranectomy was associated with greater residual hematoma thickness on the early postoperative CT scan (β = 1.99 mm, 95% CI 0.70–3.28; p = 0.003). Preoperative subdural thickness was the strongest predictor of residual thickness across all time points. At discharge and one-month follow-up, the association between membrane opening and residual thickness was attenuated. Inner membranectomy during burr-hole evacuation for CSH was associated with reduced early postoperative residual hematoma thickness and shorter hospitalization after adjustment for relevant confounders. Later radiological resolution appeared to be predominantly influenced by baseline hematoma burden rather than surgical technique. Prospective studies incorporating long-term clinical outcomes are required to further define the role of inner membranectomy.
Akyol et al. (Sun,) studied this question.