Interdisciplinary Neurosurgery (Dec 2021)
Surgery of chronic subdural hematoma under local anesthesia and its association with recurrence: A single tertiary care center experience
Abstract
Objective: Chronic subdural hematoma (CSDH) surgery is like other neurosurgical procedures in terms of its potential for major morbidities, especially recurrence, which may mandate further surgeries. An extremely limited number of studies have looked at the type of anesthesia and its association with recurrence. In fact, most of the studies that exist are focused on the safety of local anesthesia in minimizing potential cardiac and respiratory complications, rather than looking at recurrence as an outcome. This study aimed to evaluate the association between the type of anesthesia and the recurrence of CSDH. Methods: A hospital-based case series study of combined prospective and retrospective nature was conducted on 88 patients who had undergone surgical care for CSDH during the period from January 2016 through December 2018 in the neurosurgery department of Aseer Central Hospital, Abha, Saudi Arabia. Results: A total of 88 patients were included in the study. The median age was 70 years, and most patients (62%) had one or more comorbid disease(s), 47 (53.4%) underwent general anesthesia for CSDH surgery, whereas 41 (46.6%) underwent local anesthesia (LA). Recurrence within 3 months was seen in 12 patients (13.6%). Univariable regression analysis revealed that the risk of recurrence was four times more when surgery was performed under LA. Conclusions: The study is the first in the English literature to conclude that drainage of CSDH under LA is associated with a higher recurrence rate; however, the authors remain neutral and recommend individualization of treatment options based on the patient’s status. Local anesthesia may be safer in terms of postoperative anesthetic complications, but it carries a higher rate of recurrence. Further well-designed randomized studies are required.
