How I do it: simplified craniotomy for acute subdural hematoma in the elderly

ContextAcute subdural hematoma (ASH) is responsible for significant morbidity and mortality in the elderly. As military neurosurgeons, we perform a simplified technique using a linear skin incision and a small craniotomy bone flap in order to ease perioperative tolerance.MethodsThe patient lies supine, a pad under the shoulder ipsilateral to the ASH, the head completely rotated on the other side and placed on a circular pad, without head clamp. The linear frontotemporal skin incision should be twice the size of the bone flap's diameter, allowing to access the whole subdural space. Care is taken to obtain complete decompression of the temporal fossa in order to alleviate uncal herniation. A subdural drain can be placed, and the subdural space is filled with warm saline solution in order to create a closed drainage system.ConclusionThe patient is allowed to sit at postoperative day 1 and to walk at postoperative day 2. Simplified craniotomy for ASH allows to reduce operative time and provides faster functional recovery