Short-term Outcome of Mini craniotomy Verses Conventional Craniotomy for Extradural Hematoma

Open Access

Abstract

Background: Extradural hematoma (EDH) is a neurosurgical emergency; mini craniotomy offers a less invasive alternative to conventional craniotomy, potentially reducing surgical trauma and operative time, especially in resource-limited settings, with this study comparing their short-term outcomes. Methods: This RCT (Randomized Controlled Trail) at Dhaka Medical College (Apr 2023–Oct 2024) enrolled 56 EDH patients (15–60 y); 28 had mini craniotomy (Group A) and 28 conventional (Group B), comparing GCS, hematoma volume, midline shift, operative time, pain, and complications using SPSS 26 with chi-square, t-test, and Pearson correlation. Results: Baseline characteristics including age, cause of injury, preoperative GCS, hematoma volume, MLS, and time to surgery were comparable between the groups (p>0.05). The mean operative time was significantly shorter in the mini craniotomy group (84.82±11.50 minutes) compared with the conventional group (105.18±11.59 minutes) (p<0.05). Postoperative pain scores were significantly lower in the mini craniotomy group (4.43±0.79 vs 5.11±0.83, p<0.05) with reduced analgesic requirement. Postoperative residual hematoma volume was slightly higher in the mini craniotomy group (5.59±4.63 cm³ vs 3.21±2.13 cm³, p<0.05), but postoperative GCS scores, MLS, and complication rates were comparable between groups. All patients achieved good recovery (GOS 5) at 30-day follow-up. Conclusion: Mini craniotomy is a safe and effective alternative to conventional craniotomy for EDH evacuation, offering shorter operative time and reduced postoperative pain while achieving comparable neurological and radiological outcomes. Although slightly higher residual hematoma volume was observed, it did not affect short-term clinical outcomes.