• Felipe Ramirez-Velandia, Kasuni H Ranawaka, Aryan Wadhwa, Mira Salih, Thomas B Fodor, Tzak S Lau, Niels Pacheco-Barrios, Alejandro Enriquez-Marulanda, Imad S Khan, Rafael A Vega, Martina Stippler, Philipp Taussky, Jennifer Hong, and Christopher S Ogilvy.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
• Neurosurgery. 2024 Jul 5.

Background And ObjectivesPostoperative seizures are a common complication after surgical drainage of nonacute chronic subdural hematomas (SDHs). The literature increasingly supports the use of prophylactic antiepileptic drugs for craniotomy, a procedure that is often associated with larger collections and worse clinical status at admission. This study aimed to compare the incidence of postoperative seizures in patients treated with burr-hole drainage and those treated with craniotomy through propensity score matching (PSM).MethodsA retrospective cohort analysis was conducted on patients with surgical drainage of nonacute SDHs (burr-holes and craniotomies) between January 2017 to December 2021 at 2 academic institutions in the United States. PSM was performed by controlling for age, subdural thickness, subacute component, and preoperative Glasgow Coma Scale. Seizure rates and accompanying abnormalities on electroencephalographic tracing were evaluated postmatching.ResultsA total of 467 patients with 510 nonacute SDHs underwent 474 procedures, with 242 burr-hole evacuations (51.0%) and 232 craniotomies (49.0%). PSM resulted in 62 matched pairs. After matching, univariate analysis revealed that burr-hole evacuations exhibited lower rates of seizures (1.6% vs 11.3%; P = .03) and abnormal electroencephalographic findings (0.0% vs 4.8%; P = .03) compared with craniotomies. No significant differences were observed in postoperative Glasgow Coma Scale (P = .77) and length of hospital stay (P = .61).ConclusionBurr-hole evacuation demonstrated significantly lower seizure rates than craniotomy using a propensity score-matched analysis controlling for significant variables.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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